Worsening Thoracic Impedance as a Ventricular Tachyarrhythmia Risk

Abi-Saleh, Bernard; Malozzi, Christopher; Charaf, Edriss; Omar, Bassam; Massey, Clara V.; Khoury, Maurice; Verma, Sumit

doi:10.3909/ricm0665

Cited by 6 publications

(4 citation statements)

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“…The method we used to detect and quantify TI decreases was essentially based on the percentage of rolling weeks with a continuous TI decrease with no prespecified thresholds for the magnitude of decrease. Previous studies used a proprietary algorithm (the OptiVol index) that compares the current TI value with a reference 4,5,9–11 . The index is expected to increase with a progressive reduction of TI values versus the reference and resets to zero if the values are consistent day to day.…”

Section: Discussionmentioning

confidence: 99%

“…Previous studies used a proprietary algorithm (the OptiVol index) that compares the current TI value with a reference. 4,5,[9][10][11] The index is expected to increase with a progressive reduction of TI values versus the reference and resets to zero if the values are consistent day to day. It has been questioned if gradual fluid accumulations reflecting congestive HF decompensation or subacute exacerbations may go undetected.…”

Section: Timing Of Ti Decrease To Vt/vf Episodesmentioning

confidence: 99%

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Temporal association between drops in thoracic impedance and malignant ventricular arrhythmia: A longitudinal analysis of remote monitoring trends

Rodio

Iacopino²,

Pisanó

et al. 2023

Cardiovasc electrophysiol

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Introduction Thoracic impedance (TI) drops measured by implantable cardioverter‐defibrillators (ICDs) have been reported to correlate with ventricular tachycardia/fibrillation (VT/VF). The aim of our study was to assess the temporal association of decreasing TI trends with VT/VF episodes through a longitudinal analysis of daily remote monitoring data from ICDs and cardiac resynchronization therapy defibrillators (CRT‐Ds). Methods and Results Retrospective data from 2384 patients were randomized 1:1 into a derivation or validation cohort. The TI decrease rate was defined as the percentage of rolling weeks with a continuously decreasing TI trend. The derivation cohort was used to determine a TI decrease rate threshold for a ≥99% specificity of arrhythmia prediction. The associated risk of VT/VF episodes was estimated in the validation cohort by dividing the available follow‐up into 60‐day assessment intervals. Analyses were performed separately for 1354 ICD and 1030 CRT‐D patients. During a median follow‐up of 2.0 years, 727 patients (30.4%) experienced 3298 confirmed VT/VF episodes. In the ICD group, a TI decrease rate of >60% was associated with a higher risk of VT/VF episode in a 60‐day assessment interval (stratified hazard ratio, 1.42; 95% confidence interval (CI), 1.05–1.92; p = .023). The TI decrease preceded (40.8%) or followed (59.2%) the VT/VF episodes. In the CRT‐D group, no association between TI decrease and VT/VF episodes was observed (p = .84). Conclusion In our longitudinal analysis, TI decrease was associated with VT/VF episodes only in ICD patients. Preventive interventions may be difficult since episodes can occur before or after TI decrease.

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Section: Discussionmentioning

confidence: 99%

Section: Timing Of Ti Decrease To Vt/vf Episodesmentioning

confidence: 99%

Temporal association between drops in thoracic impedance and malignant ventricular arrhythmia: A longitudinal analysis of remote monitoring trends

Rodio

Iacopino²,

Pisanó

et al. 2023

Cardiovasc electrophysiol

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“…It is well known that arrhythmias are more common as HF progresses. Acute HF exacerbations are presumed to trigger arrhythmias through multiple mechanisms, including increased cardiac filling pressures and neurohormonal activation 23–26 . Current patient risk assessment for malignant arrhythmias is subjective, and device sensor‐based algorithms for risk stratification using traditional sensors have had only modest accuracy 27–30 .…”

Section: Discussionmentioning

confidence: 99%

“…Acute HF exacerbations are presumed to trigger arrhythmias through multiple mechanisms, including increased cardiac filling pressures and neurohormonal activation. 23 , 24 , 25 , 26 Current patient risk assessment for malignant arrhythmias is subjective, and device sensor‐based algorithms for risk stratification using traditional sensors have had only modest accuracy. 27 , 28 , 29 , 30 The management of ventricular arrhythmias is largely reactive, with further evaluation and treatment occurring after the arrhythmia is detected and often following ICD therapy.…”

Section: Discussionmentioning

confidence: 99%

PRecision Event Monitoring for PatienTs with Heart Failure using HeartLogic (PREEMPT‐HF) study design and enrolment

Boehmer,

Sauer,

Gardner

et al. 2023

ESC Heart Failure

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AimsThe HeartLogic multisensor index has been found to be a sensitive predictor of worsening heart failure (HF). However, there is limited data on this index's association and its constituent sensors with HF readmissions.Methods and resultsThe PREEMPT‐HF study is a global, multicentre, prospective, observational, single‐arm, post‐market study. HF patients with an implantable defibrillator device or cardiac resynchronization therapy with defibrillator with HeartLogic capabilities were eligible if sensor data collection was turned on and the HeartLogic feature was not enabled. Thus, the HeartLogic Index/alert and heart sounds sensor trends were unavailable via the LATITUDE remote monitoring system to clinicians (blinded). Evaluation of subject medical records at 6 months and a final in‐clinic visit at 12 months was required for collection of all‐cause hospitalizations and HF outpatient visits. The purpose of this study is exploratory, no formal hypothesis tests are planned, and no adjustment for multiple testing will be performed. A total of 2183 patients were enrolled at 103 sites between June 2018 and June 2020. A significant proportion of the patients were implanted with implantable defibrillator devices (39%) versus cardiac resynchronization therapy with defibrillator (61%); were female (27%); over 65 (61%); New York Heart Association class I (13%), II (53%), and III (33%); ejection fraction < 25% (21%); ischaemic (50%); and with a history of renal dysfunction (23%).ConclusionsThe PREEMPT study will provide clinical data and blinded sensor trends for the characterization of sensor changes with HF readmission, tachyarrhythmias, and event subgroups. These data may help to refine the clinical use of HeartLogic and to improve patient outcomes.

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