Intracardiac Impedance as a Method for Ventricular Volume Monitoring - Investigation by a Finite-Element Model and Clinical Data

A method for monitoring left ventricular (LV) volume changes of the human heart by intracardiac impedance measurement was developed. In order to model this method, we simulated the ventricular contraction using a finite-element model (FEM). The myocardium comprised three layers with anatomical fiber orientation. During excitation propagation contraction forces were applied, taking into account the myocardial elastic properties and the blood pressure time course. For a set of 21 contraction stages we calculated the intracardiac impedance Z between the right ventricular (RV) and LV leads for a set of common LV lead positions. The FEM results were compared to clinical data. Impedance and stroke volume were determined during overdrive pacing and end diastolic volume (EDV) at rest in 14 patients. All clinical EDV values were in the range of 147-394ml. Both the clinical data and the FEM in this volume range showed a linear correlation between admittance Y=1/Z and ventricular volume. For a quantitative comparison end diastolic impedance EDZ and the slope dY/dV were calculated. The model results across all LV lead positions were EDZ=0.16-1.2Ω, and dY/dV=3.3-21mS/ml, corresponding to clinical values of EDZ=0.14-1.46Ω and dY/dV=1-64mS/ml. In conclusion, the FEM resembled the clinical measurement data and serves as theoretical basis for ventricular volume monitoring via intracardiac impedance.