What is implantable hemodynamic monitoring and how can it help?

Symptoms related to lung congestion are the most common factor driving hospitalization in patients with heart failure. Daily weight monitoring is one way to track fluid retention, but since many factors can affect your weight, this is a relatively crude measure. Devices are now available to more directly track the pressures in your heart, which are tightly linked to the amount of excess fluid you have on board. Access to this pressure data can help your medical team monitor your heart condition from afar, and fine tune your medical regimen to limit the need for hospitalization.

Implantable hemodynamic monitors are implanted during a cardiac catheterization procedure. A catheter is typically placed in a large vein in the leg, and advanced to the heart under X-ray guidance. The monitor is deployed in a branch of a blood vessel feeding the lung, the pulmonary artery. One place, it remains in the body indefinitely. Readings are then taken on a daily basis in your home by lying down on a specialized pillow that contains an antenna which can retrieve information from the monitor. Readings are sent from your home electronics module to a central monitoring platform that your doctor or nurse can review. They will contact you to adjust your medications when your readings are out of range.

In a study of 550 patients called the CHAMPION trial, heart failure management guided by use of an implantable pulmonary artery pressure monitor reduced the rate of heart failure hospitalizations by 37% over standard management guided by serial monitoring of weights and symptoms. Based on this data, the FDA provided regulatory approval for use of this device as an adjunct to heart failure treatment in patients with heart failure and advanced (NYHA III) symptoms as well as a prior heart failure hospitalization within 12 months. An interesting feature of this device is that it seems to be equally effective in patients with heart failure and preserved ejection fraction as those with heart failure and reduced ejection fraction. As the technology is fairly new, not every center has this option available, but it is available at many specialized heart failure centers.