Single center experience with left atrial pressure remote monitoring in advanced heart failure patients

ABSTRACT

Background: Advanced heart failure (HF) is a complex clinical syndrome with scarce therapeutic options. Despite growing body of research in the field, no alternative end-stage solution is available for those individuals who are not eligible for heart transplant and mechanical circulatory support. The efficacy of implantable hemodynamic monitoring is currently being tested. Clinical manifestations of congestive HF appear late in the progression to acute decompensation, whereas intracardiac pressures rise gradually and can anticipate, even by weeks, the symptoms onset, thus offering a sweet spot to timely face an incipient acute decompensation. To date, the only implantable monitoring systems which received the regulatory agencies approval is a PAP sensor allowing PAP-guided management in symptomatic patients with reduced left ventricular ejection fraction (LVEF <35%). Although right-sided pressures data have proved their usefulness, they do not always correlate with left heart chambers pressures, so that PAP indirect estimation of left ventricular filling pressure can be misleading in some clinical contexts. Purpose. The V-LAP system is the latest-generation device, capable of monitoring the left atrial pressure (LAP) directly, by an intracardiac leadless sensor, transmitting LAP data wirelessly to an external reader. It is designed to offer a continuously updated status of the left-sided hemodynamics in order to improve the outcomes of advanced chronic HF-patient by reducing HF-related hospitalizations. Methods: In our center, V-LAP was implanted in five NYHA class III HF patients, not eligible for heart transplant, with a history of frequent hospital readmission and recurrently elevated proBNP levels. After confirmation of the device reliability, LAP trends have been remotely monitored over time in order to guide therapy optimization. Results: Over a median follow-up time of 18 months, LAP - driven therapy adjustments succeeded in noticeably reducing LAP and no HF-related hospitalization occurred in all patients considered. Morover, functional capacity improved in three out of five patients (NYHA class from III to II), and this was paralleled by an increase in the perceived quality of life as indicated by the KCCQ summary score (67.01±15.95 at baseline vs 83.21±11.94 at latest follow-up). The overall compliance of our patients to daily LAP measurements was > 90%, attesting a remarkable patient usability and acceptance. Conclusion: Preliminary data from V-LAP application at our institution expressed optimistic efficacy, along with remarkable reliability and ease of use, encouraging patients to adhere with a high compliance rate. In covid-19 era, VLAP revealed to be an excellent tool to control HF patients avoiding medical contacts and in-hospital exposure. While further study is needed, heart failure patient management guided by the V-LAP system may have the potential to significantly improve clinical outcomes.