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Ziacchi M, Calò L, D’Onofrio A, Manzo M, Dello Russo A, Santini L, Giubilato G, Carriere C, Santobuono VE, Savarese G, La Greca C, Arena G, Talarico A, Pisanò E, Giammaria M, Pangallo A, Campari M, Valsecchi S, Diemberger I. Implantable Cardioverter Defibrillator Multisensor Monitoring during Home Confinement Caused by the COVID-19 Pandemic. BIOLOGY 2022; 11:biology11010120. [PMID: 35053117 PMCID: PMC8772791 DOI: 10.3390/biology11010120] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 01/10/2022] [Accepted: 01/11/2022] [Indexed: 02/04/2023]
Abstract
Simple Summary During the COVID-19 pandemic, utilization of remote monitoring platforms was recommended. The HeartLogic algorithm identifies patients at risk of heart failure events, combining multiple sensors available on implantable cardioverter defibrillators. This analysis examined how multiple CIED sensors behave in periods of anticipated restrictions pertaining to physical activity. We demonstrated a significant drop in median activity level immediately after the implementation of stay-at-home orders, whereas there was no difference in the other contributing sensors. The weekly rate of heart failure alerts was significantly higher during the lockdown and post-lockdown than that reported in the pre-lockdown. Abstract Aims: The utilization of remote monitoring platforms was recommended amidst the COVID-19 pandemic. The HeartLogic index combines multiple implantable cardioverter defibrillator (ICD) sensors and has proved to be a predictor of impending heart failure (HF) decompensation. We examined how multiple ICD sensors behave in the periods of anticipated restrictions pertaining to physical activity. Methods: The HeartLogic feature was active in 349 ICD and cardiac resynchronization therapy ICD patients at 20 Italian centers. The period from 1 January to 19 July 2020, was divided into three phases: pre-lockdown (weeks 1–11), lockdown (weeks 12–20), post-lockdown (weeks 21–29). Results: Immediately after the implementation of stay-at-home orders (week 12), we observed a significant drop in median activity level whereas there was no difference in the other contributing parameters. The median composite HeartLogic index increased at the end of the Lockdown. The weekly rate of alerts was significantly higher during the lockdown (1.56 alerts/week/100 pts, 95%CI: 1.15–2.06; IRR = 1.71, p = 0.014) and post-lockdown (1.37 alerts/week/100 pts, 95%CI: 0.99–1.84; IRR = 1.50, p = 0.072) than that reported in pre-lockdown (0.91 alerts/week/100 pts, 95%CI: 0.64–1.27). However, the median duration of alert state and the maximum index value did not change among phases, as well as the proportion of alerts followed by clinical actions at the centers and the proportion of alerts fully managed remotely. Conclusions: During the lockdown, the system detected a significant drop in the median activity level and generated a higher rate of alerts suggestive of worsening of the HF status.
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Affiliation(s)
- Matteo Ziacchi
- Institute of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Policlinico S.Orsola-Malpighi, 40138 Bologna, Italy;
- Correspondence: ; Tel.: +39-3476785656
| | | | - Antonio D’Onofrio
- “Unità Operativa di Elettrofisiologia, Studio e Terapia delle Aritmie”, Monaldi Hospital, 80131 Naples, Italy;
| | - Michele Manzo
- OO.RR. San Giovanni di Dio Ruggi d’Aragona, 84125 Salerno, Italy;
| | - Antonio Dello Russo
- Clinica di Cardiologia e Aritmologia, Università Politecnica delle Marche, “Ospedali Riuniti”, 60126 Ancona, Italy;
| | - Luca Santini
- “Giovan Battista Grassi” Hospital, 00122 Rome, Italy;
| | | | - Cosimo Carriere
- Azienda Ospedaliera Universitaria Ospedali Riuniti di Trieste—Cattinara, 34149 Trieste, Italy;
| | | | | | | | | | | | | | - Massimo Giammaria
- Division of Cardiology, Maria Vittoria Hospital, 10144 Turin, Italy;
| | - Antonio Pangallo
- Grande Ospedale Metropolitano “Bianchi-Melacrino”, 89124 Reggio Calabria, Italy;
| | - Monica Campari
- Boston Scientific Italia, 20134 Milan, Italy; (M.C.); (S.V.)
| | | | - Igor Diemberger
- Institute of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Policlinico S.Orsola-Malpighi, 40138 Bologna, Italy;
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Estimation of Central Venous Pressure by Pacemaker Lead Impedances in Left Ventricular Assist Device Patients. ASAIO J 2019; 66:49-54. [PMID: 30913103 DOI: 10.1097/mat.0000000000000966] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Volume status assessment in left ventricular assist device (LVAD) patients remains challenging. Cardiac resynchronization therapy (CRT) devices are common in LVAD patients, and the impedance across the CRT leads may be associated with hemodynamics and serve as a tool for noninvasive estimation of volume status. Ninety-one sets of measurements including cardiac filling pressures and lead impedances were prospectively obtained during ramp tests from 11 LVAD patients (65.5 ± 9.7 years old; nine male) with CRT devices. Right atrial (RA), right ventricular (RV), and left ventricular (LV) lead impedances were all significantly associated with central venous pressure (CVP) (p < 0.05). We derived the following equation: estimated CVP = 47.90-(0.086 × RA lead impedance) + (0.013 × RV lead impedance)-(0.020 × LV lead impedance). The estimated CVP had a significant correlation (r = 0.795) and good agreement with the measured CVP (mean difference -0.14 ± 1.77 mmHg). Applying the above equation on the validation cohort of twenty-one patients also maintained a strong association with measured CVP (r = 0.705). In conclusion, we have derived a novel equation to estimate CVP using lead impedance measurements. This finding may allow noninvasive monitoring of volume status in LVAD patients.
