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UPMC studies pacemaker for congestive heart failure

Thursday, November 09, 2000

By Byron Spice, Science Editor, Post-Gazette

Weak heart muscles may be the major reason people with congestive heart failure can't pump enough blood for their body's needs, but improving the heart's rhythm may allow patients to resume some physical activities and perhaps prevent deaths.

Researchers have found that an experimental type of cardiac pacemaker that controls the rhythm of both sides of the heart can resynchronize the beating of the heart and improve its function. In a new clinical trial now under way at the UPMC Cardiovascular Institute, doctors hope to find out whether these biventricular pacemakers not only can make people feel better and exert themselves longer, but extend and save lives as well.

Dr. Srinivas Murali said the first of these patients had a pacemaker installed last week and a second patient was scheduled to be implanted this week.

It's too soon to say whether the pacemakers will help these patients, said Murali, the local principal investigator for the nationwide trial. It takes a couple of weeks to recuperate from the operation, he explained, and the benefits from the pacing develop over time.

Twenty patients will be enrolled locally in the trial, which eventually will include 2,200 patients at 80 medical centers. All will be patients with advanced heart failure who are not eligible for heart transplants.

Electrical pacing of the heart could become an important new treatment for congestive heart failure, a progressive weakening of the heart that affects between 4 million and 5 million Americans. It is often triggered by damage caused in a heart attack or heart infection. Doctors can prescribe drugs to help boost the heart's pumping action, but the only other treatment option now is a heart transplant.

As the heart gets progressively weaker, Murali said, irregularities can develop in the electrical system that keeps both sides beating in synchrony with each other. Correcting this problem allows the heart to pump more efficiently. Conventional pacemakers, which are used in people whose hearts beat too slowly, are of no use in correcting the rhythm problems in heart failure patients because those devices pace only the right side of the heart.

The biventricular pacemakers have electrical leads that extend to both sides of the heart.

Murali said the new study will follow patients for a year to determine if the devices reduce hospitalizations and prevent deaths.

One issue the study will address is whether the pacemakers can reduce the risk of sudden cardiac death.

About a third of heart failure patients will die suddenly, Murali said, but as yet doctors have no way of predicting which ones are at risk.

It's possible to implant defibrillators in patients at risk of sudden death, he acknowledged, but it's not practical to implant millions of heart failure patients with the device, which costs about $50,000.

A third of the patients enrolled in the new study will be treated with medications alone, another third with drugs and the pacemakers and the final third with drugs, pacemakers and implantable defibrillators.


To contact the Cardiovascular Institute, call (800) 533-8762.



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