Feasibility of Measuring Relative Right Ventricular Volumes and Ejection Fraction with Implantable Rhythm Control Devices

Ejection fraction (EF), the ratio between stroke volume (SV) and end-diastolic volume (EDV), is a valuable contractility indicator. Unlike SV, the Frank-Starling effect is automatically compensated in the calculation of EF. It was the aim of this study to evaluate the physiological behavior of impedance derived measurements of relative right ventricular (RV) volumes and EF, obtained with standard pacing leads. Seven patients were evaluated at the time of pacemaker implant or replacement. Since no absolute standard of comparison was available for RV volumes, the value of the measurements was assessed by observing their behavior under cardio-circulatory challenges. A 2.5-kHz carrier was fed to the ring and tip electrodes of standard bipolar pacing leads and the resulting voltage was digitized and stored. The peak-to-peak voltage (PPV) of the carrier at the time of QRS was used as EDV, and the largest PPV as end-systolic volume (ESV). Relative SV was the difference between EDV and ESV, and EF = SV/EDV x 100. Pacing was used to reduce EDV, and the effect of contractility was tested with isometric hand grip, recumbent leg exercise, or isoproterenol drip. Only minimal changes in EF were noted during incremental pacing; relative SV and EDV decreased as expected; and EF increased significantly during contractility challenges. A high correlation coefficient was observed between EDV and SV changes induced by incremental pacing at rest (r values from 0.62 to 0.98, P from < 0.01 to 0.001). The study revealed that impedance volumetry, utilizing conventional bipolar pacing leads, yields useful hemodynamic data related to EDV, ESV, and EF. Given the simplicity of the method, it is reasonable to conclude on the feasibility of using said impedance derived hemodynamic parameters in implantable rhythm control devices.