Continuous monitoring of acute myocardial ischemia by the implantable cardioverter defibrillator.
The present generation of implantable cardioverter defibrillators (ICDs) provides a very effective device for monitoring and treating life-threatening ventricular tachyarrhythmia. Patients at risk of sudden cardiac death who are directed to this form of treatment usually have severe coronary artery disease, previous myocardial infarction, and low ejection fraction. Progression of the underlying heart disease predisposes these patients to subsequent ischemic events, including symptomatic and asymptomatic myocardial ischemia and reinfarction, which carry a substantial risk of fatal ventricular proarrhythmia. Multipolar lead configurations presently available in the ICD appear to be effective in assessing acute myocardial ischemia as induced by exercise testing or transient coronary artery occlusion. Continuous monitoring of myocardial ischemia (COMONI) by a sophisticated, multimodal ICD appears to be feasible, may offer the means to closely supervise progression and various complications of the underlying heart disease, and may help to guide automatic or interactive antiischemic treatment.
Zehender
M
M
Abteilung für Kardiologie, Universitätsklinik Freiburg, Germany.
Faber
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T
Grom
A
A
Schwab
T
T
Geibel
A
A
Meinertz
T
T
Just
H
H
D000465:Algorithms; D016757:Death, Sudden, Cardiac / Q000517:prevention & control; D017147:Defibrillators, Implantable; D004554:Electric Countershock / Q000379:methods; D015716:Electrocardiography, Ambulatory; D004567:Electrodes, Implanted; D004867:Equipment Design; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods; D017202:Myocardial Ischemia / Q000150:complications / Q000175:diagnosis*; D017180:Tachycardia, Ventricular / Q000150:complications / Q000628:therapy*