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Heart-Pacing Devices Hold Promise for Heart Failure
Date:10/1/2009

Defibrillators, pacemakers offer benefits for patients with milder forms of the condition, study suggests

THURSDAY, Oct. 1 (HealthDay News) -- New research provides more evidence that a new type of pacemaker/defibrillator technology may be a good option for patients with mild forms of heart failure.

An international team of researchers reports that the kind of heart "pacing" provided by new defibrillators and pacemakers can help these patients. But the research still needs to be confirmed before doctors begin embracing its findings, said a cardiologist familiar with the research.

The technology in question "is expensive, resource-intensive, and associated with increased risk of complications compared with less complex devices," explained Dr. Jeptha Curtis, an assistant professor of medicine at the Yale University School of Medicine.

Heart failure occurs when the heart fails to pump blood properly, often as a result of heart attacks, and affects an estimated 5.7 million Americans. "Patients often feel fatigue, as well as shortness of breath from fluid building up in the lungs and swelling of the legs from fluid building up there as well," said Dr. Kevin Heist, a cardiac electrophysiologist at Massachusetts General Hospital.

Cardiac resynchronization therapy defibrillators, which shock the heart to return it to a normal rhythm, are used in some patients with advanced cases of heart failure. Pacemakers are also available with the technology, Heist said.

The devices control the left and right sides of the heart, which can improve heart failure symptoms like shortness of breath and fatigue, Heist said.

The new study, published online Sept. 30 in the Journal of the American College of Cardiology, looked at whether the kind of heart control used in some new defibrillators -- known as biventricular pacing -- would work in patients with milder cases of heart failure.

The researchers randomly assigned 262 patients with defibrillators or pacemakers to receive normal treatment with the devices or to have an extra "pacing" function turned on to help their hearts beat more properly. The patients who got the more expanded treatment did better and lived longer.

"However, the study is definitely not definitive, and we will need to see the results of similar, ongoing trials before we change practice," Curtis said.

One problem is that the research is part of a larger study that hasn't shown such a dramatic improvement in patients due to the technology, Curtis said.

"The reasons of this discrepancy are not clear, but it makes it that much more important that the results be confirmed before we start using this technology more aggressively," he said.

Heist, however, said another study came up with similar results.

Overall, only about 20 percent of patients whose lives may be improved by defibrillators actually get them, Heist said. "This is due to a combination of patient reluctance and lack of knowledge by referring physicians," he said. "Many lives could be saved if this rate could be improved."

More information

For more about heart failure, visit the American Heart Association.



SOURCES: Jeptha Curtis, M.D., assistant professor, medicine, Yale University School of Medicine, New Haven, Conn.; Kevin Heist, M.D., Ph.D., cardiac electrophysiologist, Massachusetts General Hospital, Boston; Sept. 30, 2009, Journal of the American College of Cardiology, online


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