Safety of bioelectrical impedance analysis in advanced heart failure patients

Abstract

Background: Cardiac cachexia and frailty are major complications of advanced heart failure (AHF). Bioelectrical impedance analysis (BIA) may provide valuable information regarding fluid balance, muscle mass and prognosis. The main concerns regarding the use of BIA in AHF patients remain arrhythmias and electromagnetic interferences with cardiac implantable electronic devices (CIEDs). Reliable data regarding patients on continuous-flow ventricular assist device (cf-VAD) remain scarce. The aim of this study is to evaluate the safety of BIA in AHF patients on pro-arrhythmogenic therapy with an implanted CIED and/or with a cf-VAD. Methods: We prospectively performed 217 BIA measurements in 143 AHF patients at risk of severe arrhythmias due to inotropic support/a history of ventricular arrhythmias and/or treated with CIED, including 104 patients with an ICD, CRT or pacemaker and 95 patients with a cf-VAD. All patients were under continuous Electrocardiogram (ECG) monitoring and clinical surveillance for 24 hours. Results: No adverse events were observed during the 217 BIA measurements: No rhythm disturbances were documented in the telemetric monitoring during or within 30 minutes after the measurement. CIEDs showed no malfunction, regardless of the location measured or the device manufacturer. In particular, no inappropriate shocks were observed. No alarms, flow disturbances, or malfunctions of the cf-VAD occurred during or after the measurements. Conclusion: We consider BIA a safe measurement with major clinical relevance in our cohort of AHF patients, despite an increased arrhythmic potential on inotropic support or the presence of implanted electronic devices (ICD, CRT, pacemaker and cf-VAD).

Comparison of feasibility and results of frailty assessment methods prior to left ventricular assist device implantation

“…Of all evaluated methods, we were able to perform BIA in 100% of patients: Independently from active participation and exercise tolerance, it can be performed at the bedside with minimal time expenditure and no known negative side effects. 49 CT showed a comparable availability, but required a greater logistical effort, especially in sedated patients. In contrast to BIA, its usefulness for subsequent measurements for monitoring progression of frailty is limited due to the side effects of the radiation.…”

Bioimpedance Spectroscopy in Heart Transplantation: Posttransplant Changes in Body Composition and Effects in Outcomes

“…Another shortcoming of this study is that BIS was not performed before heart transplantation if the patient had an implanted cardiac device (a contraindication for BIS when the study commenced in 2017). In 2020, Roehrich et al 25 determined that bioelectrical impedance analysis measurements were safe in patients with implanted electronic devices. This finding expands the practical use of BIS in patients before and after heart transplantation, irrespective of the presence of one of these devices.…”

A Current Review of the Uses of Bioelectrical Impedance Analysis and Bioelectrical Impedance Vector Analysis in Acute and Chronic Heart Failure Patients: An Under-valued Resource?

“…A potential for BIA to interfere with electrical current of pacemakers and defibrillators resulting in malfunction of the device, signal oversensing or stimulation inhibition, has been reported (Fabregat-Andrés et al, 2015; Kyle et al, 2004b). However, more recent studies tested the safety of BIA in heart failure patients and reported no interference with battery and functions of cardiac implantable electronic devices (CIED) and cardiac resynchronization therapy (Buch et al, 2012; Chabin et al, 2019; Fabregat-Andrés et al, 2015; Garlini et al, 2020; Meyer et al, 2017; Roehrich et al, 2020) (Supplement 4). Following this, some versions of BIA were shown to be safe to use, under manufacturer guidance.…”