Erik R. Larson

Left ventricular epicardial admittance measurement for detection of acute LV dilation

There are two implanted heart failure warning systems incorporated into biventricular pacemakers/automatic implantable cardiac defibrillators and tested in clinical trials: right heart pressures, and lung conductance measurements. However, both warning systems postdate measures of the earliest indicator of impending heart failure: left ventricular (LV) volume. There are currently no proposed implanted technologies that can perform LV blood volume measurements in humans. We propose to solve this problem by incorporating an admittance measurement system onto currently deployed biventricular and automatic implantable cardiac defibrillator leads. This study will demonstrate that an admittance measurement system can detect LV blood conductance from the epicardial position, despite the current generating and sensing electrodes being in constant motion with the heart, and with dynamic removal of the myocardial component of the returning voltage signal. Specifically, in 11 pigs, it will be demonstrated that 1) a physiological LV blood conductance signal can be derived; 2) LV dilation in response to dose-response intravenous neosynephrine can be detected by blood conductance in a similar fashion to the standard of endocardial crystals when admittance is used, but not when only traditional conductance is used; 3) the physiological impact of acute left anterior descending coronary artery occlusion and resultant LV dilation can be detected by blood conductance, before the anticipated secondary rise in right ventricular systolic pressure; and 4) a pleural effusion simulated by placing saline outside the pericardium does not serve as a source of artifact for blood conductance measurements.

A bio-telemetric device for measurement of left ventricular pressure-volume loops using the admittance technique in conscious, ambulatory rats

This paper presents the design, construction and testing of a device to measure pressure-volume loops in the left ventricle of conscious, ambulatory rats. Pressure is measured with a standard sensor, but volume is derived from data collected from a tetrapolar electrode catheter using a novel admittance technique. There are two main advantages of the admittance technique to measure volume. First, the contribution from the adjacent muscle can be instantaneously removed. Second, the admittance technique incorporates the nonlinear relationship between the electric field generated by the catheter and the blood volume. A low power instrument weighing 27 g was designed, which takes pressure-volume loops every 2 min and runs for 24 h. Pressure-volume data are transmitted wirelessly to a base station. The device was first validated on 13 rats with an acute preparation with 2D echocardiography used to measure true volume. From an accuracy standpoint, the admittance technique is superior to both the conductance technique calibrated with hypertonic saline injections, and calibrated with cuvettes. The device was then tested on six rats with 24 h chronic preparation. Stability of animal preparation and careful calibration are important factors affecting the success of the device.

Embedded Medical Devices: Pressure Volume Loops in Rodents

Man has been instrumenting the human body with electrical devices since the early 1800s. McWilliam built an electrical stimulator of the heart in 1889. In the 1930s, Hyman built and patented multiple versions of an artificial pacemaker. The first one was operated by a hand crank and spring motor to generate and supply the electricity. Around 1960, battery powered pacemakers arrived on the scene. There are five companies that currently provide pacemakers: Biotronik, Boston Scientific, Medtronic, St. Jude Medical, and Sorin. Hearing aids, glucose monitors, artificial joints and limbs, and biopotentials monitors are additional devices that can be implanted.

Accuracy considerations in catheter based estimation of left ventricular volume

Cardiac volume estimation in the Left Ventricle from impedance or admittance measurement is subject to two major sources of error: parallel current pathways in surrounding tissues and a non uniform current density field. The accuracy of volume estimation can be enhanced by incorporating the complex electrical properties of myocardium to identify the muscle component in the measurement and by including the transient nature of the field non uniformity. Cardiac muscle is unique in that the permittivity is high enough at audio frequencies to make the muscle component of the signal identifiable in the imaginary part of an admittance measurement. The muscle contribution can thus be uniquely identified and removed from the combined muscle - blood measurement. In general, both error sources are transient and are best removed in real time as data are collected. This paper reviews error correction methods and establishes that the relative magnitudes of the error concerns are different in small and large hearts.

