Intrathoracic impedance monitoring in patients with heart failure - Correlation with fluid status and feasibility of early warning preceding hospitalization

Background - Patients with heart failure are frequently hospitalized for fluid overload. A reliable method for chronic monitoring of fluid status is therefore desirable. We evaluated an implantable system capable of measuring intrathoracic impedance to identify potential fluid overload before heart failure hospitalization and to determine the correlation between intrathoracic impedance and standard measures of fluid status during hospitalization. Methods and Results - Thirty-three patients with NYHA class III and IV heart failure were implanted with a special pacemaker in the left pectoral region and a defibrillation lead in the right ventricle. Intrathoracic impedance was regularly measured and recorded between the lead and the pacemaker case. During hospitalizations, pulmonary capillary wedge pressure and fluid status were monitored. Ten patients were hospitalized for fluid overload 25 times over 20.7 +/- 8.4 months. Intrathoracic impedance decreased before each admission by an average of 12.3 +/- 5.3% ( P < 0.001) over an average of 18.3 +/- 10.1 days. Impedance reduction began 15.3 +/- 10.6 days ( P < 0.001) before the onset of worsening symptoms. There was an inverse correlation between intrathoracic impedance and pulmonary capillary wedge pressure ( r = - 0.61, P < 0.001) and between intrathoracic impedance and net fluid loss ( r = - 0.70, P < 0.001) during hospitalization. Automated detection of impedance decreases was 76.9% sensitive in detecting hospitalization for fluid overload, with 1.5 false-positive ( threshold crossing without hospitalization) detections per patient-year of follow-up. Conclusions - Intrathoracic impedance is inversely correlated with pulmonary capillary wedge pressure and fluid balance and decreased before the onset of patient symptoms and before hospital admission for fluid overload. Regular monitoring of impedance may provide early warning of impending decompensation and diagnostic information for titration of medication.