Admittance to detect alterations in left ventricular stroke volume

Erik R. Larson, John E. Porterfield, Sandeep Sagar, Juan Marmol-Velez, Manoj Panday, Daniel Escobedo, Joel Michalek, Yongjian Ouyang, Jonathan W. Valvano, John A. Pearce, Marc D. Feldman

Research output: Contribution to journalArticle

3 Scopus citations

Abstract

Background Implantable cardioverter-defibrillators monitor intracardiac electrograms (EGMs) to discriminate between ventricular and supraventricular tachycardias. The incidence of inappropriate shocks remains high because of misclassification of the tachycardia in an otherwise hemodynamically stable individual. Coupling EGMs with an assessment of left ventricular (LV) stroke volume (SV) could help in gauging hemodynamics during an arrhythmia and reducing inappropriate shocks. Objective The purpose of this study was to use the admittance method to accurately derive LV SV. Methods Ultrasonic flow probe and LV endocardial crystals were used in canines (n = 12) as the standard for LV SV. Biventricular pacing leads were inserted to obtain admittance measurements. A tetrapolar, complex impedance measurement was made between the Bi-V leads. The real and imaginary components of impedance were used to discard the myocardial component from the blood component to derive instantaneous blood conductance (Gb). Alterations in SV were measured during right ventricular pacing, dopamine infusion, and inferior vena cava occlusion. Results Gb tracks steady-state changes in SV more accurately than traditional magnitude (ie, |Y|, without removal of the muscle signal) during right ventricular pacing and dopamine infusion (P =.004). Instantaneous LV volume also was tracked more accurately by Gb than ∣Y∣ in the subset of subjects that underwent inferior vena cava occlusions (n = 5, P =.025). Finite element modeling demonstrates that admittance shifts more sensitivity of the measurement to the LV blood chamber as the mechanism for improvement (see Online Appendix). Conclusion Monitoring LV SV is possible using the admittance method with biventricular pacing leads. The technique could be piggybacked to complement EGMs to determine if arrhythmias are hemodynamically unstable.

Original languageEnglish (US)
Pages (from-to)2075-2083
Number of pages9
JournalHeart Rhythm
Volume11
Issue number11
DOIs
StatePublished - Nov 2014

Keywords

  • Biventricular pacing/defibrillation
  • Inappropriate shocks
  • Shock reduction
  • Ventricular fibrillation
  • Ventricular tachycardia

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

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    Larson, E. R., Porterfield, J. E., Sagar, S., Marmol-Velez, J., Panday, M., Escobedo, D., Michalek, J., Ouyang, Y., Valvano, J. W., Pearce, J. A., & Feldman, M. D. (2014). Admittance to detect alterations in left ventricular stroke volume. Heart Rhythm, 11(11), 2075-2083. https://doi.org/10.1016/j.hrthm.2014.06.034