CONTINUOUS MONITORING OF ACUTE MYOCARDIAL-ISCHEMIA BY THE IMPLANTABLECARDIOVERTER-DEFIBRILLATOR

The present generation of implantable cardioverter defibrillators (ICD s) provides a very effective device for monitoring and treating life-t hreatening ventricular tachyarrhythmia, Patients at risk of sudden car diac death who are directed to this form of treatment usually have sev ere coronary artery disease, previous myocardial infarction, and low e jection fraction. Progression of the underlying heart disease predispo ses these patients to subsequent ischemic events, including symptomati c 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 i n assessing acute myocardial ischemia as induced by exercise testing o r transient coronary artery occlusion. Continuous monitoring of myocar dial ischemia (COMONI) by a sophisticated, multimodal ICD appears to b e feasible, may offer the means to closely supervise progression and v arious complications of the underlying heart disease, and may help to guide automatic or interactive antiischemic treatment.