Emerging Implantable-Device Technology for Patients at the Intersection of Electrophysiology and Heart Failure Interdisciplinary Care.

Cardiac implantable electronic devices, including implantable cardioverter-defibrillators and therapy, are part of guideline-indicated treatment for a subset of patients with heart failure with reduced ejection fraction. Current technological advancements in cardiac implantable electronic devices have allowed the detection of specific physiological parameters that are used to forecast clinical decompensation through algorithmic, multiparameter remote monitoring. Other recent emerging technologies, including cardiac contractility modulation and baroreflex activation therapy, may provide symptomatic or physiological benefits in patients without indications for cardiac resynchronization. Our goal in this state-of-the-art review is to describe the new commercially available technologies, their purported mechanisms of action, and the evidence surrounding their clinical roles, limitations and future directions. Finally, we underline the need for standardized workflow and close interdisciplinary management of this population to ensure the delivery of high-quality care.

Ambulatory factors influencing pulmonary artery pressure waveforms and implications for clinical practice.

CardioMEMS, a remote pulmonary artery pressure monitoring system, provides waveform patterns for the ambulatory heart failure patient. These waveforms provide significant insights into patient volume and clinical management. We aim to provide a foundation for understanding the determinants of waveform characteristics and provide practical examples illustrating how to interpret and integrate common scenario waveforms into clinical decision-making. A total of three groups of relevant scenarios were included namely (a) location and activity at time of waveform transmission, (b) impact of contemporary interventions, and (c) arrhythmias. We illustrate that waveform analysis can be individualized to each patient's care strategy in the appropriate clinical context to help guide clinical decision-making.

Diurnal variation of pulmonary artery pressure in ambulatory heart failure patients.

BACKGROUND: There is limited information on diurnal variation in pulmonary artery pressures (PAP) in ambulatory heart failure (HF) patients. We aimed to study the variation in morning and night-time PAP in HF patients with an implanted CardioMEMS® sensor. METHODS: In this prospective, single centre study we enrolled patients who had a cardioMEMS sensor and consented to participate (End stage renal disease and recent hospitalisation for acute HF were exclusions). Subjects were asked to transmit PAP and non-invasive blood pressure information in morning and at night-time for 7 consecutive days. Categorical and continuous variables were reported as percentages and mean ± SD respectively. Repeated measure ANOVA was used to compare the diurnal changes in PAP among different subgroups. Pierson correlation coefficient was performed to assess correlation between diurnal variation of PAP and left ventricular ejection fraction. RESULTS: Thirty subjects were included in analysis. There was a significant nocturnal rise in PASP and mPAP compared to morning readings (+2.59 mmHg, p = 0.003 and +1.24 mmHg with p = 0.02 respectively) while night-time PADP did not change significantly (+0.48 mmHg, p = 0.18) without significant change in systemic blood pressure or pulse rate. CONCLUSION: The described diurnal changes in PAP should be considered when managing ambulatory HF patients based on these readings. PADP can be used reliably without concern for the time of day the readings were recorded.HighlightsThere is a diurnal variation in PAP in ambulatory heart failure patientsPulmonary artery systolic and mean pulmonary artery pressures are higher at night-time than in morning.Pulmonary artery diastolic pressures do not vary significantly with time of day.These findings should inform clinical decisions in management of these patients about the time of the day readings are taken.