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Title: Electrocardiographic monitoring of myocardial ischaemia : novel methods and potential application in implanted devices
Author: Ghuran, Azad Valentine
Awarding Body: University of Edinburgh
Current Institution: University of Edinburgh
Date of Award: 2006
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The major objective of this thesis was to investigate whether myocardial ischaemia can be reliably detected from intracardiac electrograms (EGMs) that are potentially available in implanted devices such as pacemakers and implantable cardioverter defibrillators. It also investigated whether novel parameters of repolarisation (T wave morphology descriptors) can be used as indices to monitor myocardial ischaemia. The first study investigated the optimal unipole for monitoring myocardial ischaemia (induced by balloon inflation during angioplasty) from a quadripolar intracardiac electrode placed within the right ventricle. This study showed that EGM recordings obtained from unipoles near the distal tip of the electrode are less sensitive in detecting myocardial ischaemia when compared to recordings obtained from more proximal unipoles. Due to the direct contact of the tip electrode with the myocardial wall, the EGM from more distal unipoles are often superimposed by local signals with morphologies similar to local action potentials. Consequently, in order to improve the sensitivity of intracardiac EGM monitoring, the average recording of the two most proximal unipoles within the right ventricular cavity were used as “a single unipole”. This was then used in the subsequent two studies for multilead bipolar EGM reconstruction. The second and third studies investigated the diagnostic accuracy of detecting myocardial ischaemia using four bipolar leads reconstructed from the unipoles that are potentially available in implanted devices. The fourth study investigated the application of novel descriptors of T wave morphology in monitoring myocardial ischaemia. In summary, the presented clinical studies demonstrate that monitoring myocardial ischaemia from intracardiac electrodes, analogous to those of implanted cardiac devices is feasible. However current technology limits this detection ability. The development of novel T wave morphology descriptors may improve the diagnostic accuracy of monitoring myocardial ischaemia.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (M.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available