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

Abstract

BackgroundNewer 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 ResultsWe 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).ConclusionsIf intracardiac ECGs ST changes are detected, it is necessary to use additional modalities even in asymptomatic patients.Clinical Trial RegistrationURL: http://upload.umin.ac.jp. Unique identifier: UMIN000011824.

Clinical valuation of ST changes in a group of patients with ventricular arrhythmias: The inSighT Study

“…Predictive value of ST-segment changes detected by ICD was investigated by Watanabe et al (2018). In this study, 173 patients after implantation of ICD with the ST-segment monitoring function were followed for a mean of 23.…”

“…This resulted in a lack of data to confirm a likely relation of ST‐segment changes with ongoing ischemia, which is the most important limitation of our study. Predictive value of ST‐segment changes detected by ICD was investigated by Watanabe et al ( 2018 ). In this study, 173 patients after implantation of ICD with the ST‐segment monitoring function were followed for a mean of 23.3 ± 7.7 months.…”

<p>The AngelMed Guardian® System in the Detection of Coronary Artery Occlusion: Current Perspectives</p>

“…For instance, the prospective ESTIMATION trial demonstrated that the use of ICD with a continuous ST-monitoring via intracardiac EKG was safe and effective for detecting asymptomatic myocardial ischemia, with a sensitivity, specificity, and negative predictive value of 75.0%, 72.5%, and 93.5% among participants who underwent myocardial perfusion imaging. 66 The Guardian System is the first implanted device in ambulatory subjects with advanced multivessel cardiac disease to provide ST-segment shift alerting, thereby helping in the detection of a disease process with high morbidity and mortality, where earlier intervention can result in clinical benefit. The Guardian System alert has the capability to accurately recognize coronary occlusion as compared to patient-perceived symptoms alone.…”