By Dr. Todd Rudo
Congestive heart failure (CHF), a failure of the heart as a pump to circulate blood throughout the body, affects over five million people in the United States and an estimated 23 million worldwide. The condition is caused by severe weakening of the heart muscle as the result of coronary artery disease, blockages in the small blood vessels responsible for supplying nutrients to the heart. CHF can lead to significant problems including fatigue, leg swelling, and exertional shortness of breath.
One component to CHF recently discovered, called dyssynchrony, refers to a loss of coordination of the heart’s walls during an individual heartbeat. Instead of all the walls squeezing and relaxing in sequence, an area may be delayed or not squeezed at all, causing further decline in the overall efficiency of the heart as a pump. Dyssynchrony is now the target of a new technology called biventricular pacing.
Biventricular pacing involves implanting pacing wires in a manner very similar to a standard pacemaker. What is unique about this technology is the placement of an extra wire specifically to the location that is squeezing later than the rest of the heart, forcing it to beat appropriately in sequence. While a simple concept, this new technology has led to tremendous improvement in quality of life for many patients worldwide. Not all patients with heart disease are candidates for this technology, but for those with significant weakening of the heart muscle and evidence of dyssynchrony, it is truly revolutionary.
Biventricular pacing is used often in conjunction with an implanted defibrillator, a device that detects abnormal heart activity and corrects it by delivering a high-energy shock directly to the heart. The technology from both is integrated into a single, small, implantable device and is recommended in patients with a high risk of certain life threatening heart rhythm abnormalities.
Biventricular pacemakers and defibrillators are implanted by a relatively simple, low-risk surgery, typically performed in one to two hours under a combination of local anesthetic and light sedation. This procedure involves only a small incision for implantation of the device under the skin; open-heart surgery is not required. Restrictions and recovery time after the implant are minimal. The implanting physician, called an electrophysiologist, is a cardiologist with special training in the treatment of heart rhythm problems and related surgical techniques.
While heart disease and congestive heart failure can lead to significant limiting symptoms, technological advances such as biventricular pacing and defibrillators are now offering opportunity for great improvement in quality of life for patients and making great strides in reducing overall mortality.
Todd J. Rudo, MD, is a board certified cardiac electrophysiologist with Main Line Cardiology Associates and is on staff at Paoli Hospital.
Pub Date: September 2008
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