Real-time detection and alerting for acute ST-segment elevation myocardial ischemia using an implantable, high-fidelity, intracardiac electrogram monitoring system with long-range telemetry in an ambulatory porcine model

被引:27
作者
Fischell, Tim A. [1 ]
Fischell, David R.
Fischell, Robert E.
Virmani, Renu
DeVries, Jennifer J.
Krucoff, Mitchell W.
机构
[1] Borgress Heart Inst, Kalamazoo, MI USA
[2] AngelMed Syst Inc, Tinton Falls, NJ USA
[3] CV Path, Gaithersburg, MD USA
[4] MPI, Res, Mattawan, MI USA
[5] Duke Univ, Med Ctr, Durham, NC USA
[6] Duke Univ, Duke Clin Res Inst, Durham, NC USA
关键词
D O I
10.1016/j.jacc.2006.07.058
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
OBJECTIVES The purpose of this study was to evaluate feasibility of using real-time, high-fidelity, intracardiac electrogram monitoring from a permanently implantable ischemia detection system (IlDS), with long-range telemetry capability to detect ST-segment shifts associated with acute or subacute coronary occlusion in a porcine model. BACKGROUND Early identification of coronary occlusion with ST-segment elevation could profoundly accelerate the timing of revascularization and improve clinical outcomes. METHODS This paper reports the first investigation using real-time, high-fidelity, intracardiac electrogram monitoring from a permanently IIDS, with long-range telemetry capability. This IlDS was tested in an ambulatory porcine model, with acute coronary occlusion precipitated by stent thrombosis. Two overlapping copper stents were implanted in the left anterior descending (n = 3), the circumflex (n = 3), or the right coronary artery (n = 2) of juvenile farm pigs. Monitoring was carried using telemetry from the IIDS. RESULTS All stented pigs had acute ST-segment elevation event(s) triggering the alerting thresholds of the IIDS. All triggered events were confirmed to be caused by thrombosis of the copper stent(s), and well correlated to infarct age and location. Four of the 8 pigs died from ventricular fibrillation, recorded by the IIDS at a mean time of 70 +/- 121 h after ST-segment alert. The sensitivity and specificity of alerting for ST-segment shift, associated with thrombotic coronary occlusion, were 100% and 100%, respectively. CONCLUSIONS This study demonstrates the ability of an implantable ischemia detection system to detect ST-segment elevation from coronary occlusion in a porcine model of ST-segment elevation myocardial infarction. ST-segment elevation was sufficient to trigger alerting thresholds in all 3 epicardial coronary distributions. Such a system, with real-time alerting capability, could advance the time frame of reperfusion therapy and potentially prevent, rather than interrupt, acute myocardial infarction in patients with coronary artery disease.
引用
收藏
页码:2306 / 2314
页数:9
相关论文
共 24 条
  • [1] *AM HEART ASS, 1999, HEART STROK STAT UPD
  • [2] [Anonymous], 1988, LANCET, V2, P349
  • [3] [Anonymous], 1986, Lancet, V1, P397
  • [4] Antman Elliott M, 2004, J Am Coll Cardiol, V44, P671, DOI 10.1016/j.jacc.2004.07.002
  • [5] Demographic, belief, and situational factors influencing the decision to utilize emergency medical services among chest pain patients
    Brown, AL
    Mann, NC
    Daya, M
    Goldberg, MR
    Meischke, H
    Taylor, J
    Smith, K
    Osganian, S
    Cooper, L
    [J]. CIRCULATION, 2000, 102 (02) : 173 - +
  • [6] Use of Emergency Medical Services in acute myocardial infarction and subsequent quality of care - Observations from the National Registry of Myocardial Infarction 2
    Canto, JG
    Zalenski, RJ
    Ornato, JP
    Rogers, WJ
    Kiefe, CI
    Magid, D
    Shlipak, MG
    Frederick, PD
    Lambrew, CG
    Littrell, KA
    Barron, HV
    [J]. CIRCULATION, 2002, 106 (24) : 3018 - 3023
  • [7] Chew Derek P, 2002, J Invasive Cardiol, V14 Suppl A, p3A
  • [8] Time delay to treatment and mortality in primary angioplasty for acute myocardial infarction - Every minute of delay counts
    De Luca, G
    Suryapranata, H
    Ottervanger, JP
    Antman, EM
    [J]. CIRCULATION, 2004, 109 (10) : 1223 - 1225
  • [9] Timing is everything - Motivating patients to call 9-1-1 at onset of acute myocardial infarction
    Faxon, D
    Lenfant, C
    [J]. CIRCULATION, 2001, 104 (11) : 1210 - 1211
  • [10] Potential of an intracardiac electrogram for the rapid detection of coronary artery occlusion
    Fischell, Tim A.
    Fischell, David R.
    Fischell, Robert E.
    Baskerville, Susan
    Hendrick, Susan
    Moshier, Carol
    Harwood, Jonathan P.
    Krucoff, Mitchell W.
    [J]. CARDIOVASCULAR REVASCULARIZATION MEDICINE, 2005, 6 (01) : 14 - 20