Initial clinical results using intracardiac electrogram monitoring to detect and alert patients during coronary plaque rupture and ischemia

Tim A. Fischell, David R. Fischell, Alvaro Avezum, M. Sasha John, David Holmes, Malcolm Foster, Richard Kovach, Paulo Medeiros, Leopoldo Piegas, Helio Guimaraes, C. Michael Gibson

Research output: Contribution to journalArticle

35 Citations (Scopus)

Abstract

Objectives We report the first clinical studies of intracardiac ST-segment monitoring in ambulatory humans to alert them to significant ST-segment shifts associated with thrombotic occlusion. Background Despite improvements in door-to-balloon times, delays in symptom-to-door times of 2 to 3 h remain. Early alerting of the presence of acute myocardial infarction could prompt patients to seek immediate medical evaluation. Methods Intracardiac monitoring was performed in 37 patients at high risk for acute coronary syndromes. The implanted monitor continuously evaluated the patients' ST segments sensed from a conventional pacemaker right ventricle apical lead, and alerted patients to detected ischemic events. Results During follow-up (median 1.52 years, range 126 to 974 days), 4 patients had ST-segment changes of <3 SDs of their normal daily range, in the absence of an elevated heart rate. This in combination with immediate hospital monitoring led to angiogram and/or intravascular ultrasonography, which confirmed thrombotic coronary occlusion/ruptured plaque. The median alarm-to-door time was 19.5 min (6, 18, 21, and 60 min, respectively). Alerting for demand-related ischemia at elevated heart rates, reflective of flow-limiting coronary obstructions, occurred in 4 patients. There were 2 false-positive ischemia alarms related to arrhythmias, and 1 alarm due to a programming error that did not prompt cardiac catheterization. Conclusions Shifts exceeding 3 SD from a patient's daily intracardiac ST-segment range may be a sensitive/specific marker for thrombotic coronary occlusion. Patient alerting was associated with a median alert-to-door time of 19.5 min for patients at high risk of recurrent coronary syndromes who typically present with 2- to 3-h delays.

Original languageEnglish (US)
Pages (from-to)1089-1098
Number of pages10
JournalJournal of the American College of Cardiology
Volume56
Issue number14
DOIs
StatePublished - Sep 28 2010

Fingerprint

Cardiac Electrophysiologic Techniques
Rupture
Ischemia
Coronary Occlusion
Interventional Ultrasonography
Heart Rate
Ambulatory Monitoring
Acute Coronary Syndrome
Cardiac Catheterization
Heart Ventricles
Cardiac Arrhythmias
Angiography
Reference Values
Myocardial Infarction

Keywords

  • electrogram
  • ischemia monitoring
  • myocardial infarction
  • vulnerable plaque

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Initial clinical results using intracardiac electrogram monitoring to detect and alert patients during coronary plaque rupture and ischemia. / Fischell, Tim A.; Fischell, David R.; Avezum, Alvaro; John, M. Sasha; Holmes, David; Foster, Malcolm; Kovach, Richard; Medeiros, Paulo; Piegas, Leopoldo; Guimaraes, Helio; Gibson, C. Michael.

In: Journal of the American College of Cardiology, Vol. 56, No. 14, 28.09.2010, p. 1089-1098.

Research output: Contribution to journalArticle

Fischell, TA, Fischell, DR, Avezum, A, John, MS, Holmes, D, Foster, M, Kovach, R, Medeiros, P, Piegas, L, Guimaraes, H & Gibson, CM 2010, 'Initial clinical results using intracardiac electrogram monitoring to detect and alert patients during coronary plaque rupture and ischemia', Journal of the American College of Cardiology, vol. 56, no. 14, pp. 1089-1098. https://doi.org/10.1016/j.jacc.2010.04.053
Fischell, Tim A. ; Fischell, David R. ; Avezum, Alvaro ; John, M. Sasha ; Holmes, David ; Foster, Malcolm ; Kovach, Richard ; Medeiros, Paulo ; Piegas, Leopoldo ; Guimaraes, Helio ; Gibson, C. Michael. / Initial clinical results using intracardiac electrogram monitoring to detect and alert patients during coronary plaque rupture and ischemia. In: Journal of the American College of Cardiology. 2010 ; Vol. 56, No. 14. pp. 1089-1098.
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abstract = "Objectives We report the first clinical studies of intracardiac ST-segment monitoring in ambulatory humans to alert them to significant ST-segment shifts associated with thrombotic occlusion. Background Despite improvements in door-to-balloon times, delays in symptom-to-door times of 2 to 3 h remain. Early alerting of the presence of acute myocardial infarction could prompt patients to seek immediate medical evaluation. Methods Intracardiac monitoring was performed in 37 patients at high risk for acute coronary syndromes. The implanted monitor continuously evaluated the patients' ST segments sensed from a conventional pacemaker right ventricle apical lead, and alerted patients to detected ischemic events. Results During follow-up (median 1.52 years, range 126 to 974 days), 4 patients had ST-segment changes of <3 SDs of their normal daily range, in the absence of an elevated heart rate. This in combination with immediate hospital monitoring led to angiogram and/or intravascular ultrasonography, which confirmed thrombotic coronary occlusion/ruptured plaque. The median alarm-to-door time was 19.5 min (6, 18, 21, and 60 min, respectively). Alerting for demand-related ischemia at elevated heart rates, reflective of flow-limiting coronary obstructions, occurred in 4 patients. There were 2 false-positive ischemia alarms related to arrhythmias, and 1 alarm due to a programming error that did not prompt cardiac catheterization. Conclusions Shifts exceeding 3 SD from a patient's daily intracardiac ST-segment range may be a sensitive/specific marker for thrombotic coronary occlusion. Patient alerting was associated with a median alert-to-door time of 19.5 min for patients at high risk of recurrent coronary syndromes who typically present with 2- to 3-h delays.",
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AU - Fischell, David R.

