June 12, 2002 -- Almost 5 million Americans have heart failure, and that number is expected to double in the next five years. But research suggests a new high-tech pacemaker may be able to relieve symptoms in some people with heart failure, keeping them out of the hospital.
Cardiologist Joshua M. Hare, MD, says the study findings are the best evidence yet that this type of pacemaker is for certain people with heart failure. But, he tells WebMD, the treatment should be reserved for those whose symptoms cannot be adequately controlled with drugs. Hare is director of the heart failure research program at Baltimore's Johns Hopkins Medical Institutions.
In someone without heart disease, the two large pumping chambers of the heart beat at the same time. But in about 30% of people with heart failure, these two chambers don't beat together, which decreases the heart's pumping action. Patients with this complication often have worsening of the symptoms that typically occur with heart failure, including fatigue, shortness of breath, and swelling of the feet and ankles.
The new high-tech pacemakers are able to synchronize the two pumping chambers.
Researchers looked at more than 450 people with moderate-to-severe heart failure who also had pumping chambers that did not work together. The study appears in the June 13 issue of The New England Journal of Medicine. The research was funded by Medtronic -- a WebMD sponsor.
After six months of treatment, those who'd received the pacemakers along with conventional drug treatment had better quality of life and were able to walk farther than those who'd been treated with drugs alone. In addition, only 8% of people in the pacemaker group ended up in the hospital with worsening heart failure, compared with 15% of those who'd received only drugs.
In people with moderate-to-severe heart failure and heart chambers that are out of sync, getting the chambers to work together results in significant improvement in symptoms, says lead author William T. Abraham, MD, of the University of Kentucky College of Medicine.
"Right now, what we know about this therapy is that it makes patients feel better. But they may not need it if symptoms can be controlled with medication," Hare says. "We don't yet know if this therapy helps patients live longer. If future studies show that it does, then it would be an appropriate first-line treatment for all patients in this category."
Also, a potential difficulty with the treatment, Hare says, is a high rate of implantation and maintenance problems. The pacemakers could not be implanted successfully in 8% of people in the study, and other patients experienced problems after implantation. The devices are harder to implant than conventional pacemakers, because they have an extra wire that must be fed into a small vein in the heart.