Hemodynamic Sensor in Cardiac Implantable Electric Devices: The Endocardial Accelaration Technology

Abstract

There have been substantial progresses in the technology of cardiac implantable electric devices (CIEDs) during the past decades. One of the progresses is represented by the development of a hemodynamic sensor embedded at the tip of a pacing lead that measures myocardial contractility by the analysis of myocardial mechanical vibrations occurring during the cardiac cycle. This sensor, providing continuous hemodynamic monitoring, could play an important role in clinical practice because of several clinical applications in CIEDs recipients. The objectives of this work are to report how this sensor operates and to review the main findings about its clinical applications.

Contractility sensor-guided optimization of cardiac resynchronization therapy: results from the RESPOND-CRT trial

“…The SonR sensor records an endocardial acceleration signal corresponding to these vibrations. The highest amplitude of the signal occurs during the isovolumetric contraction phase of the cardiac cycle and corresponds to the cardiac contractility 15 . The correlation between the amplitude of the recorded signal and LV dP / dt max , as a surrogate of the contractile function of the heart, has been demonstrated 16 .…”

Automatic Continuous CRT Optimization to Improve Hemodynamic Response: An Italian Single-Center Experience

“…Recently introduced SonR technology uses a cardiac contractility sensor in the tip of a permanent pacing lead to endocardially measure cardiac muscle vibrations, which are directly correlated with LV dP/dt max [8][9][10]. A dedicated algorithm in certain CRT-defibrillator (CRT-D) systems (MicroPort CRM, Saluggia, Italy) uses SonR sensor metrics to implement automatic weekly optimization of AV and VV delays [11].…”

Assessment of Myocardial Contractility by SonR Sensor in Patients Undergoing Cardiac Resynchronization Therapy

“…During the last 40 years, cardiac implantable electric devices evolved considerably and various technological aspects have been progressed (electrodes, connectors, sensors, algorithms) mainly related to the detection of cardiac arrhythmias, management of pacing/sensing thresholds, reduction of unnecessary ventricular pacing, prevention of atrial tachyarrhythmia recurrence, development of rate responsive pacing and rate adaptive atrioventricular (AV) delay functions, aimed at a better management of patients . One innovation is represented by the development of a hemodynamic sensor (SonR) incorporated at the tip of an implantable pacing lead, able to detect the acceleration of the endocardial wall of the left ventricle . SonR sensor records and amplifies myocardial vibrations during the entire cardiac cycle, transforming them into an electric signal that is processed and converted into a peak endocardial acceleration (PEA) signal .…”

“…One innovation is represented by the development of a hemodynamic sensor (SonR) incorporated at the tip of an implantable pacing lead, able to detect the acceleration of the endocardial wall of the left ventricle . SonR sensor records and amplifies myocardial vibrations during the entire cardiac cycle, transforming them into an electric signal that is processed and converted into a peak endocardial acceleration (PEA) signal . Previous studies have revealed a high correlation between PEA amplitude recorded in the right ventricle and left ventricular (LV) dP/dt max .…”

“…2 SonR sensor records and amplifies myocardial vibrations during the entire cardiac cycle, transforming them into an electric signal that is processed and converted into a peak endocardial acceleration (PEA) signal. 2 Previous studies have revealed a high correlation between PEA amplitude recorded in the right ventricle and left ventricular (LV) dP/dt max. 3,4 Recently, a biventricular implantable cardiac defibrillator (ICD) system with SonR sensor encapsulated at the tip of the atrial pacing lead (Paradym SonR cardiac ©2015 Wiley Periodicals, Inc. resynchronization therapy-defibrillator [CRT-D] system, Sorin Group, Saluggia, Italy) was developed and a good correlation between right atrial (RA) SonR signal and LV dP/dt max has been reported.…”