Usefulness of monitoring congestive heart failure by multiple impedance vectors

Panescu, Dorin; Naware, Mihir; Siou, Jeff; Nabutovsky, Yelena; Holmstrom, N.; Blomqvist, Andreas; Shah, Riddhi; Gutfinger, Dan; Khoury, Dirar S.

doi:10.1109/iembs.2008.4650500

Cited by 7 publications

(11 citation statements)

References 3 publications

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“…To our knowledge, the present study is the first to investigate ICZ variations in humans by using a permanent biventricular pacing system. Previous studies evaluating multiple ICZ vectors have been performed in animal experimental models, therefore in different structural anatomical contexts 13,18,19 . Our results not only suggest that ICZ measurement by biventricular lead electrodes is feasible and can be applied to the human heart, but also seem to be in line with the available animal data, with regard to the correlation between ICZ and hemodynamic variables 13,18,19 …”

Section: Discussionsupporting

confidence: 79%

Multiple Vector Impedance Measurements During Biventricular Pacing: Feasibility and Possible Implications for Hemodynamic Monitoring

Valzania

Eriksson

M.Sc.

et al. 2009

Pacing Clinical Electrophis

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Section: Discussionsupporting

confidence: 79%

Multiple Vector Impedance Measurements During Biventricular Pacing: Feasibility and Possible Implications for Hemodynamic Monitoring

Valzania

Eriksson

M.Sc.

et al. 2009

Pacing Clinical Electrophis

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“…Stahl et al 17 showed a strong correlation between intracardiac impedance parameters and stroke volume in a porcine model. Panescu et al 18 examined multiple impedance vectors derived from implanted biventricular implantable cardioverter-defibrillator devices in a canine/ovine model of heart failure, and demonstrated good correlation between cardiogenic impedance and progression of heart failure.…”

Section: Discussionmentioning

confidence: 99%

Relationship between intracardiac impedance and left ventricular contractility in patients undergoing cardiac resynchronization therapy

et al. 2011

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AimsCardiac resynchronization therapy (CRT) has dramatically improved the symptoms and prognosis of patients with heart failure in large randomized clinical trials. Optimization of device settings may maximize benefit on an individual basis, although the best method for this is not yet established. We evaluated the use of cardiogenic impedance measurements (derived from intracardiac impedance signals) in CRT device optimization, using invasive left ventricular (LV) dP/dtmax as the reference.Methods and resultsSeventeen patients underwent invasive haemodynamic assessment using a pressure wire placed in the LV cavity at the time of CRT device implantation. Intracardiac impedance measurements were made at different atrioventricular (AV) and interventricular (VV) delays and compared with LV dP/dtmax. We assessed the performance of patient-specific and generic impedance-based models in predicting acute haemodynamic response to CRT. In two patients, LV catheterization with the pressure wire was unsuccessful and in two patients LV lead delivery was unsuccessful; therefore, data were acquired for 13 out of 17 patients. Left ventricular dP/dtmax was 919 ± 182 mmHg/s at baseline and this increased acutely (by 24%) to 1121 ± 226 mmHg/s as a result of CRT. The patient-specific impedance-based model correctly predicted the optimal haemodynamic response (to within 5% points) for AV and VV delays in 90 and 92% of patients, respectively.ConclusionCardiogenic impedance measurements are capable of correctly identifying the maximum achievable LV dP/dtmax as measured by invasive haemodynamic assessment. This study suggests that cardiogenic impedance can potentially be used for CRT optimization and may have a role in ambulatory assessment of haemodynamics.

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“…With currents flowing between intracardiac electrodes (RV, LV, and RA) and to the CIED casing, enlargement in ventricular volumes will decrease the impedance since more of the heart is encompassed by these impedance vectors. Four intrathoracic and 2 intracardiac vectors were examined in 16 dogs and 5 sheep [63]. Impedance values measured by all vectors decreased with the onset of HF, with the maximum decrease occurring with LV‐Can and LV–RV.…”

Section: Sensors For Heart Failure (Table 2)mentioning

confidence: 99%

Optimizing heart failure therapy with implantable sensors

Lau

Siu

Tse

2012

Journal of Arrhythmia

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a b s t r a c tHeart failure (HF)-related hospitalization is associated with significant mortality and morbidity and can be prevented by early intervention. Implantable sensors detect early pathophysiological changes in HF, using an accelerometer, a paced electrogram, impedance and pressure sensors in implanted intracardiac leads, or stand-alone devices. Such sensors monitor daily activity, QT and ST intervals, pulmonary fluid, and intracardiac pressures at various points. Sensor data are available either by patient's or physician's regular interrogation, or using remote patient monitoring. Different sensors have different levels of sensitivity and specificity for HF detection, and they have the ability to antedate HF exacerbation and thereby allow for the initiation of intervention to avert decompensation. Clinical studies suggest that alone or in combination, such sensors have a greater beneficial impact than conventional therapy on acute HF outcome.

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Usefulness of monitoring congestive heart failure by multiple impedance vectors

Cited by 7 publications

References 3 publications

Multiple Vector Impedance Measurements During Biventricular Pacing: Feasibility and Possible Implications for Hemodynamic Monitoring

Multiple Vector Impedance Measurements During Biventricular Pacing: Feasibility and Possible Implications for Hemodynamic Monitoring

Relationship between intracardiac impedance and left ventricular contractility in patients undergoing cardiac resynchronization therapy

Optimizing heart failure therapy with implantable sensors

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