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Special Heart Devices Help People with Congestive Heart Failure

WASHINGTON, D.C. - Special pacemaker-like devices can improve the lives of some people with congestive heart failure (CHF), many of whom have no alternative other than a transplant. The devices may even help them live longer, according to results of a multicenter European trial being presented here today at the 21st Annual Scientific Sessions of the North American Society of Pacing and Electrophysiology (NASPE).

"Our study shows if a patient has moderate to severe congestive heart failure and is on the maximum tolerable medication, one of these devices will likely make a huge improvement by increasing exercise capacity and general well-being," said Angelo Auricchio, M.D., Ph.D., electrophysiologist and associate professor in the department of cardiology at University Hospital, Magdeburg, Germany. "Although our study did not measure survival, we noted that 80 percent of the patients who received the devices were alive after two years, whereas typically, 40 to 50 percent would be alive."

In the United States, about 5 million people suffer from congestive heart failure, which means the heart is not pumping enough blood to meet the body's needs. Some of these patients also have problems with electrical conduction of impulses to the ventricles, the pumping chambers of the heart. This causes the heart to beat too fast and doesn't allow the heart rate to vary according to the person's exertion level, as it should. A new device, called a ventricular resynchronizer, has been shown to be very useful for such patients.

The study is part of the Pacing Therapies for Congestive Heart Failure (PATH-CHF) trial at six European centers, five in Germany and one in the Netherlands.

The devices used in this study evolved from pacemaker technology and are implanted in the chest with leads, or wires, connecting them to the heart. Pacemakers are given to people whose hearts beat too slowly; the pacemaker speeds it up. Ventricular resynchronizers can be used for patients with CHF and conduction problems in the ventricles, not to increase the heart rate, but to help the heart beat more efficiently, which may result in less demand on the heart to beat faster.

"In congestive heart failure, the heart compensates for its poor pumping quality by beating faster and at a steady rate," said Dr. Auricchio. "That's bad because it means you need more oxygen. The congestive heart is like an inefficient engine, burning too much gasoline."

Medications can improve the pumping quality, but in some cases they aren't enough. A ventricular resynchronizer can slow the heart down and help it to pump more blood with each beat.

In the study, 15 of the 42 PATH-CHF patients had ventricular resynchronizers implanted in their chests and wore monitors that constantly recorded their heart rates. The patients were an average of 60 years old. After a month with the device, their hearts beat an average of 5 percent more slowly. Heart rate variability improved by 30 percent, a sign that the heart reacted more physiologically. Exercise capacity, measured by how far the patient could walk in six minutes, increased by 18 percent. According to a patient questionnaire, their quality of life improved by more than 100 percent. Heart rate pumping efficiency increased an average of 15 percent.

CHF can be caused by a number of different conditions, including heart attack, valvular heart disease, heart birth defects, infections of the heart and high blood pressure.

"These patients are relatively young and for many of them who have no hope except for a new heart, this is a very good option," said Dr. Auricchio.

Co-authors of a paper on the topic being presented by Dr. Auricchio at the meeting are: Gerrard Carlson, Ph.D.; Veerichetty Kadhiresan, Ph.D.; Walter Hoersch; Julio Spinelli, Ph.D.; and Uli Michel.

Based in Natick, Mass., the North American Society of Pacing and Electrophysiology is a professional organization of physicians, scientists and allied professionals throughout the world dedicated to the study and management of cardiac arrhythmias. Its mission is to improve the care of patients by promoting research, education and training, and providing leadership towards optimal healthcare policies and standards.

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