Advances in ECG-Based Cardiac Ischemia Monitoring - A Review

Abstract

Real-time ST-segment monitoring for ischemia detection was introduced for clinical use in the 80s. To overcome the earlier systems' limitation on the number of leads monitored, systems that support continuous 12-lead ECG acquisition were developed. Derived 12-lead ECGs from 5-wire and 6-wire lead sets were also developed when direct 12 -lead acquisition was not practical. Several innovative graphical solutions were developed to manage the large amount of date from continuous 12-lead ST monitoring, including ST Map for better visual tracking of ST measurements, STEMI Map for more accurate tracking of STEMI criteria, and ST Topology for more efficient ST trending review. To further improve the accuracy of acute ischemia/infraction detection, two advanced 12-lead based lead derivation methods are being developed. The vessel-specific leads (VSLs) method measures ST elevation from three optimal leads, calculated from the 12-lead ECG, for detecting ST-segment deviation during coronary occlusion. The computed electrocardiographic imaging (CEI) method presents a bulls-eye polar plot of the heart surface potentials based on inverse calculation from the body-surface potential mapping derived from the 12-lead ECG. Early results show that these methods could be a useful clinical decision support tool for improving the accuracy of ECG-based triage of chest-pain patients.