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European Heart Journal Advance Access originally published online on February 19, 2007
European Heart Journal 2007 28(15):1835-1840; doi:10.1093/eurheartj/ehl506
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© The European Society of Cardiology 2007. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Clinical utility of intrathoracic impedance monitoring to alert patients with an implanted device of deteriorating chronic heart failure

Dirk Vollmann1,*, Herbert Nägele2, Patrick Schauerte3, Uwe Wiegand4, Christian Butter5, Gabriele Zanotto6, Aurelio Quesada7, Axel Guthmann8, Michael R.S. Hill9, Barbara Lamp for the European InSync Sentry Observational Study Investigators10

1 Herzzentrum, Abteilung Kardiologie und Pneumologie, Klinikum der Georg-August-Universität, Robert-Koch-Strasse 40, 37075 Göttingen, Germany
2 Medizinische Klinik, St Adolfstift, Krankenhaus Reinbek, Germany
3 Medizinische Klinik I, Universitätsklinikum, RWTH Aachen, Germany
4 Medizinische Klinik II, Universitätsklinikum Schleswig Holstein, Campus Lübeck, Germany
5 Herzzentrum Brandenburg, Bernau, Germany
6 Maggiore Borgo Trento, Verona, Italy
7 Hospital General Universitario, Valencia, Spain
8 Medtronic GmbH, Düsseldorf, Germany
9 Medtronic Bakken Research Center, Maastricht, The Netherlands
10 Herz- und Diabeteszentrum NRW, Bad Oeynhausen, Germany

Received 1 June 2006; revised 4 January 2007; accepted 12 January 2007; online publish-ahead-of-print 19 February 2007.

* Corresponding author. Tel: +49 0551 39 12970; fax: +49 0551 39 10267. E-mail address: dirkvollmann2000{at}aol.com

Aims: To evaluate the utility of intrathoracic impedance monitoring for detecting heart failure (HF) deterioration in patients with an implanted cardiac resynchronization/defibrillation device.

Methods and results: Patients enrolled in the European InSync Sentry Observational Study were audibly alerted by a device algorithm if a decrease in intrathoracic impedance suggested fluid accumulation. Clinical HF status and device data were assessed at enrolment, during regular follow-up, and if patients presented with an alert or HF deterioration. Data from 373 subjects were analysed. Fifty-three alert events and a total of 53 clinical events (HF deterioration defined by worsening of HF signs and symptoms) were reported during a median of 4.2 months. Adjusted for multiple events per patient, the alert detected clinical HF deterioration with 60% sensitivity (95% CI 46–73) and with a positive predictive value of 60% (95% CI 46–73). Higher NYHA class at baseline was predictive for adequate alert events during follow-up (P < 0.05). In 11 of 20 HF deteriorations without preceding alert, an upstroke of the fluid index occurred without reaching the programmed alert threshold.

Conclusion: A device-based algorithm that alerts patients in case of decreasing intrathoracic impedance facilitates the detection of HF deterioration. Future randomized, controlled trials are needed to test whether the tailored use of intrathoracic impedance monitoring can improve the ambulatory management of patients with chronic HF and an implanted device.

Key Words: Detection algorithm • Heart failure • Impedance • Implantable device


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