Percutaneous implantation of pulmonary artery pressure sensors for monitoring treatment of chronic heart failure

The condition

2.1 Heart failure happens when the pumping action of the heart is impaired by structural or functional abnormalities. It can lead to reduced blood flow to the body tissues and increased filling pressure in the heart. This causes congestion and oedema in the lungs (causing breathlessness) and the body (causing swelling in the legs). Symptoms include breathlessness, reduced exercise tolerance, oedema, fatigue and malaise.

Current treatments

2.2 Diagnosis and management of chronic heart failure is described in NICE's guideline on chronic heart failure in adults. Treatments include lifestyle changes, medicines, device implantation (to help control heart rhythm) and heart surgery (such as a bypass operation or a heart transplant).

2.3 Chronic heart failure needs regular monitoring to identify signs of deterioration and modify treatment, with the aim of improving the patient's quality of life and avoiding hospital admissions. Monitoring includes assessment of functional capacity, fluid status, blood pressure, cardiac rhythm, renal function, and cognitive and nutritional status. Medication is reviewed and adjusted if necessary. Implantable devices to monitor haemodynamic changes may assist heart failure monitoring.

The procedure

2.4 A delivery catheter is introduced into a large vein (usually the femoral vein) under local anaesthesia. Under radiological guidance, the catheter is used to pass a small pressure sensor through the heart and into a suitable branch of the pulmonary artery. The pressure sensor is deployed and the delivery catheter removed. Data on pulmonary artery pressure (PAP), such as pressure trend information and PAP waveforms, are transmitted from the sensor to an external monitor in the patient's home. The monitor securely transmits the data to a remote database that can be accessed by the heart failure team. Collection and transmission of data are usually done by the patient daily or more frequently if required by the heart failure team.

2.5 This procedure allows the provision of data to guide the management of chronic heart failure, with the aim of reducing hospitalisations caused by heart failure.