title: Impact of continuous intracardiac ST-segment monitoring on mid-term outcomes of ICD-implanted patients with coronary artery disease. Early results of a prospective comparison with conventional ICD outcomes.
abstract: BACKGROUND
  Although myocardial ischaemia monitored by some implantable cardioverter-defibrillators (ICDs) might improve patient care, the clinical usefulness of this technology has not yet been validated.
  
  
  OBJECTIVE
  To investigate the potential impact of ICD-based ischaemia monitoring on clinical care and patient management of ICD recipients.
  
  
  METHODS
  Prospective, controlled, non-randomised study.
  
  
  METHODS
  Single-centre, university hospital.
  
  
  METHODS
  Consecutive patients with known coronary artery disease, followed up for at least 6 months.
  
  
  METHODS
  Patients implanted with either an ICD providing continuous intracardiac ST monitoring (n=53; ST group) or with an ICD without this capability (n=50).
  
  
  METHODS
  Major cardiovascular events, appropriateness of ST-shift episodes and unscheduled device-related visits.
  
  
  RESULTS
  During follow-up (15.4±8.4 months), one patient experienced ST-shift events confirmed by angiography to be related to myocardial ischaemia. Myocardial infarction was a rare event and occurred in one patient (ST group) who had an ST-elevation myocardial infarction 3 weeks after the implant, but at this time the algorithm had not yet been activated. In the ST group, seven patients had one or more episodes of false-positive ST events (median 9, range 1-90). The programmable features of the device helped overcome the problem in six patients. Among patients with a remote monitoring system, unscheduled outpatient visits were significantly increased in the ST group (17 vs 4; p=0.032).
  
  
  CONCLUSIONS
  Although, this study was underpowered by the small number of acute ischaemic events, ICD-based ST monitoring failed to provide a benefit over ICDs without this capability and increased unscheduled evaluations in patients with remote follow-up. The sensitivity and specificity of the algorithm still require validation.
authors: Division of Cardiology, Department of Internal Medicine, University of Rome Tor Vergata, Rome, Italy. forleo@me.com
authors: Giovanni B
authors: GB
authors: Forleo
authors: Manfredi
authors: M
authors: Tesauro
authors: Germana
authors: G
authors: Panattoni
authors: Domenico G
authors: DG
authors: Della Rocca
authors: Lida P
authors: LP
authors: Papavasileiou
authors: Domenico
authors: D
authors: Sergi
authors: Arianna
authors: A
authors: Di Molfetta
authors: Luca
authors: L
authors: Santini
authors: Francesco
authors: F
authors: Romeo
mesh_terms: D000368:Aged; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000503:physiopathology* / Q000628:therapy; D017147:Defibrillators, Implantable; D022062:Electrophysiologic Techniques, Cardiac / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008991:Monitoring, Physiologic / Q000379:methods*; D011379:Prognosis; D011446:Prospective Studies; D015203:Reproducibility of Results; D013997:Time Factors