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Santini L, Mahfouz K, Schirripa V, Danisi N, Leone M, Mangone G, Campari M, Valsecchi S, Ammirati F. Preliminary experience with a novel Multisensor algorithm for heart failure monitoring: The HeartLogic index. Clin Case Rep 2018; 6:1317-1320. [PMID: 29988678 PMCID: PMC6028422 DOI: 10.1002/ccr3.1573] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 04/12/2018] [Indexed: 11/10/2022] Open
Abstract
We report the first case of a patient in whom an implantable cardioverter-defibrillator (ICD) endowed with HeartLogic, a novel algorithm for heart failure (HF) monitoring, was implanted in clinical practice. The good temporal association between HeartLogic index threshold crossings and HF hospitalizations confirms the high sensitivity in detecting gradual worsening of HF.
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Affiliation(s)
- Luca Santini
- Cardiology Division“Giovan Battista Grassi” HospitalOstia lidoRomeItaly
| | - Karim Mahfouz
- Cardiology Division“Giovan Battista Grassi” HospitalOstia lidoRomeItaly
| | | | - Nicola Danisi
- Cardiology Division“Giovan Battista Grassi” HospitalOstia lidoRomeItaly
| | | | | | | | | | - Fabrizio Ammirati
- Cardiology Division“Giovan Battista Grassi” HospitalOstia lidoRomeItaly
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Suzuki H, Nodera M, Kamioka M, Kaneshiro T, Kamiyama Y, Takeishi Y. Intracardiac impedance after cardiac resynchronization therapy is a novel predictor for worsening of heart failure. Heart Vessels 2017; 32:926-931. [DOI: 10.1007/s00380-017-0953-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Accepted: 01/20/2017] [Indexed: 01/07/2023]
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Herz ND, Engeda J, Zusterzeel R, Sanders WE, O'Callaghan KM, Strauss DG, Jacobs SB, Selzman KA, Piña IL, Caños DA. Sex differences in device therapy for heart failure: utilization, outcomes, and adverse events. J Womens Health (Larchmt) 2015; 24:261-71. [PMID: 25793483 DOI: 10.1089/jwh.2014.4980] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Multiple studies of heart failure patients demonstrated significant improvement in exercise capacity, quality of life, cardiac left ventricular function, and survival from cardiac resynchronization therapy (CRT), but the underenrollment of women in these studies is notable. Etiological and pathophysiological differences may result in different outcomes in response to this treatment by sex. The observed disproportionate representation of women suggests that many women with heart failure either do not meet current clinical criteria to receive CRT in trials or are not properly recruited and maintained in these studies. METHODS We performed a systematic literature review through May 2014 of clinical trials and registries of CRT use that stratified outcomes by sex or reported percent women included. One-hundred eighty-three studies contained sex-specific information. RESULTS Ninety percent of the studies evaluated included ≤ 35% women. Fifty-six articles included effectiveness data that reported response with regard to specific outcome parameters. When compared with men, women exhibited more dramatic improvement in specific parameters. In the studies reporting hazard ratios for hospitalization or death, women generally had greater benefit from CRT. CONCLUSIONS Our review confirms women are markedly underrepresented in CRT trials, and when a CRT device is implanted, women have a therapeutic response that is equivalent to or better than in men, while there is no difference in adverse events reported by sex.
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Affiliation(s)
- Naomi D Herz
- Center for Devices and Radiological Health, United States Food and Drug Administration , Silver Spring, Maryland
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Charles CJ, Rademaker MT, Melton IC, Gutfinger D, Eigler NL, Qu F, Troughton RW. Thoracic impedance measures tissue characteristics in the vicinity of the electrodes, not intervening lung water: implications for heart failure monitoring. J Clin Monit Comput 2014; 29:65-76. [PMID: 24619657 PMCID: PMC4309910 DOI: 10.1007/s10877-014-9570-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2013] [Accepted: 03/05/2014] [Indexed: 11/25/2022]
Abstract
The rationale for intrathoracic impedance (Z) detection of worsening heart failure (HF) presupposes that changes in Z reflect changes in pulmonary congestion, but is confounded by poor specificity in clinical trials. We therefore tested the hypothesis that Z is primarily affected by tissue/water content in proximity to electrodes rather than by lung water distribution between electrodes through the use of a new computational model for deriving the near-field impedance contributions from the various electrodes. Six sheep were implanted with a left atrial pressure (LAP) monitor and a cardiac resynchronization therapy device which measured Z from six vectors comprising of five electrodes. The vector-based Z was modelled as the summation of the near-field impedances of the two electrodes forming the vector. During volume expansion an acute increase in LAP resulted in simultaneous reductions in the near-field impedances of the intra-cardiac electrodes, while the subcutaneous electrode showed several hours of lag (all p < 0.001). In contrast, during the simulated formation of device-pocket edema (induced by fluid injection) the near-field impedance of the subcutaneous electrode had an instantaneous response, while the intra-cardiac electrodes had a minimal inconsistent response. This study suggests that the primary contribution to the vector based Z is from the tissue/water in proximity to the individual electrodes. This novel finding may help explain the limited utility of Z for detecting worsening HF.
