MEMS Technology in Cardiology: Advancements and Applications in Heart Failure Management Focusing on the CardioMEMS Device.

Heart failure (HF) is a complex clinical syndrome associated with significant morbidity, mortality, and healthcare costs. It is characterized by various structural and/or functional abnormalities of the heart, resulting in elevated intracardiac pressure and/or inadequate cardiac output at rest and/or during exercise. These dysfunctions can originate from a variety of conditions, including coronary artery disease, hypertension, cardiomyopathies, heart valve disorders, arrhythmias, and other lifestyle or systemic factors. Identifying the underlying cause is crucial for detecting reversible or treatable forms of HF. Recent epidemiological studies indicate that there has not been an increase in the incidence of the disease. Instead, patients seem to experience a chronic trajectory marked by frequent hospitalizations and stagnant mortality rates. Managing these patients requires a multidisciplinary approach that focuses on preventing disease progression, controlling symptoms, and preventing acute decompensations. In the outpatient setting, patient self-care plays a vital role in achieving these goals. This involves implementing necessary lifestyle changes and promptly recognizing symptoms/signs such as dyspnea, lower limb edema, or unexpected weight gain over a few days, to alert the healthcare team for evaluation of medication adjustments. Traditional methods of HF monitoring, such as symptom assessment and periodic clinic visits, may not capture subtle changes in hemodynamics. Sensor-based technologies offer a promising solution for remote monitoring of HF patients, enabling early detection of fluid overload and optimization of medical therapy. In this review, we provide an overview of the CardioMEMS device, a novel sensor-based system for pulmonary artery pressure monitoring in HF patients. We discuss the technical aspects, clinical evidence, and future directions of CardioMEMS in HF management.

Expanded application of wearable cardioverter defibrillators beyond current guidelines: proposal for a European register explained through single clinical scenarios.

The wearable cardioverter defibrillator (WCD) is becoming a more and more widely used instrument for the prevention of sudden cardiac death of patients either with a secondary prevention implantable cardioverter defibrillator indication or with a transient high risk of sudden cardiac death. Although clinical practice has demonstrated a benefit of protecting patients for a period as long as 3-6 months with such devices, the current European guidelines concerning ventricular arrhythmias and sudden cardiac death are still extremely restrictive in the patient selection in part because of the costs derived from such a prevention device, in part because of the lack of robust randomised trials.To illustrate expanded use cases for the WCD, four real-life clinical cases are presented where patients received the device slightly outside the established guidelines. These cases demonstrate the broader utility of WCDs in situations involving acute myocarditis, thyrotoxicosis, pre-excited atrial fibrillation and awaiting staging/prognosis of a lung tumour. The findings prompt expansion of the existing guidelines for WCD use to efficiently protect more patients whose risk of arrhythmic cardiac death is transient or uncertain. This could be achieved by establishing a European register of the patients who receive a WCD for further analysis.

Fusion Imaging of Non-Invasive and Invasive Cardiac Electroanatomic Mapping in Patients with Ventricular Ectopic Beats: A Feasibility Analysis in a Case Series.

In patients with premature ventricular contractions (PVCs), non-invasive mapping could locate the PVCs' origin on a personalized 3-dimensional (3D) heart model and, thus, facilitate catheter ablation therapy planning. The aim of our report is to evaluate its accuracy compared to invasive mapping in terms of assessing the PVCs' early activation zone (EAZ). For this purpose, non-invasive electrocardiographic imaging (ECGI) was performed using the Amycard 01C system (EP Solutions SA, Switzerland) in three cases. In the first step, a multichannel ECG (up to 224 electrodes) was recorded, and the dominant PVCs were registered. Afterward, a cardiac computed tomography (in two cases) or magnetic resonance imaging (in one case) investigation was carried out acquiring non-contrast torso scans for 8-electrode strip visualization and contrast heart acquisition. For the reconstructed epi/endocardial meshes of the heart, non-invasive isochronal maps were generated for the selected multichannel ECG fragments. Then, the patients underwent an invasive electrophysiological study, and the PVCs' activation was evaluated by a 3D mapping system (EnSite NavX Precision, Abbott). Finally, using custom-written software, we performed 3D fusion of the non-invasive and invasive models and compared the resulting isochronal maps. A qualitative analysis in each case showed the same early localization of the dominant PVC on the endocardial surface when comparing the non-invasive and invasive isochronal maps. The distance from the EAZ to the mitral or tricuspid annulus was comparable in the invasive/non-invasive data (36/41 mm in case N1, 73/75 mm in case N2, 9/12 mm in case N3). The area of EAZ was also similar between the invasive/non-invasive maps (4.3/4.5 cm2 in case N1, 7.1/7.0 cm2 in case N2, 0.4/0.6 cm2 in case N3). The distances from the non-invasive to invasive earliest activation site were 4 mm in case N1, 7 mm in case N2, and 4 mm in case N3. Such results were appropriate to trust the clinical value of the preoperative data in these cases. In conclusion, the non-invasive identification of PVCs before an invasive electrophysiological study can guide clinical and interventional decisions, demonstrating appropriate accuracy in the estimation of focus origin.