Background Implantable Cardiac Hemodynamic Monitors (ICHM) provide real time measurements of PADP (Pulmonary Artery Diastolic Pressures). Implanted pacemakers / defibrillators (CRM) sense thoracic impedance as a subacute and chronic measurement of pulmonary vascular congestion. CRM devices have programmable pacemaker timing intervals that adjust in a closed loop system based on intracardiac electrical signals. No closed loop systems based on mechanical indices of cardiopulmonary status are available. Real time monitoring of PADP has potential to automatically direct optimal CRM timing intervals as part of a closed loop system (CLS). We chose to look at events within cases. Events are defined as specific iterations in timing of base rate, variation in paced chamber, and/or AV interval timing. Hypothesis Changes in CRM timing will affect acute measurements of PADP in patients with HF that will impact venous congestion. Methods 19 patients with ICHM, PPMs / ICDs, history of HFpEF (n = 8) or HFrEF (n=11), and baseline HR = 3 mm Hg change from baseline PAD during any reprogramming (Y); from those that did not (N). Results 5 of 7 cases had > 3 mm change (mean =16) in PADP from intrinsic conduction to RV pacing. 3 of these patients were in sinus rhythm and 2 in permanent atrial fibrillation. 3 of 22 cases with changes in AV timing had > 3 mmHg increase in PAD from baseline settings.1 of 5 cases CRT settings had > 3 mmHg increase when RV pacing alone. Discussion Acute changes in PADP were noted in a majority of cases with RV pacing rather than intrinsic conduction. Changes in AV delays infrequently affected PADP. Further work is needed to determine if chronic changes in PADP occur as a result of changes in pacing timing in order to determine if CLS could improve implantable cardiac hemodynamic measurements.

Background/purpose: Interventional cardiovascular procedures are performed while operators view multiple visual displays including fluoroscopic and ultrasonic images, intracardiac electrical signals, electroanatomic mapping data, and hemodynamic indices. Operators are unable to palpate physiologic and biophysical signals or feel intracardiac anatomy due to the attenuation and dampening properties of cardiac catheters. This poses a significant limitation when performing higher risk procedures such as complex coronary interventions, transeptal or epicardial puncture to gain access to the left atrium or pericardium for ablation of heart rhythm disorders, cardiac device delivery, and when attempting to maintain stable tissue contact force ("CF") during ablation of cardiac arrhythmia. Methods/materials: We utilized signals acquired from a prototype sensorized cardiac guiding catheter, conventional transeptal puncture kit with end hole manometry, commercially available contact force sensing ablation catheter, and epicardial puncture needle, input these signals into a novel signal processing system and generated palpable sensations to blinded subjects using a proprietary tactile/force (haptic) feedback system. Qualitative and quantitative analysis of the system was performed. Results/conclusion: The proprietary haptic (tactile and force) feedback system provides sense of touch during cardiovascular interventions recreating palpable, real-time biophysical events and physiologic information and enables operators to react to critical cardiovascular signals with minimal delay relative to visual motor reaction time to simple display data. Summary: We describe a proprietary haptic (tactile and force) feedback system that provides sense of touch during cardiovascular interventions recreating palpable, real-time biophysical events and physiologic information. (C) 2018 Published by Elsevier Inc.

Transeptal and Epicardial Puncture (TEP) are necessary for ablation of cardiac arrhythmia, left atrial appendage occlusion, and valve repair. TEP can cause perforation, especially in inexperienced hands. Catheters do not reliably enable palpation of biophysical events. Tactile feedback is

SMART AF showed that consistent contact during ablation improves pulmonary vein (PV) isolation but use of contact force (CF) displays led to a 2.5% risk of tamponade and required procedural, ablation, fluoroscopy times of 3.7 +/- 1.4 h, 2.0 +/- 1 h and 41.5 +/- 26 min. When the HRS Consensus