Authors
Shevchenko Yu.L., Sveshnikov A.V., Marchak D.I., Gerashenko A.V., Ermakov D.Yu.
Clinic of Thoracic and Cardiovascular Surgery St. George’s of National Medical and Surgical Center. N.I. Pirogov, Moscow
Abstract
Nowadays, the routine method of ischemia control in endovascular interventions on the coronary arteries is electrocardiography in standard and amplified leads from the patient’s limbs. The position of ECG electrodes on the patient’s chest reduces the visualization during radioscopy, and the execution of intracoronary ECG is associated with technical difficulties and is determined by the availability of consumables in the department. Academician L. Shevchenko proposed a unified method of invasive electrocardiography with positioning of the electrode in the coronary sinus in order to control intraoperative ischemia in endovascular interventions for coronary heart disease.
In order of study of information content of the ECG from the coronary sinus, the patients were divided into 2 groups: the main group — 10 patients with atherosclerosis of the anterior descending artery of the heart and the control group — 5 patients with native coronary bed. As part of the study routine diagnostic tests and operations, an electrode connected to the station for electrophysiological examination was implanted in the coronary sinus of all patients.
The proposed method of intraoperative monitoring of ischemia showed higher efficiency compared to the standard method of ECG assessment. This original technique opens up additional wide opportunities for the study of intraoperative myocardial ischemia in PCI and can serve as a highly informative engine for the study of myocardial physiology.
Keywords: coronary heart disease, intraoperative monitoring of ischemia, electrocardiography of the coronary sinus.
References
1. Bokeriya, L.A, Bokeriya, O.L., Melikulov, A.H., Le, T.G. Invazivnoe ehlektrofiziologicheskoe issledovanie: rol’ v prognoze vnezapnoj serdechnoj smerti // Annaly aritmologii, № 2, 2010. 42 p.
2. Bokeriya, L.A., Gudkova, R.G. Bolezni sistemy krovoobrashcheniya i serdechno-sosudistaya hirurgiya v Rossiyskoj Federacii. Sostoyanie i problemy // Analiticheskij vestnik soveta federacii, 2015. 9 p.
3. Mirzahanova, L.R. EHffektivnost’ koronarnogo stentirovaniya i konservativnoj terapii u bol’nyh pozhilogo vozrasta: rezul’taty dlitel’nogo prospektivnogo nablyudeniya // Racional’naya Farmakoterapiya v Kardiologii. 2011 T. 6, № 7. 708 p.
4. Revishvili, A.SH., Bojcov, S.A., Davtyan, K.V., Zenin, S.A., Kuznecov, V.A., Kupcov, V.V., Lebedev, D.S., Lomidze, N.N., Medvedev, M.M., Nedostup, A.V., Neminushchij, N.M., Pevzner, A.V., Pokushalov, E.A., Rzaev, F.G., Tatarskij, B.A., Termosesov, S.A., Tyurina, T.V, SHubik, YU.V., YAshin, S.M. Klinicheskie rekomendacii po provedeniyu ehlektrofiziologicheskih issledovanij, kateternoj ablyacii i primeneniyu implantiruemyh antiaritmicheskih ustrojstv // Novaya redakciya. 2017. 702 p.
5. Shevchenko, YU.L., Bobrov, L.L., Obrezan, A.G. Diastolicheskaya funkciya levogo zheludochka / YU.L. SHevchenko, L.L. Bobrov, A.G. Obrezan. // M.: GEHOTAR-Media, 2002. 240 p.
6. Shevchenko, YU.L., Borisov, I.A., Viller, A.G., Paleev, F.N., Kolesova, M.B. Vozmozhnosti sovremennyh ehndovaskulyarnyh tekhnologij v lechenii tyazhelyh form ishemicheskoj bolezni serdca. // Kachestvo zhizni. Medicina. 2003. T. 2. Р. 28.
7. Acharya, U.R., Fujita, H., Adam, M., Lih, O.S., Sudarshan, V., Hong, T.J., Koh, J., Hagiwara, Y., Shua, C.K., Poo, C.K., San, T.R. Automated characterization and classification of coronary artery disease and myocardial infarction by decomposition of ECG signals: A comparative study // Information Sciences. 2017. Vol. 377. P. 17–29.
8. Acharya, R., Fujita, H., Lih, O. S., Adam, M., Tan, J. H., Chua, C.C. Automated detection of coronary artery disease using different durations of ECG segments with convolutional neural network // Knowledge-Based Systems. 2017. Vol. 132. P. 62–71.
9. Fakhri, Y., Busk, M., Schoos, M.M., Terkelsen, C.J., Kristensen, S.D., Wagner, G. S., Sejersten, M., Clemmensen, P. and Kastrup, J. Evaluation of acute ischemia in pre-procedure ECG predicts myocardial salvage after primary PCI in STEMI patients with symptoms > 12 hours // J. of Electrocardiology. 2016. Vol. 49. № 3. P. 278–283.
10. Friedman, P.L. Value of the intracoronary electrocardiogram to monitor myocardial ischemia during percutaneous transluminal coronary angioplasty. / P.L. Friedman, T.L. Shook, J.M Kirshenbaum et al. // Therapy and prevention. Angioplasty. 1986. Vol. 74, № 2. – P. 330–340.
11. Jino, V.B., Kumaran, S., Swaminathan, N., Palanisamy, G., Gnanavelu, G., Ravishankar, G., Kumaran, N., Venkatesan, S. and Paul, G.J. A study on the ECG estimation of the extent of ischemia and its relation to the clinical and angiographic outcome in STEMI // Indian Hearth Journal. 2017. Vol. 69. № 2. P. 23–24.
12. Loewe, A., Schulze, W.H., Jiang, Y., Wilhems, M., Luik, A., Dossel, O. and Seemann, G. ECG-Based Detection of Early Myocardial Ischemia in a Computational Model: Impact of Additional Electrodes, Optimal Placement, and a New Feature for ST Deviation // BioMed Research International. Vol. 2015. 12 p.
13. Oguro, T., Fijii, M., Fuse, K., Takahashi, M., Fujita, S., Kitazawa, H., Sato, M., Ikeda, Y., Okade, M. and Aizawa, Y. Electrical alternans induced by a brief period of myocardial ischemia during percutaneous coronary intervention: The characteristic ECG morphology and relationship to mechanical alternans // Hearth Rhytm. 2015. Vol. 12, № 11. P. 2272–2277.
