title: Admittance to detect alterations in left ventricular stroke volume.
abstract: 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).
  
  
  CONCLUSIONS
  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.
authors: Department of Electrical Engineering, University of Texas at Austin, Austin, Texas.
authors: Erik R
authors: ER
authors: Larson
authors: Admittance Technologies, Austin, Texas.
authors: John E
authors: JE
authors: Porterfield
authors: Division of Cardiology, The University of Texas Health Science Center at San Antonio, San Antonio, Texas.
authors: Sandeep
authors: S
authors: Sagar
authors: Division of Cardiology, The University of Texas Health Science Center at San Antonio, San Antonio, Texas.
authors: Juan
authors: J
authors: Marmol-Velez
authors: Division of Cardiology, The University of Texas Health Science Center at San Antonio, San Antonio, Texas.
authors: Manoj
authors: M
authors: Panday
authors: Division of Cardiology, The University of Texas Health Science Center at San Antonio, San Antonio, Texas.
authors: Daniel
authors: D
authors: Escobedo
authors: Department of Epidemiology and Biostatistics, The University of Texas Health Science Center at San Antonio, San Antonio, Texas.
authors: Joel
authors: J
authors: Michalek
authors: Department of Epidemiology and Biostatistics, The University of Texas Health Science Center at San Antonio, San Antonio, Texas.
authors: Yongjian
authors: Y
authors: Ouyang
authors: Department of Electrical Engineering, University of Texas at Austin, Austin, Texas.
authors: Jonathan W
authors: JW
authors: Valvano
authors: Department of Electrical Engineering, University of Texas at Austin, Austin, Texas.
authors: John A
authors: JA
authors: Pearce
authors: Admittance Technologies, Austin, Texas; Division of Cardiology, The University of Texas Health Science Center at San Antonio, San Antonio, Texas; Department of Veterans Affairs, South Texas Veterans Health Care System, San Antonio, Texas. Electronic address: feldmanm@uthscsa.edu.
authors: Marc D
authors: MD
authors: Feldman
mesh_terms: D000818:Animals; D004195:Disease Models, Animal; D004285:Dogs; D022062:Electrophysiologic Techniques, Cardiac; D020342:Finite Element Analysis; D006439:Hemodynamics / Q000502:physiology; D013318:Stroke Volume / Q000502:physiology*; D017180:Tachycardia, Ventricular / Q000503:physiopathology*
keywords: Biventricular pacing/defibrillation; Inappropriate shocks; Shock reduction; Ventricular fibrillation; Ventricular tachycardia