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ST‐Segment Deviation Following Implantable Cardioverter Defibrillator Shocks: Incidence, Timing, and Clinical Significance
Author(s) -
GUREVITZ OSNAT,
LIPCHENCA IGOR,
YAACOBY ELAD,
SEGAL ERAN,
PEREL AZRIEL,
ELDAR MICHAEL,
GLIKSON MICHAEL
Publication year - 2002
Publication title -
pacing and clinical electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.686
H-Index - 101
eISSN - 1540-8159
pISSN - 0147-8389
DOI - 10.1046/j.1460-9592.2002.01429.x
Subject(s) - medicine , implantable cardioverter defibrillator , st segment , cardiology , shock (circulatory) , left axis deviation , clinical significance , incidence (geometry) , electrocardiography , depression (economics) , myocardial infarction , physics , economics , optics , macroeconomics
GUREVITZ, O., et al. : ST‐Segment Deviation Following Implantable Cardioverter Defibrillator Shocks: Incidence, Timing, and Clinical Significance. ST‐segment analysis is frequently used during surgical procedures, while ST deviation is considered a sign of myocardial injury. ST deviations were reported following transthoracic and epicardial electrical shocks. The prevalence, timing, and clinical significance of ST‐segment deviation following endocardial ICD shocks are discussed in this article. Twenty‐eight patients undergoing 125 shock episodes during ICD implantation or testing were included. A 12‐lead ECG was recorded at baseline, continuously during the first 3–10 seconds, 1 minute after test shocks, 3–10 seconds and 1 and 5 minutes after each shock given to terminate VF. ST deviation was diagnosed when the ST‐segment was displaced ≥ 1 mm in at least one lead compared to baseline. ST‐segment deviations were observed after 49 (39%) of all shock episodes in 17 (61%) of patients. ST elevation was observed after 30 (24%) of all shock episodes, and ST depression after 31 (25%). Following 13 shock episodes in seven patients, ST‐elevation and depression were observed. ST depressions occurred more frequently after shocks given to terminate VF than after lower energy test shocks (28% vs 18% respectively, P = 0.045 ). However, there was no significant difference in the prevalence of ST elevations between the lower or higher energy shocks. No adverse clinical events were observed in patients with or without postshock ST‐segment deviation. ST‐segment deviation following endocardial ICD shocks is a frequent phenomenon, occurring acutely and resolving during the first few minutes postshock. It may have no prognostic implications.