Daily Shock Impedance Measured by Implantable Cardioverter Defibrillator is Useful in the Management of Congestive Heart Failure

Matsushita, Kohei; Ishikawa, Toshiyuki; Sumita, Shinichi; Kobayashi, Tsukasa; Ogawa, Hayato; Inoue, Noriko; Matsumoto, Katsumi; Taima, Minoru; Nakazawa, Ichirou; Sugano, Teruyasu; Ishigami, Tomoaki; Uchino, Kenji; Umemura, Satoshi

doi:10.1253/circj.70.1462

Cited by 6 publications

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“…from 1 a.m. to 5 p.m.);patient activity, assessed using an in-built accelerometer sensor and expressed in per cent of 24 h, where a minute was considered ‘active’ if the current sensor rate was greater than or equal to the activity threshold;right ventricular apical pacing lead impedance, calculated from four measurements per day; andthe number of ventricular extrasystoles during 24 h. The enhanced predictor also included:heart rate variability, assessed via daily standard deviation of 5-minute average atrial-atrial intervals recorded every 5 min;painless shock impedance, a kind of thoracic impedance, 17 derived from four measurements per day.These seven parameters were selected because their subtle changes and potential relationships may not be readily recognized in regular Home Monitoring data, in contrast to single events such as ventricular tachyarrhythmia, defibrillation shock, atrial fibrillation, or low percentage of cardiac resynchronization that can all be brought to the physician's attention through immediate notifications, so-called event reports. Furthermore, a mixture of both—trend changes and selected single events—is included in a web-based visualization tool called ‘Heart Failure Monitor’ that can be used routinely for patient monitoring.…”

Section: Methodsmentioning

confidence: 99%

Potential value of automated daily screening of cardiac resynchronization therapy defibrillator diagnostics for prediction of major cardiovascular events: results from Home‐CARE (Home Monitoring in Cardiac Resynchronization Therapy) study

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et al. 2011

European J of Heart Fail

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AimTo investigate whether diagnostic data from implanted cardiac resynchronization therapy defibrillators (CRT-Ds) retrieved automatically at 24 h intervals via a Home Monitoring function can enable dynamic prediction of cardiovascular hospitalization and death.Methods and resultsThree hundred and seventy-seven heart failure patients received CRT-Ds with Home Monitoring option. Data on all deaths and hospitalizations due to cardiovascular reasons and Home Monitoring data were collected prospectively during 1-year follow-up to develop a predictive algorithm with a predefined specificity of 99.5%. Seven parameters were included in the algorithm: mean heart rate over 24 h, heart rate at rest, patient activity, frequency of ventricular extrasystoles, atrial–atrial intervals (heart rate variability), right ventricular pacing impedance, and painless shock impedance. The algorithm was developed using a 25-day monitoring window ending 3 days before hospitalization or death. While the retrospective sensitivities of the individual parameters ranged from 23.6 to 50.0%, the combination of all parameters was 65.4% sensitive in detecting cardiovascular hospitalizations and deaths with 99.5% specificity (corresponding to 1.83 false-positive detections per patient-year of follow-up). The estimated relative risk of an event was 7.15-fold higher after a positive predictor finding than after a negative predictor finding.ConclusionWe developed an automated algorithm for dynamic prediction of cardiovascular events in patients treated with CRT-D devices capable of daily transmission of their diagnostic data via Home Monitoring. This tool may increase patients’ quality of life and reduce morbidity, mortality, and health economic burden, it now warrants prospective studies.ClinicalTrials.gov NCT00376116.

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Section: Methodsmentioning

confidence: 99%

Potential value of automated daily screening of cardiac resynchronization therapy defibrillator diagnostics for prediction of major cardiovascular events: results from Home‐CARE (Home Monitoring in Cardiac Resynchronization Therapy) study

Sack

Wende

Nägele

et al. 2011

European J of Heart Fail

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“…While such a conservative approach is understandable, the consequence is overstatement of the annualized costs for device therapy. 13 That will further enhance the benefits of ICD remote monitoring systems by detecting an early sign of impending acute decompensated heart failure, which accounts for about 1,000,000 annual hospital admissions. The decline in observed utility among the living ICD patients is in some degree an artifact of the HUI, which was normed in healthy people.…”

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confidence: 99%