HeartLogic multisensor algorithm response prior to ventricular arrhythmia events

• DOI: 10.1002/joa3.12913
• Publication Date: 2023-09-05T09:06:15Z
• Authors: Shohei Kataoka; Yuta Morioka; Miwa Kanai; Kyoichiro Yazaki; Shun Hasegawa; Satoshi Higuchi; Daigo Yagishita; Morio Shoda; Junichi Yamaguchi
• Keywords: RC666-701; cardiac resynchronization therapy defibrillator; heart failure; Diseases of the circulatory (Cardiovascular) system; Spotlights; ventricular arrhythmia

The HeartLogic multisensor algorithm™ (Boston Scientific) calculates the score based on heart sounds, nighttime rate, thoracic impedance, respiratory and patient activity level. MultiSENSE study showed that algorithm had a high negative predictive value good sensitivity for failure (HF) events.1 However, there were unexplained alerts. alert state was shown to be associated with atrial fibrillation occurrence.2 We hypothesized scores would elevated in ventricular arrhythmia (VA) events. Therefore, present retrospective, single-center, observational investigated whether responds VA Thirty-five patients who underwent cardiac resynchronization therapy defibrillator (CRT-D) implantation at Tokyo Women's Medical University between 2017 2021 included this study, which approved by Ethics Committee of (No. 4159-R2). examined both HF events, prediction accuracy determined using cut-off 16, as previously described.1 Since it is not possible define without any receiver operating characteristic curve calculate optimal event unfeasible. we compared events defined appropriate CRT-D therapy, including antitachycardia pacing defibrillation tachycardia (VT) or fibrillation. day therapy. hospitalization, unscheduled outpatient visits intravenous treatments augmented oral medications,1 death from HF, left assist device (LVAD) implantation. event. All confirmed medical records. Categorical variables are presented numbers proportions Fisher's exact test. Continuous mean standard deviation median interquartile range Mann–Whitney U Wilcoxon signed-rank time onset increase also same way. an point zero before occurrence. Statistical significance set p-values <.05. JMP Pro 16® software (SAS Institute Inc.) used analysis. 35 age 62.7 ± 15.2 years, 26 (74.3%) male. most common underlying diseases dilated cardiomyopathy (18 patients, 51.4%), followed hypertrophic (6 17.1%) ischemic 17.1%). ejection fraction 31.1 8.2%. Indications defibrillators detection zones Table 1. During follow-up 1081 (interquartile [IQR]: 745–1454) days, 104 80 24 observed 19 (54%). 13 HF-related hospitalizations, 9 visits, 1 death, LVAD From total number (n = 104), calculated true positive predicting 76.9% 23.1%, respectively. 8 (IQR: 5–11) 7–19), respectively; latter significantly higher than (p .002) (Figure 1). Most related mild such hospitalizations visits. separately analyzed more severe 43 38, 23 (13–37) days 31 (20–78) shorter hospitalization 2). In representative case 70-year-old man after implantation, increased approximately 30 while being hospitalized HF; however, discharge following treatment diuretics, decreased 0. Approximately 2 months discharge, slightly increased. Seven later, anti-tachycardia VT. 4. month again. Shock administered 3). key findings were: 8, days. demonstrates prior hypothesized. designed predict worsening HF. mechanism may Increased intracardiac pressure causes stretching myocytes, prolonging duration action potential shortening effective refractory period.3 Additionally, neurohumoral factors This sympathetic activation increases norepinephrine endothelin-1 release heart, involved development VAs.4 Altered calcium handling during occurrence triggered premature contractions due early after-depolarizations delayed after-depolarizations.5 Due these mechanisms, exacerbation induces VAs contributes substrate VAs. revealed originally proposed suboptimal large-scale future studies, must determined. 13, lower study.1 different thresholds hospital Japan United States attributable variation. Japan, access hospitals easier US, allowing relatively symptoms affect threshold Japan. addition, 35% treatment, have influenced study. two major limitations. First, retrospective small sample size, potentially causing selection bias. Second, led underestimation given exacerbation. conclusion, responded possibly because exacerbations closely Thus, Score help some treated CRT-D, especially determining value. None. authors no competing interests disclose. Written informed consent obtained all patients. Not applicable. deidentified participant data will shared.