Direct Left Atrial Pressure Monitoring in Severe Heart Failure: Long-Term Sensor Performance

• DOI: 10.1007/s12265-010-9229-z
• Publication Date: 2010-10-14T03:03:51Z
• Authors: Richard W. Troughton; Jay Ritzema; Neal L. Eigler; Iain C. Melton; Henry Krum; Philip B. Adamson; Saibal Kar; Prediman K. Shah; James S. Whiting; J. Thomas Heywood; Spencer Rosero; Jagmeet P. Singh; Leslie Saxon; Ray Matthews; Ian G. Crozier; William T. Abraham
• Keywords: Pharmaceutical Science; Monitoring, Ambulatory; Kaplan-Meier Estimate; Severity of Illness Index; Article; 03 medical and health sciences; 0302 clinical medicine; Predictive Value of Tests; Genetics; Pressure; Humans; Genetics(clinical); Prospective Studies; Pulmonary Wedge Pressure; Registries; Heart Failure; Australia; Hemodynamics; Reproducibility of Results; Equipment Design; Electrodes, Implanted; 3. Good health; Calibration; Heart Function Tests; Molecular Medicine; Atrial Function, Left; Equipment Failure; Cardiology and Cardiovascular Medicine; New Zealand

We report the stability, accuracy, and development history of a new left atrial pressure (LAP) sensing system in ambulatory heart failure (HF) patients. A total of 84 patients with advanced HF underwent percutaneous transseptal implantation of the pressure sensor. Quarterly noninvasive calibration by modified Valsalva maneuver was achieved in all patients, and 96.5% of calibration sessions were successful with a reproducibility of 1.2 mmHg. Absolute sensor drift was maximal after 3 months at 4.7 mmHg (95% CI, 3.2-6.2 mmHg) and remained stable through 48 months. LAP was highly correlated with simultaneous pulmonary wedge pressure at 3 and 12 months (r = 0.98, average difference of 0.8 ± 4.0 mmHg). Freedom from device failure was 95% (n = 37) at 2 years and 88% (n = 12) at 4 years. Causes of failure were identified and mitigated with 100% freedom from device failure and less severe anomalies in the last 41 consecutive patients (p = 0.005). Accurate and reliable LAP measurement using a chronic implanted monitoring system is safe and feasible in patients with advanced heart failure.