Cardiac resynchronization therapy optimization by finger plethysmography

Butter, Christian; Stellbrink, Christoph; Belalcazar, Andres; Villalta, Don; Schlegl, Michael; Sinha, Anil M.; Cuesta, Francisca; Reister, Craig

doi:10.1016/j.hrthm.2004.07.002

Cited by 58 publications

(28 citation statements)

References 25 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Based on these results, we expect the direct proportionality to generally hold for Ϫ10 ⌬P Յ 10 mmHg in this preparation. The demonstration of direct proportionality between transient changes in average peripheral blood volume and mean arterial pressure extends previous work in which changes in peripheral volume pulse amplitude were correlated with aortic pulse pressure (9,27) and stroke volume (15).…”

Section: Discussionsupporting

confidence: 83%

“…It is an attractive sensing technology for use in implanted devices because it functions from a location outside the bloodstream, can be implemented in embodiments that consume little power and volume, requires no moving parts, and has the potential to support a variety of diagnostic and therapeutic applications. PPG has been applied to a number of clinical problems, including noninvasive monitoring of arterial oxygenation as the enabling technology of the pulse oximeter (30,37,40), beat-to-beat blood pressure measurement (5,28,41,42), atrioventricular (AV) pacing delay optimization (9,14,15,27), and blood flow monitoring after free tissue transfer (26). The mechanism of PPG and its clinical applications have recently been extensively reviewed (3,22,39).…”

mentioning

confidence: 99%

See 1 more Smart Citation

Hemodynamic sensing using subcutaneous photoplethysmography

Turcott

Pavek²

2008

American Journal of Physiology-Heart and Circulatory Physiology

View full text Add to dashboard Cite

Turcott RG, Pavek TJ. Hemodynamic sensing using subcutaneous photoplethysmography. Am J Physiol Heart Circ Physiol 295: H2560 -H2572, 2008. First published October 10, 2008 doi:10.1152/ajpheart.00574.2008.-Pacemakers and implantable defibrillators presently operate without access to hemodynamic information. If available, such data would allow tailoring of delivered therapy according to perfusion status, optimization of device function, and enhancement of disease monitoring and management. A candidate method for hemodynamic sensing in these devices is photoplethysmography (PPG), which uses light to noninvasively detect changes in blood volume. The present study tested the hypotheses that PPG can function in a subcutaneous location, that the acute changes in blood volume it detects are directly proportional to changes in arterial pressure, and that optimum pacing intervals identified by it are concordant with those determined by arterial pressure. Aortic pressure and PPG were simultaneously recorded in 10 dogs under general anesthesia during changes in atrioventricular (AV) delay and bursts of rapid pacing to simulate tachyarrhythmias. Direct proportionality between transient changes in pressure and PPG waveforms was tested using regression analysis. Scatter plots had a linear appearance, with correlation coefficients of 0.95 (SD 0.03) and 0.72 (SD 0.24) for rapid-pacing and AV delay protocols, respectively. The data were well described by a directly proportional relationship. Optimum AV delays estimated from the induced changes in aortic pressure and PPG waveforms were concordant. This preliminary canine study demonstrates that PPG can function subcutaneously and that it may serve as a surrogate for acute changes in arterial pressure.defibrillator; pacemaker; sensor; atrioventricular delay; arrhythmia THE USE OF CHRONICALLY IMPLANTED, microprocessor-based cardiovascular devices has accelerated in recent years due to expanding indications of conventional therapies, such as those provided by automatic defibrillators (18), as well as the development of new therapeutic and diagnostic technologies that have broadened the range of clinical application. Examples of the latter include biventricular pacing (8,20,36), hemodynamic monitoring (2, 38), and electrocardiographic monitoring using implantable loop recorders (7). The increasing role of implantable devices and a desire for improved device performance are driving a need for increasingly sophisticated physiological sensing. The ideal sensor would enable a number of distinct applications including disease monitoring and optimization of device function and delivered therapy. It would have minimal impact on the longevity and volume of the device and would be integrated into the device itself, rather than requiring intravascular placement, which increases the cost and risk of complications.Photoplethysmography (PPG) uses light to noninvasively detect changes in microvascular blood volume (12). It is an attractive sensing technology for use in implanted devices because i...

show abstract

Section: Discussionsupporting

confidence: 83%

mentioning

confidence: 99%

Hemodynamic sensing using subcutaneous photoplethysmography

Turcott

Pavek²

2008

American Journal of Physiology-Heart and Circulatory Physiology

View full text Add to dashboard Cite

show abstract

“…Currently several methods are being used for optimization of AV-delay at various institutions including optimization according to the Ritter formula [28,29], use of bioimpedance [30], radionuclide ventriculography [31] or finger plethysmography [32], use of automated suggestion based on historical databases which take into account intrinsic AV-delay, QRS width and electrode positioning (ExpertEase, Guidant). Due to a lack of chronic data on the benefit of AV-delay optimization some centers simply program the device with a short AV-interval between 100 and 130 ms, although a recent study demonstrated a benefit of echocardiographically guided optimization of AV-delay [33].…”

Section: Comparison With Alternative Methods For Optimization Of Av-dmentioning

confidence: 99%

Immediate and chronic effects of AV-delay optimization in patients with cardiac resynchronization therapy

Hardt

Yazdi

Bauer

et al. 2007

International Journal of Cardiology

View full text Add to dashboard Cite

“…They optimized sequential biventricular pacing which, increased LV systolic performance (EF and LV outfl ow-tract-velocity-time-integral) compared to simultaneous stimulation estimated by noninvasive Doppler echocardiography. Other noninvasive studies have confi rmed that a better effect on hemodynamic response in CRT is obtained with both AV and VV delays as verifi ed by 3-dimensional echocardiography [22], radionuclide ventriculography [23], fi nger plethysmography [24] and recently, ICG [10,11,25]. Comparing optimization techniques, echocardiographic methods yield statistically insignifi cant data in the majority of patients (62-82%) whereas ICG yields statistically signifi cant results in 84% and 75% of patients for AV and VV interval optimization respectively [26].…”

Section: Vv Delaymentioning

confidence: 94%