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

J Am Heart Assoc. 2018 Jun 30;7(13):e009332. doi: 10.1161/JAHA.118.009332.

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.

Keywords: coronary artery disease; implantable cardioverter‐defibrillator; ischemia.

Publication types

  • Case Reports
  • Multicenter Study
  • Observational Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Asymptomatic Diseases
  • Coronary Artery Disease / diagnosis
  • Coronary Artery Disease / epidemiology*
  • Coronary Artery Disease / physiopathology
  • Death, Sudden, Cardiac / epidemiology
  • Death, Sudden, Cardiac / prevention & control*
  • Defibrillators, Implantable
  • Electric Countershock / instrumentation*
  • Electrocardiography, Ambulatory / instrumentation*
  • Female
  • Humans
  • Incidence
  • Japan / epidemiology
  • Male
  • Middle Aged
  • Myocardial Ischemia / diagnosis*
  • Myocardial Ischemia / epidemiology
  • Myocardial Ischemia / physiopathology
  • Predictive Value of Tests
  • Primary Prevention / instrumentation*
  • Prospective Studies
  • Prosthesis Design
  • Reproducibility of Results
  • Risk Factors
  • Secondary Prevention / methods*
  • Time Factors
  • Treatment Outcome

Associated data

  • UMIN-CTR/UMIN000011824