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(Circulation. 2006;113:e705-e706.)
© 2006 American Heart Association, Inc.

Images in Cardiovascular Medicine

Dynamic Myocardial Ischemia Caused by Circumflex Artery Stenosis Detected by a New Implantable Left Atrial Pressure Monitoring Device

Jay L.T. Ritzema-Carter, BM, MRCP; David Smyth, MBChB, MD; Richard W. Troughton, MBChB, PhD; Ian G. Crozier, MBChB, MD; Iain C. Melton, MBChB; A. Mark Richards, MD, PhD, DSc; Neal Eigler, MD; James Whiting, PhD; Saibal Kar, MD; Henry Krum, MD; William T. Abraham, MD

From Christchurch Hospital, Christchurch, New Zealand (J.L.T.R.-C., D.S., R.W.T., I.G.C., I.C.M., A.M.R.); Cedars-Sinai Medical Center, Los Angeles, Calif (N.E., J.W., S.K.); Monash University, Alfred Hospital, Melbourne, Australia (H.K.); and The Ohio State University, Columbus, Ohio (W.T.A.).

Correspondence to Dr Jay Ritzema-Carter, 2nd Floor, Parkside West, Christchurch Hospital, Private Bag 4710, Christchurch, New Zealand 8001. E-mail jay.ritzemacarter{at}cdhb.govt.nz

An 81-year-old man with severe left ventricular dysfunction (left ventricular ejection fraction 24%), prior coronary artery bypass grafting, symptomatic heart failure (New York Heart Association class III), and an investigational percutaneously implanted permanent left atrial pressure (LAP) monitoring system (HeartPOD Savacor, Inc, Los Angeles, Calif) in situ (Figure 1) was admitted with an acute coronary syndrome. High-fidelity resting LAP waveforms were acquired at least twice daily by the patient, using a hand-held computer to communicate with the implant by radiofrequency digital telemetry. Mean LAP variations included frequent, diurnal increases to 35 mm Hg, with large c-V waves >60 mm Hg. The patient underwent successful stenting of an unprotected circumflex marginal branch (Figure 2). Figure 3 shows hemodynamic waveforms during the angioplasty. Myocardial ischemia may elevate LAP by causing transient systolic or diastolic left ventricular dysfunction or mitral regurgitation from papillary muscle dysfunction. In this patient, ambulatory direct LAP monitoring detected dynamic ischemia and helped to confirm successful revascularization of the culprit circumflex artery.

View larger version (57K): [in this window] [in a new window]   Figure 1. The HeartPOD sensor lead positioned across atrial septum on chest radiograph (black arrows) and transesophageal echocardiogram (white arrow). There was minimal protrusion of the permanently implanted transducer tip (white arrow) into the left atrium (LA). RA indicates right atrium.

View larger version (70K): [in this window] [in a new window]   Figure 2. Native circumflex marginal branch stenosis before (A) and after (B) stenting.

View larger version (24K): [in this window] [in a new window]   Figure 3. LAP and electrogram waveforms from the implanted monitoring system showing a normal LAP at baseline (A), LAP elevation during 20-second coronary occlusion with massive c-V waves (B), and normalization of LAP and c-V waves within 3 minutes after successful circumflex artery stenting (C). IEGM indicates intracardiac electrogram.

	Acknowledgments

 
Catherine Cruickshank was Study Coordinator at the Cardiology Department, Christchurch Hospital.

Disclosures

Dr Troughton has a research grant from the study sponsor, Savacor, Inc, Los Angeles, Calif, to participate in the HOMEOSTASIS 1 Trial. Drs Eigler, Whiting, and Kar have financial interests in the study sponsor. Dr Abraham serves as a consultant to the sponsor and as Study Chairman. The other authors report no conflicts.

	Footnotes

 
The online-only Data Supplement can be found at http://circ.ahajournals.org/cgi/content/full/113/15/e705/DC1.

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This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Ritzema-Carter, J. L.T. Articles by Abraham, W. T. Search for Related Content PubMed PubMed Citation Articles by Ritzema-Carter, J. L.T. Articles by Abraham, W. T. Related Collections Other heart failure Related Article