• Jan Becher, Susann G Kaufmann, Stefan Paule, Bernhard Fahn, Olaf Skerl, Wolfgang R Bauer, Georg Ertl, and Sebastian K G Maier.
• Medizinische Klinik und Poliklinik I, Universitätsklinikum, Oberdürrbacher Strasse 6, 97080 Würzburg, Germany.
• Europace. 2010 May 1;12(5):731-40.

AimsHeart failure patients are often equipped with implanted devices and are frequently hospitalized due to volume overload. Reliable prediction of imminent fluid congestion has the potential to provide early detection of cardiac decompensation and therefore might be capable of enhancing therapy management. We investigated whether implant-based impedance (Z) measurement is closely correlated with directly assessed extravascular lung water and might thus be useful for patient monitoring.Methods And ResultsIn sheep, pulmonary fluid congestion was induced. Continuous haemodynamic monitoring was performed and extravascular lung water index (EVLWI) assessed. An implanted device with a right ventricular lead measured Z using different electrode configurations. All animals developed gradual pulmonary fluid accumulation leading to inclining lung oedema: EVLWI did increase from 9.5 +/- 1 to 21.1 +/- 5.1 mL/kg (+127%). A concomitant decrease of Z by up to 23%, depending on the electrode configuration, was observed and regression analysis between Z and EVLWI yielded a significant inverse correlation.ConclusionChanges of Z show a strong inverse correlation with changes of directly measured EVLWI. This allows the application of Z as a measure of intrathoracic fluid status and has the potential to optimize patient care, especially in the context of evolving telemedicine concepts.

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