Abstract 2557: Medical Therapy Directed By A New Implantable Left Atrial Pressure Sensing Device Reduces Episodes of Hemodynamic Deterioration In Ambulatory Heart Failure Patients
Background: We evaluated if monitoring of directly measured left atrial pressure (LAP), coupled with adjustment of medication doses could optimise hemodynamic profiles without detrimental effects.
Methods: The first 9 patients with a new implantable direct LAP sensor are reported. All had recent acute heart failure (HF) decompensation requiring iv diuretics and current NYHA II-IV symptoms. Patients acquired twice-daily LAP readings at home and the data was downloaded during clinic visits. During the control period, patients were managed clinically for 3 months by physicians blinded to LAP. Thereafter, patients were dynamically managed with pre-set physician-prescribed instructions allowing titration of neurohormonal antagonists, loop diuretics and nitrates according to twice daily LAP recordings. Dosing instructions were relayed to the patient by a modified PDA as part of the sensor system.
Results: There was a greater frequency of LAP readings in the compensated range during dynamic than control phases (p<0.001) and fewer episodes of LAP > 25mmHg (5.3% vs 22.3%, p<0.001, Table⇓). Guided by LAP profiles, ACEI/ARB and β-blocker doses increased (22% and 34% respectively, p=0.1, 0.07), loop diuretic doses fell by 21% and creatinine was unchanged (1.4±0.4 vs. 1.4±0.3 mg/dl, p=NS) during dynamic therapy versus control. There were improvements in NYHA class (2.4±0.5 vs 2.0±0.7; p=0.02) and peak VO2 (15 ± 3 vs 16 ± 3 ml/kg/min; p = 0.15, n=7) for control versus dynamic phase. There were no HF hospitalisations during dynamic therapy.
Conclusions: Dynamic therapy based on ambulatory direct LAP measurement was associated with improved hemodynamic profiles, fewer episodes of LAP >25 mmHg, more optimal use of neurohormonal antagonists, reduced loop diuretic requirement without clinical decompensation or change in renal function. Therapy guided by direct LAP monitoring might be useful in optimising HF management.