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Continuous ST‐Monitoring Function of Implantable Cardioverter Defibrillator Detects Silent Ischemia in Patients With Coronary Artery Disease

Authors :
Tetsuya Watanabe
Keiji Hirooka
Yoshio Furukawa
Masanori Yabuki
Akio Hirata
Kazunori Kashiwase
Ryu Shutta
Takanao Mine
Hiroya Mizuno
Toshikazu Tanaka
Takahiro Doi
Akihiro Yoshida
Yuji Okuyama
Shinsuke Nanto
Source :
Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease, Vol 7, Iss 13 (2018)
Publication Year :
2018
Publisher :
Wiley, 2018.

Abstract

Background Newer implantable cardioverter defibrillators can monitor intracardiac ECGs , but their ability to detect ischemia is unclear. This study investigated the usefulness of implantable cardioverter defibrillators with an ST‐monitoring function in coronary artery disease patients. Methods and Results We conducted a prospective study of implantable cardioverter defibrillator patients with the ST‐monitoring function. One hundred seventy‐three patients who received implantable cardioverter defibrillators for primary or secondary prevention of sudden cardiac death. All patients underwent medical examinations at least every 6 months, with standard 12‐lead ECGs and device checks that included analysis of the ST‐monitoring function. Myocardial perfusion imaging or coronary angiography was performed during the follow‐up. The mean follow‐up duration was 23.3±7.7 months. Significant ST changes occurred in 15 patients (8.7%), of whom 14 were asymptomatic. The incidence of angina pectoris was significantly higher in the ST change (+) group than that in the ST change (−) group (28.6% versus 7.2%, P=0.03). In the patients who underwent myocardial perfusion imaging, the sensitivity, specificity, and negative predictive value of the ST‐monitoring feature to detect ischemia were 75.0%, 72.5%, and 93.5%, respectively. The sensitivity, specificity, and negative predictive value of the ST‐monitoring feature to predict residual stenosis evaluated using coronary angiography were 76.9%, 83.5%, and 97.5%, respectively. The percentage of patients with a septal right ventricular lead was significantly lower in the ST change (+) group than in the ST change (−) group (13.5% versus 33.5%, P=0.01). Conclusions If intracardiac ECGs ST changes are detected, it is necessary to use additional modalities even in asymptomatic patients. Clinical Trial Registration URL: upload.umin.ac.jp. Unique identifier: UMIN000011824.

Details

Language :
English
ISSN :
20479980
Volume :
7
Issue :
13
Database :
Directory of Open Access Journals
Journal :
Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease
Publication Type :
Academic Journal
Accession number :
edsdoj.3c43f98b7ac24cc28dbed847276c8efa
Document Type :
article
Full Text :
https://doi.org/10.1161/JAHA.118.009332