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TriageHF™ leverages trended diagnostic data available today in the Medtronic Heart Failure Management Report.
The thoracic impedance trend plots the daily averages of the patient’s raw intrathoracic impedance against the reference trend.
Decreases in intrathoracic impedance occur on average 15 days before symptom onset and 18 days before hospitalisation.1
The OptiVol fluid index quantifies the spread between the daily averages and the reference trend. It is a graphical representation of the accumulation of consecutive day-to-day differences between the Daily and Reference impedance.
(OptiVol monitoring is not intended to replace assessments, which are part of standard clinical practice.)
The atrial tachycardia/atrial fibrillation (AT/AF) burden trend plots the total time spent in AT/AF on a daily basis.
Underappreciated AT episodes may be an important trigger for acute pulmonary congestion/volume overload.2
This trend displays the daily average and maximum ventricular rates occurring during AT/AF.
Poor rate control with atrial tachyarrhythmias is associated with earlier time to first hospitalisation.3, 4
The device accelerometer accumulates the number of activity counts sensed each minute. A minute is considered active if the counts exceed a threshold equal to walking approximately 70 steps per minute.
Activity level measured by an implantable cardiac device decreased significantly in the days leading up to a heart failure hospitalisation.5
The median atrial heart rate is determined every 5 minutes, and a variability value is plotted each day.
Low HRV (< 50 ms) is associated with increased risk for heart failure hospitalisations and mortality. Conversely, patients with HRV > 100 ms are at significantly lower risk.5
The percent pacing per day trend provides a view of pacing over time; it displays the daily percentage of atrial and ventricular pacing.
Information regarding percentage of ventricular pacing is important for maximising CRT, especially in patients with AF where poor rate control can compromise CRT and therapies.7, 8
This trend displays an annotation for the day on which a defibrillation therapy, cardioversion therapy, or atrial shock therapy was delivered.
This trend provides a history of ventricular tachyarrhythmias. The device records the total number of spontaneous VT and VF episodes each day.
Prof. Mario Oliveira (Lisbon)
Yu CM, Wang L, Chau E, et al. Intrathoracic impedance monitoring in patients with heart failure: correlation with fluid status and feasibility of early warning preceding hospitalization. Circulation. August 9, 2005;112(6):841-848.
Jhanjee R, Templeton GA, Sattiraju S, et al. Relationship of paroxysmal atrial tachyarrhythmias to volume overload: assessment by implanted transpulmonary impedance monitoring. Circ Arrhythm Electrophysiol. October 2009;2(5);488-494.
Ousdigian KT, Johnson WB, Koehler JL, Wilkoff BL. Very poor rate control during atrial tachyarrhythmias predicts cardiovascular hospitalizations. J Card Fail. August 2006;12(6)(suppl 1):S57-S58.
Willems R, Morck ML, Exner DV, Rose SM, Gillis AM. Ventricular highrate episodes in pacemaker diagnostics identify a high-risk subgroup of patients with tachy-brady syndrome. Heart Rhythm. October 2004;1(4):414-421.
Adamson PB, Smith AL, Abraham WT, et al. Continuous autonomic assessment in patients with symptomatic heart failure: prognostic value of heart rate variability measured by an implanted cardiac resynchronization device. Circulation. October 19, 2004;110(16):2389-2394.
Casolo GC, Stroder P, Sulla A, Chelucci A, Freni A, Zerauschek M. Heart rate variability and functional severity of congestive heart failure secondary to coronary artery disease. Eur Heart J. March 1995;16(3):360-367.
Whellan DJ, Ousdigian KT, Al-Khatib SM, et al. Combined heart failure [HF] device diagnostics identify patients at higher risk of subsequent heart failure hospitalizations: Results from PARTNERS HF study. J Am Coll Cardiol. April 27, 2010;55(17):1803-1810.
Gasparini M, Auricchio A, Regoli F, et al. Four-year efficacy of cardiac resynchronization therapy on exercise tolerance and disease progression: the importance of performing atrioventricular junction ablation in patients with atrial fibrillation. J Am Coll Cardiol. August 15, 2006;48(4):734-743.