Optimal ECG monitoring during percutaneous transluminal coronary angioplasty of the left anterior descending artery

Feldman, Ted; Childers, Rory; Chua, K. G.

doi:10.1002/ccd.1810130410

Cited by 10 publications

(2 citation statements)

References 7 publications

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“…Most of these patients have ischemia observed through monitoring with a single lead (V2; 79%). This observation is similar to results obtained by Feldman et al [7], who noted ST deviation in 11 of 14 patients (79%). These investigators did not monitor lead V 1 , V3, or V4.…”

Section: Discussionsupporting

confidence: 92%

Monitoring of ischemia during percutaneous coronary angioplasty: Influence of guidewire, balloon placement, and lead selection

Rezkalla

Moushmoush

Connors

et al. 1988

Cathet. Cardiovasc. Diagn.

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We examined the sensitivity of the surface 12-lead electrocardiogram (ECG) for detecting ischemia during guidewire and deflated balloon passage as well as during balloon inflation in proximal epicardial stenoses during percutaneous transluminal coronary angioplasty (PTCA) of 55 patients. Ischemia (ST change greater than or equal to 0.1 mV) by 12-lead ECG was detected in 28% of patients after guidewire passage, in 50% after deflated balloon passage, and in 76% during balloon inflation vs. 17%, 14%, and 50%, respectively, by limb lead monitoring alone. The best single lead for detecting ischemia during PTCA was V2 for left anterior descending and circumflex and III for right coronary artery inflations. The addition of a selected second precordial lead further enhanced ischemia monitoring. We conclude that ischemia is common during PTCA even during wire and deflated balloon passage, that the 12-lead ECG is more sensitive for monitoring ischemia during PTCA than conventional techniques, and that laboratories can optimize their ability to detect ischemia during PTCA by selecting appropriate leads.

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Section: Discussionsupporting

confidence: 92%

Monitoring of ischemia during percutaneous coronary angioplasty: Influence of guidewire, balloon placement, and lead selection

Rezkalla

Moushmoush

Connors

et al. 1988

Cathet. Cardiovasc. Diagn.

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“…Application of the Intracoronary Electrocardiogram to Study Regional Ischemia Using the IC‐ECG to evaluate the S‐ECG, it was found that lead V 2 was the single best lead to detect LAD ischemia, 60 and that left circumflex distribution transmural ischemia was not well reflected by S‐ECG 61 . Using the IC‐ECG and collateral flow index measured during vascular occlusion in angiographically normal arteries, Wustmann et al showed that functional collaterals exist and could prevent ischemia in 20–25% of subjects 62 .…”

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confidence: 99%

The Intracoronary Electrocardiogram in Percutaneous Coronary Intervention

Yong¹,

Lowe²,

Ng³

et al. 2009

J Interven Cardiology

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The technique of obtaining an epicardial electrocardiogram trace by connecting the guidewire during coronary angioplasty to an electrocardiogram lead has been used since 1985. The intracoronary electrocardiogram appears to be more sensitive than the surface electrocardiogram in detecting transient ischemia, particularly in the territory of the left anterior descending and left circumflex coronary arteries. Importantly, recent studies have shown the intracoronary electrocardiogram to be particularly useful in demonstrating pre- and postconditioning during interventional procedures, predicting periprocedural myocardial damage, and in the determination of regional viability in the catheterization laboratory. Barriers to the use of the intracoronary electrocardiogram in the clinical setting include the lack of standardized methods for acquiring and analyzing the intracoronary electrocardiogram, and the lack of commercially available continuous intracoronary monitoring systems to permit analysis while performing coronary interventions. Facilitating these relatively simple technical developments may permit optimal integration of the intracoronary electrocardiogram into the catheterization laboratory.

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ST segment alternans during coronary angioplasty

Sochanski

Feldman

Chua

et al. 1992

Cathet. Cardiovasc. Diagn.

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Four patients with severe proximal or mid-LAD stenosis were noted to have ST alternans during balloon angioplasty. Neither mechanical alternans nor increased ventricular ectopy were noted. In contrast to prior descriptions in animals or patients with variant angina, ST alternans did not occur following a premature ventricular contraction. Frequent use of calcium channel blockers during PTCA may interfere with the mechanism leading to electrical alternans and its consequences as seen in animal studies, accounting for the low frequency with which this phenomenon is noted during PTCA.

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Optimal ECG monitoring during percutaneous transluminal coronary angioplasty of the left anterior descending artery

Cited by 10 publications

References 7 publications

Monitoring of ischemia during percutaneous coronary angioplasty: Influence of guidewire, balloon placement, and lead selection

Monitoring of ischemia during percutaneous coronary angioplasty: Influence of guidewire, balloon placement, and lead selection

The Intracoronary Electrocardiogram in Percutaneous Coronary Intervention

ST segment alternans during coronary angioplasty

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