Multiple Vector Impedance Measurements During Biventricular Pacing: Feasibility and Possible Implications for Hemodynamic Monitoring

BACKGROUND: Intracardiac impedance (ICZ) has been known to reflect contractile capacity of the heart, and a strong relationship has been documented between stroke volume and ICZ. In this pilot study, conducted in heart failure patients during implantation of a biventricular device, we investigated acute changes in multiple vector ICZ signals during different pacing modes, and whether ICZ can be used to monitor hemodynamic variations. METHODS: Z1 and Z2 impedance signals were recorded in the right ventricle (RV), and between the left ventricle (LV) and RV, respectively, in 12 patients during four programming modes. ICZ signals were analyzed with respect to average and peak-to-peak (p2p) amplitude and systolic slope, and correlated with noninvasive hemodynamic and echocardiographic variables. RESULTS: ICZ p2p amplitude decreased during LV stimulation both in Z1 and in Z2 configuration (P = 0.021 and P = 0.022 vs intrinsic conduction, respectively). No significant variations in average amplitude or systolic slope were observed. ICZ variables correlated directly with hemodynamic measures (r = 0.48, P < 0.05, between Z2 p2p amplitude and pulse pressure), LV ejection fraction (r = 0.32, P < 0.05, for Z1 average amplitude), RV ejection fraction (r = 0.75, P < 0.05, for Z1 p2p amplitude), and inversely with ventricular volumes. CONCLUSIONS: Variations in ICZ may be observed during different pacing modes and seem to correlate with hemodynamic and echocardiographic variables. Multiple vector ICZ measurement may be a feasible tool for hemodynamic assessment in patients treated with biventricular pacing.