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Affiliation(s)
- Christopher J Charles
- Christchurch Heart Institute, University of Otago, P.O. Box 4345, Christchurch, New Zealand,
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De Meester P, Budts W, Gewillig M. Transvenous valve-in-valve replacement preserving the function of a transvalvular defibrillator lead. Catheter Cardiovasc Interv 2014; 84:1148-52. [DOI: 10.1002/ccd.25451] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Revised: 12/03/2013] [Accepted: 02/16/2014] [Indexed: 11/06/2022]
Affiliation(s)
- Pieter De Meester
- Department of Congenital Cardiology; University Hospitals Leuven; Leuven Belgium
| | - Werner Budts
- Department of Congenital Cardiology; University Hospitals Leuven; Leuven Belgium
| | - Marc Gewillig
- Department of Pediatric Cardiology; University Hospitals Leuven; Leuven Belgium
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Daubert JC, Saxon L, Adamson PB, Auricchio A, Berger RD, Beshai JF, Breithard O, Brignole M, Cleland J, DeLurgio DB, Dickstein K, Exner DV, Gold M, Grimm RA, Hayes DL, Israel C, Leclercq C, Linde C, Lindenfeld J, Merkely B, Mont L, Murgatroyd F, Prinzen F, Saba SF, Shinbane JS, Singh J, Tang AS, Vardas PE, Wilkoff BL, Zamorano JL, Anand I, Blomström-Lundqvist C, Boehmer JP, Calkins H, Cazeau S, Delgado V, Estes NAM, Haines D, Kusumoto F, Leyva P, Ruschitzka F, Stevenson LW, Torp-Pedersen CT. 2012 EHRA/HRS expert consensus statement on cardiac resynchronization therapy in heart failure: implant and follow-up recommendations and management. Europace 2013; 14:1236-86. [PMID: 22930717 DOI: 10.1093/europace/eus222] [Citation(s) in RCA: 201] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
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Daubert JC, Saxon L, Adamson PB, Auricchio A, Berger RD, Beshai JF, Breithard O, Brignole M, Cleland J, Delurgio DB, Dickstein K, Exner DV, Gold M, Grimm RA, Hayes DL, Israel C, Leclercq C, Linde C, Lindenfeld J, Merkely B, Mont L, Murgatroyd F, Prinzen F, Saba SF, Shinbane JS, Singh J, Tang AS, Vardas PE, Wilkoff BL, Zamorano JL. 2012 EHRA/HRS expert consensus statement on cardiac resynchronization therapy in heart failure: implant and follow-up recommendations and management. Heart Rhythm 2012; 9:1524-76. [PMID: 22939223 DOI: 10.1016/j.hrthm.2012.07.025] [Citation(s) in RCA: 186] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2012] [Indexed: 11/30/2022]
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Sack S, Wende CM, Nägele H, Katz A, Bauer WR, Barr CS, Malinowski K, Schwacke H, Leyva F, Proff J, Berdyshev S, Paul V. 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. Eur J Heart Fail 2012; 13:1019-27. [PMID: 21852311 PMCID: PMC3157971 DOI: 10.1093/eurjhf/hfr089] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Aim To 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 results Three 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. Conclusion We 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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Affiliation(s)
- Stefan Sack
- Cardiology Department, Universitätsklinikum Essen, Essen, Germany.
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Affiliation(s)
- Faisal M. Merchant
- From the Cardiology Division (F.M.M.), Emory University School of Medicine, Atlanta, Ga; and the Cardiology Division (G.W.D., J.P.S.), Massachusetts General Hospital Heart Center, Harvard Medical School, Boston, Mass
| | - G. William Dec
- From the Cardiology Division (F.M.M.), Emory University School of Medicine, Atlanta, Ga; and the Cardiology Division (G.W.D., J.P.S.), Massachusetts General Hospital Heart Center, Harvard Medical School, Boston, Mass
| | - Jagmeet P. Singh
- From the Cardiology Division (F.M.M.), Emory University School of Medicine, Atlanta, Ga; and the Cardiology Division (G.W.D., J.P.S.), Massachusetts General Hospital Heart Center, Harvard Medical School, Boston, Mass
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