Admittance to detect alterations in left ventricular stroke volume

BACKGROUND Implantable cardioverter-defibrillators monitor intracardiac electrograms (EGMs) to discriminate between ventricular and supraventricular tachycardias. The incidence of inappropriate shocks remains high because of misclassification of the tachycardia in an otherwise hemodynamically stable individual. Coupling EGMs with an assessment of left ventricular (LV) stroke volume (SV) could help in gauging hemodynamics during an arrhythmia and reducing inappropriate shocks. OBJECTIVE The purpose of this study was to use the admittance method to accurately derive LV SV. METHODS Ultrasonic flow probe and LV endocardial crystals were used in canines (n = 12) as the standard for LV SV. Biventricular pacing leads were inserted to obtain admittance measurements. A tetrapolar, complex impedance measurement was made between the Bi-V leads. The real and imaginary components of impedance were used to discard the myocardial component from the blood component to derive instantaneous blood conductance (Gb). Alterations in SV were measured during right ventricular pacing, dopamine infusion, and inferior vena cava occlusion. RESULTS Gb tracks steady-state changes in SV more accurately than traditional magnitude (ie, |Y|, without removal of the muscle signal) during right ventricular pacing and dopamine infusion (P = .004). Instantaneous LV volume also was tracked more accurately by Gb than ∣Y∣ in the subset of subjects that underwent inferior vena cava occlusions (n = 5, P = .025). Finite element modeling demonstrates that admittance shifts more sensitivity of the measurement to the LV blood chamber as the mechanism for improvement (see Online Appendix). CONCLUSION Monitoring LV SV is possible using the admittance method with biventricular pacing leads. The technique could be piggybacked to complement EGMs to determine if arrhythmias are hemodynamically unstable.

Validation of a New Micro-Manometer Pressure Sensor for Cardiovascular Measurements in Mice

Abstract The Scisense (London, ON, Canada) micro-manometer pressure sensor is currently being used by investigators to evaluate cardiovascular physiology in mice, but has not been validated to date. The purpose of the current study is to compare the 1.2 F Scisense pressure sensor to the current gold standard produced by Millar Instruments (Houston, TX) (1.4 F). In vitro comparisons were preformed including temperature drift, frequency response analysis up to 250 Hz, and damping coefficient and natural frequency determined via a pop test. The authors also performed in vivo comparisons including pressure drift, dose-response studies to IV isoproterenol, maximum adrenergic stimulation with IV dobutamine, and simultaneous placement of both micro-manometer pressure sensors in the same intact murine hearts. The authors conclude that both sensors are equivalent, and that the Scisense pressure sensor represents an alternative to the current gold standard, the Millar micro-manometer pressure sensor for in vivo pressure measurements in the mouse.

Analysis of the Spatial Sensitivity of Conductance/Admittance Catheter Ventricular Volume Estimation

Conductance catheters are known to have a nonuniform spatial sensitivity due to the distribution of the electric field. The Geselowitz relation is applied to murine and multisegment conductance catheters using finite element models to determine the spatial sensitivity in a uniform medium and simplified left ventricle models. A new formulation is proposed that allows determination of the spatial sensitivity to admittance. Analysis of FEM numerical modeling results using the Geselowitz relation provides a true measure of parallel conductance in simplified left ventricle models for assessment of the admittance method and hypertonic saline techniques. The spatial sensitivity of blood conductance (Gb) is determined throughout the cardiac cycle. Gb is converted to volume using Weis equation to determine if the presence of myocardium alters the nonlinear relationship through changes to the electric field. Results show that muscle conductance (Gm) from the admittance method matches results from the Geselowitz relation and that the relationship between Gb and volume is accurately fit using Weis equation. Single-segment admittance measurements in large animals result in a more evenly distributed sensitivity to the LV blood pool. The hypertonic saline method overestimates parallel conductance throughout the cardiac cycle in both murine and multisegment conductance catheters.

Application of the Geselowitz relationship to the murine conductance catheter

Conductance catheters are known to have a nonuniform spatial sensitivity due to the distribution of the electric field. The Geselowitz relation is applied to the murine conductance catheter using a finite element model to determine catheters spatial sensitivity in uniform media. Further analysis of FEM numerical modeling results using the Geselowitz relation provides a true measure of parallel conductance in a simplified murine left ventricle for assessment of the admittance method and hypertonic saline techniques. The spatial sensitivity of blood conductance (Gb) is determined throughout the cardiac cycle. Gb is converted to volume using Weis equation to determine if the presence of myocardium alters the nonlinear relationship through changes to the electric field shape. Results show that the admittance method correctly calculates Gb in comparison to the Geselowitz relation, and that the relationship between Gb and volume is accurately fit using Weis equation.