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AU - John, M. Sasha

AU - Holmes, David

AU - Foster, Malcolm

AU - Kovach, Richard

AU - Medeiros, Paulo

AU - Piegas, Leopoldo

AU - Guimaraes, Helio

AU - Gibson, C. Michael

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N2 - Objectives We report the first clinical studies of intracardiac ST-segment monitoring in ambulatory humans to alert them to significant ST-segment shifts associated with thrombotic occlusion. Background Despite improvements in door-to-balloon times, delays in symptom-to-door times of 2 to 3 h remain. Early alerting of the presence of acute myocardial infarction could prompt patients to seek immediate medical evaluation. Methods Intracardiac monitoring was performed in 37 patients at high risk for acute coronary syndromes. The implanted monitor continuously evaluated the patients' ST segments sensed from a conventional pacemaker right ventricle apical lead, and alerted patients to detected ischemic events. Results During follow-up (median 1.52 years, range 126 to 974 days), 4 patients had ST-segment changes of <3 SDs of their normal daily range, in the absence of an elevated heart rate. This in combination with immediate hospital monitoring led to angiogram and/or intravascular ultrasonography, which confirmed thrombotic coronary occlusion/ruptured plaque. The median alarm-to-door time was 19.5 min (6, 18, 21, and 60 min, respectively). Alerting for demand-related ischemia at elevated heart rates, reflective of flow-limiting coronary obstructions, occurred in 4 patients. There were 2 false-positive ischemia alarms related to arrhythmias, and 1 alarm due to a programming error that did not prompt cardiac catheterization. Conclusions Shifts exceeding 3 SD from a patient's daily intracardiac ST-segment range may be a sensitive/specific marker for thrombotic coronary occlusion. Patient alerting was associated with a median alert-to-door time of 19.5 min for patients at high risk of recurrent coronary syndromes who typically present with 2- to 3-h delays.

AB - Objectives We report the first clinical studies of intracardiac ST-segment monitoring in ambulatory humans to alert them to significant ST-segment shifts associated with thrombotic occlusion. Background Despite improvements in door-to-balloon times, delays in symptom-to-door times of 2 to 3 h remain. Early alerting of the presence of acute myocardial infarction could prompt patients to seek immediate medical evaluation. Methods Intracardiac monitoring was performed in 37 patients at high risk for acute coronary syndromes. The implanted monitor continuously evaluated the patients' ST segments sensed from a conventional pacemaker right ventricle apical lead, and alerted patients to detected ischemic events. Results During follow-up (median 1.52 years, range 126 to 974 days), 4 patients had ST-segment changes of <3 SDs of their normal daily range, in the absence of an elevated heart rate. This in combination with immediate hospital monitoring led to angiogram and/or intravascular ultrasonography, which confirmed thrombotic coronary occlusion/ruptured plaque. The median alarm-to-door time was 19.5 min (6, 18, 21, and 60 min, respectively). Alerting for demand-related ischemia at elevated heart rates, reflective of flow-limiting coronary obstructions, occurred in 4 patients. There were 2 false-positive ischemia alarms related to arrhythmias, and 1 alarm due to a programming error that did not prompt cardiac catheterization. Conclusions Shifts exceeding 3 SD from a patient's daily intracardiac ST-segment range may be a sensitive/specific marker for thrombotic coronary occlusion. Patient alerting was associated with a median alert-to-door time of 19.5 min for patients at high risk of recurrent coronary syndromes who typically present with 2- to 3-h delays.

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KW - ischemia monitoring

KW - myocardial infarction

KW - vulnerable plaque

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