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[A new method for the diagnosis of myocardial ischemia in patients with an implanted programmable pacemaker]
Insights
Implanted programmable pacemakers (IPP) can help detect myocardial ischemia. This stress-echocardiography variant effectively diagnosed ischemia in patients with pacemakers, showing improved diagnostic accuracy.
Area of Science:
- Cardiology
- Medical Devices
- Diagnostic Imaging
Background:
- Continuous pacing (CP) is used for arrhythmias and conduction abnormalities.
- Assessing myocardial ischemia in pacemaker patients presents diagnostic challenges.
Purpose of the Study:
- To evaluate the applicability of implanted programmable pacemakers (IPP) for detecting myocardial ischemia.
- To assess a novel stress-echocardiography (echoCG) technique using IPP-driven stimulation.
Main Methods:
- 28 patients on CP (VVI/AAI) underwent enhanced stimulation via IPP.
- Two-dimensional echoCG registered impaired local contractility (ILC) of the left ventricle.
- Diagnostic criteria were met in 27 out of 28 cases.
Main Results:
- The IPP-based stress-echoCG test was diagnostic in most patients.
- 11 patients showed positive results, with a significant increase in ILC index (3 ± 3 to 9 ± 5, p < 0.01).
Conclusions:
- This IPP-based stress-echoCG variant is a viable method for diagnosing myocardial ischemia in pacemaker patients.
- Limitations were noted for AAI and VVI CP regimens.
Abstract:
Implanted programmable pacemaker (IPP) applicability for detection of myocardial ischemia has been tried in patients with continuous pacing (CP). 28 patients (mean age 59 +/- 9 years) on CP in VVI and AAI regimens because of arrhythmia and abnormal cardiac conduction underwent loading test with enhanced stimulation made with IPP on the changed program. Impaired local contractility (ILC) of the left ventricle was registered at two-dimensional echoCG. The test reached diagnostic criteria in 27 cases. The results of the test appeared positive in 11 patients whose ILC index increased from 3 +/- 3 to 9 +/- 5 (p < 0.01), on the average. The authors believe this variant of stress-echoCG applicable for diagnosis of myocardial ischemia in IPP patients. Limitations are indicated in AAI and VVI CP regimens.