Optimizing heart failure therapy with implantable sensors

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Optimizing heart failure therapy with implantable sensors Chu-Pak Lau, David C.W. Siu, Hung-Fat Tse Journal of Arrhythmia Volume 28, Issue 1, Pages 4-18 (February 2012) DOI: 10.1016/j.joa.2012.02.003 Copyright © 2012 Japanese Heart Rhythm Society Terms and Conditions

Fig. 1 Performance for SDAAM, night heart rate, and patient activity to detect ADHF. Plots show sensitivity to detect impending cardiovascular hospitalization versus number of false-positive detections per patient-year of monitoring, as a function of detection threshold. SDAAM=standard deviation of median sensed atrial to atrial intervals. Reproduced with permission [28]. Journal of Arrhythmia 2012 28, 4-18DOI: (10.1016/j.joa.2012.02.003) Copyright © 2012 Japanese Heart Rhythm Society Terms and Conditions

Fig. 2 Time to first heart failure (HF) hospitalization in a post-hoc analysis of class III/IV HF in COMPASS-HF Study. There was a 33% improvement in the time to the first HF events. Hazard ratios (HRs) are from a Cox proportional hazards regression model. CHRONICLE=medtronic implanted hemodynamic monitor. Reproduced with permission [39]. Journal of Arrhythmia 2012 28, 4-18DOI: (10.1016/j.joa.2012.02.003) Copyright © 2012 Japanese Heart Rhythm Society Terms and Conditions

Fig. 3 The HeartPOD left atrial pressure sensor. (A) Patient advisory module. (B) Left atrial pressure sensing device. (C) Close-up image of the sensor tip. Reproduced with permission [41]. Journal of Arrhythmia 2012 28, 4-18DOI: (10.1016/j.joa.2012.02.003) Copyright © 2012 Japanese Heart Rhythm Society Terms and Conditions

Fig. 4 Wireless implantable pulmonary artery (PA) pressure sensor. (A) CardioMENS sensor for implanting in a distal branch of the PA. (B) Cumulative heart-failure-related hospitalizations during entire period of randomized single-blind follow-up. Reproduced with permission [46]. Journal of Arrhythmia 2012 28, 4-18DOI: (10.1016/j.joa.2012.02.003) Copyright © 2012 Japanese Heart Rhythm Society Terms and Conditions

Fig. 5 Intrathoracic impedance measurement by an implantable system. Reproduced with permission [5]. Journal of Arrhythmia 2012 28, 4-18DOI: (10.1016/j.joa.2012.02.003) Copyright © 2012 Japanese Heart Rhythm Society Terms and Conditions

Fig. 6 (A) Operation of algorithm for detecting decreases in impedance over time. Differences between measured impedance (bottom) and reference impedance (solid line) are accumulated over time to produce fluid index (top). Threshold is then applied to fluid index to detect sustained decreases in impedance. (B) Example of impedance reduction before heart failure hospitalization (arrow) for fluid overload and impedance increase during intensive diuresis during hospitalization. Label indicates reference baseline (initial reference impedance value when daily impedance value consistently falls below reference impedance line before admission). Magnitude and duration of impedance reduction are also shown. Days in hospital are shaded. Reproduced with permission [5]. Journal of Arrhythmia 2012 28, 4-18DOI: (10.1016/j.joa.2012.02.003) Copyright © 2012 Japanese Heart Rhythm Society Terms and Conditions

Fig. 7 Biventricular impedance derived raw data recording (ECG, surface electrocardiogram; AortaP, aortic blood pressure; Z, intracardiac impedance. Vertical lines 100ms in front of the QRS complex). The respiratory influence is clearly visible in the pressure and impedance traces. Reproduced with permission [66]. Journal of Arrhythmia 2012 28, 4-18DOI: (10.1016/j.joa.2012.02.003) Copyright © 2012 Japanese Heart Rhythm Society Terms and Conditions

Fig. 8 Combined HF device diagnostics triggered. The Venn diagram shows that 72% of evaluations had ≥2 HF device diagnostics triggered, with the remaining 28% triggered by OptiVol Fluid Index ≥100. OptiVol Fluid Index, low activity, and low heart rate variability (HRV) were the most common reasons for triggers. HF=heart failure; AF=atrial fibrillation; ICD=implantable cardioverter-defibrillator; RVR=rapid ventricular response. Reproduced with permission [72]. Journal of Arrhythmia 2012 28, 4-18DOI: (10.1016/j.joa.2012.02.003) Copyright © 2012 Japanese Heart Rhythm Society Terms and Conditions