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(Circulation. 2007;116:2952-2959.)
© 2007 American Heart Association, Inc.

Heart Failure

Direct Left Atrial Pressure Monitoring in Ambulatory Heart Failure Patients

Initial Experience With a New Permanent Implantable Device

Jay Ritzema, BM, MRCP; Iain C. Melton, MBChB; A. Mark Richards, MD, DSc; Ian G. Crozier, MBChB, MD; Chris Frampton, PhD; Robert N. Doughty, MBBS, MD; James Whiting, PhD; Saibal Kar, MD; Neal Eigler, MD; Henry Krum, MBBS, PhD; William T. Abraham, MD; Richard W. Troughton, MBChB, PhD

From the Department of Cardiology, Christchurch Hospital, Christchurch, New Zealand (J.R., I.C.M., A.M.R., I.G.C., C.F., R.W.T.); Auckland City Hospital, Auckland, New Zealand (R.N.D.); Cedars-Sinai Medical Center, Los Angeles, Calif (J.W., S.K., N.E.); The Alfred Hospital, Melbourne, Australia (H.K.); and Ohio State University, Columbus (W.T.A.).

Correspondence to Dr Jay Ritzema, Department of Cardiology, Parkside West, Christchurch Hospital, Private Bag 4710, Christchurch, New Zealand 8001. E-mail jayr{at}cdhb.govt.nz

Received March 12, 2007; accepted September 21, 2007.

Background— We describe the first human experience with a permanently implantable, direct left atrial pressure (LAP) monitoring system in ambulatory patients with chronic heart failure.

Methods and Results— Eight patients with established heart failure and at least 1 heart failure hospitalization or unplanned visit for parenteral therapy in the last year underwent device implantation under fluoroscopic guidance. All subjects received aspirin 150 mg and clopidogrel 75 mg daily. Subjects measured LAP twice daily and attended a clinic regularly for data upload and device calibration. Right heart catheterization was performed at the time of device implantation and at 12 weeks. The device was implanted in all subjects with no procedural complications. At the 12-week follow-up, 87% of device LAP measurements were within ±5 mm Hg of simultaneous pulmonary capillary wedge pressure readings over a wide range of pressures (1.6 to 71 mm Hg). Net drift corrected by calibration was –0.2±1.9 mm Hg/mo. During short-term follow-up, there were no device-related complications or systemic emboli. There were no deaths, no unplanned heart failure clinic visits, and no admissions for heart failure.

Conclusions— Ambulatory monitoring of direct LAP with a new implantable device was well tolerated, feasible, and accurate at a short-term follow-up. Further follow-up and investigation are warranted to evaluate the clinical utility of LAP monitoring in patients with heart failure.

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