Feasibility of using multivector impedance to monitor pulmonary congestion in heart failure patients

Philip F. Binkley, James G. Porterfield, Linda M. Porterfield, Scott L. Beau, Raffaele Corbisiero, G. Stephen Greer, Charles J. Love, Melanie Turkel, Anders Bjorling, Fujian Qu, Taraneh G. Farazi

Research output: Contribution to journalArticlepeer-review

Abstract

Purpose: Pulmonary edema (PE) is associated with fluid accumulation in the lungs. Device-based impedance measurements have been used to detect fluid overload prior to hospitalization. However, studies have reported a high false positive rate (FPR). The objective of this study was to develop and test a new multivector impedance-based algorithm that reliably tracks PE clinical events. Methods: We enrolled patients with implanted CRT-Ds in 23 US centers within 2 weeks of device implant. Six-vector impedance data was collected automatically by the CRT-Ds every 30 min during emergency department visits/hospitalizations and every 2 h at all other times. Detection algorithms for cardiac resynchronization therapy defibrillator (CRT-D) and implantable cardiac defibrillator (ICD) devices were developed using those impedance vectors that would be available in corresponding devices and retrospectively evaluated. Results: There were 75 patients (69 % male), mean age 66±12 years, with a LVEF of 23±6 % and QRS of 149±25 ms. Twenty-one major clinical events occurred over 8.2±2.6 months of follow-up time. CRT-D vector combinations resulted in a sensitivity of 71.4 % (95 % confidence interval 47.8-88.7) and a FPR of 0.56 (0.30-0.94) false positives per patient-year (FPs/pt-yr); ICD vector combinations resulted in a sensitivity of 61.9 % (38.4-81.9) and a FPR of 0.63 (0.36-0.90) FPs/pt-yr. In comparison, the single-vector RVCoil-Can implementation of this algorithm resulted in a sensitivity of 57.1 % (34.0-78.2) and a FPR of 0.74 (0.44- 1.12) FPs/pt-yr. Conclusions: This multivector impedance algorithm was effective in tracking PE clinical events in this patient population. Additional studies are needed to prospectively evaluate the performance of this algorithm in a larger population.

Original languageEnglish (US)
Pages (from-to)197-206
Number of pages10
JournalJournal of Interventional Cardiac Electrophysiology
Volume35
Issue number2
DOIs
StatePublished - Nov 1 2012
Externally publishedYes

Keywords

  • Congestion
  • Heart failure
  • Impedance
  • Implantable device
  • Pulmonary edema

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

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