Non-invasive continuous blood pressure monitoring of tachycardic episodes during interventional electrophysiology

Abstract

AimsWe thought to evaluate feasibility of continuous non-invasive blood pressure monitoring during procedures of interventional electrophysiology.Methods and resultsWe evaluated continuous non-invasive finger blood pressure (BP) monitoring by means of the Nexfin device in 22 patients (mean age 70 ± 24 years), undergoing procedures of interventional electrophysiology, in critical situations of hypotension caused by tachyarrhythmias or by intermittent incremental ventricular temporary pacing till to the maximum tolerated systolic BP fall (mean 61 ± 14 mmHg per patient at a rate of 195 ± 37 bpm). In all patients, Nexfin was able to detect immediately, at the onset of tachyarrythmia, the changes in BP and recorded reliable waveforms. The quality of the signal was arbitrarily classified as excellent in 11 cases, good in 10 cases, and sufficient in 1 case. In basal conditions, calibrations of the signal occurred every 49.2 ± 24.3 s and accounted for 4% of total monitoring time; during tachyarrhythmias their frequency increased to one every 12.7 s and accounted for 19% of total recording duration. A linear correlation for a range of BP values from 41 to 190 mmHg was found between non-invasive and intra-arterial BP among a total of 1055 beats from three patients who underwent simultaneous recordings with both methods (coefficient of correlation of 0.81, P < 0.0001).ConclusionIn conclusion, continuous non-invasive BP monitoring is feasible in the clinical practise of an interventional electrophysiology laboratory without the need of utilization of an intra-arterial BP line.

Impact of non invasive and beat-to-beat arterial pressure monitoring on intraoperative hemodynamic management

“…There is a study, using systemic vasoactive drugs, suggesting that regional vascular tone may not be a significant contributing factor to the results obtained by this technology [42]. Secondly, although many studies have validated the Finapres technology used by Nexfin compared to standard auscultatory sphygmomanometry and intra-arterial catheterization in different populations [14,[16][17][18][19][20][21], our study showed a significant mean percent error with Bland-Altman analysis between the SBP NXF compared to SBP CUFF as well as a concordance of only 81.3%. With the new method described by Critchley et al, primarily for cardiac output monitor trending, the authors recommend a mean polar angle or angular bias of less than ±5°and radial limits of agreement less than ±30°in order for a device to display good trending ability [26].…”

“…In addition, the Nexfin device provides cardiac output values calculated based on a pulse contour analysis method described by Bogert et al [15]. The Nexfin has been well-validatedto non-invasivelyand continuously monitor arterial pressures [16][17][18][19][20][21][22].…”

The estimation of cardiac output by the Nexfin device is of poor reliability for tracking the effects of a fluid challenge

“…The Nexfin has been quite largely validated for measuring arterial pressure [4-10]. However, its reliability to measure cardiac index (CI) has been mainly investigated in non-critically ill patients [5,11-15].…”

Noninvasive continuous hemodynamic monitoring

“…During such procedures Nexfin recorded reliable BP waveforms notwithstanding the presence of tachyarrhythmia [114]. The authors stated that continuous noninvasive BP monitoring is feasible in the interventional electrophysiology laboratory and may replace intra-arterial BP in that setting.…”