Coronary Artery Disease Clinical Trial
Official title:
A Clinical Evaluation of ST Changes in a Group of Patients Having Ventricular Arrhythmias
The purpose of this investigation is to determine the prevalence of device-recorded ST segment changes occurring before appropriate Implantable Cardiac Defibrillator (ICD) therapies (ATP or Shock) and to define their temporal relationship to ventricular arrhythmias.
Sudden cardiac death due to cardiac arrhythmia is a devastating and unpredictable
complication of coronary artery disease.
Implantation of automatic implantable cardioverter defibrillators (ICD) is a well established
therapy for the treatment and prevention of sudden cardiac death. Evidence for the use of
these devices has been provided by a number of landmark clinical trials over the last 16
years.
Reduction in ischemia can be achieved by coronary artery revascularization but in many
patients may occur a gradual progression to recurrence of ischemia resulting in further life
threatening arrhythmias. It is reasonable to assume that unchecked progression of ischemic
heart disease may result in increased mortality in ICD patients. It has been shown that the
long term mortality risk for ICD patients can be linked to the time since the last coronary
revascularization procedure. Both MADIT-II and Sudden Cardiac Death in Heart Failure trial
(SCD-HeFT) showed that patients receiving inappropriate ICD therapy have an increased risk of
death. It has been speculated that this may be due to progression of the disease and
recurrent ischemia.
A feature available in some ICDs manufactured by St Jude medical enables the constant beat to
beat monitoring of the intra-cardiac ST segment using the implanted ICD leads. Similar
systems have demonstrated this approach to be a reliable method of identifying ischemic
events. However, the predictive value of the ST monitoring feature in identifying pending
arrhythmic events has yet to be established. Prediction of worsening ischemia could play an
important part in allowing physicians to identify ICD patients with greater mortality risk
and allow them the time to personalize patient therapy in order to reduce that risk.
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