Two
Pacemakers Better For Some Heart Patients
Quality
Of Life Improves, Study Finds
A two-pronged attack on irregular electrical
activity in the heart can improve the quality of life in certain people
with heart failure, a new study says.
Study participants who received two pace-making
devices, one to correct how the heart pumps and another to keep its
beats regular, were more likely to report gains in their overall quality
of life after six months than those who got only one pacemaker. They
also were able to exercise better and had a general improvement in their
daily activities.
The study, reported
in the Journal of the American Medical Association (JAMA),
was not able to determine if the therapy prolonged life or significantly
eased heart failure.
"The combination
of [the two pacemakers] does, in fact, yield very nice outcomes,"
says Dr. Clyde Yancy, a spokesman for the American Heart Association
(AHA) who is familiar with the findings.
People
with Heart Failure Can Stay Active
Quality-of-life
issues and the ability to exercise are increasing concerns of people
with heart failure, adds Dr. Yancy, a cardiologist at the University
of Texas Southwestern Medical Center.
Heart failure affects
as many as 5 million Americans, directly and indirectly, accounting
for 280,000 deaths each year, according to the AHA.
The condition involves a gradual weakening of the heart
muscle, depriving the rest of the body of blood. Heart failure often
includes a buildup of fluid in the lungs that strains breathing.
Drugs including beta-blockers, diuretics, and ACE inhibitors
can help ease the symptoms of the ailment, but it has no cure.
About 10 percent of people with heart failure have an
electrical anomaly in their ventricles, or pumping chambers, that is
a major cause of death. Cardiac resynchronization therapy, or CRT, is
intended to reduce that risk by making the muscles contract more efficiently.
Implantable defibrillators (ICDs) even out abnormal
heart rhythms that are linked to sudden death. Roughly 5 percent of
heart-failure patients in the US, or about 250,000 people, are good
candidates for treatment with both devices.
The study followed 369 men and women with moderate-to-severe
heart failure that failed to respond well to medication. Of those, 187
had both CRT and an implantable defibrillator that were functioning,
while the rest had a working defibrillator but the CRT had not been
activated.
After six months,
more patients with both pacemakers reported improvements in their quality
of life than those with defibrillators alone. They were also more likely
to show gains in certain measures of exercise capacity, though unlike
in previous studies CRT did not help people on a test of timed walking.
Combined
Pacemakers Not for Everyone
Not everyone benefited
from the combined pacemakers. While 52 percent of people who received
the devices showed clinical improvement, one-third worsened. Adding
a CRT also raises the risk of complications, which occurred in almost
half of those who got both devices.
Still, the study suggests that the dual approach does
help patients feel better and does not interfere with the action of
the defibrillator, the researchers say.
"Patients who
get the combined treatment get some of the important benefits of cardiac
resynchronization, and at the same time the defibrillator function of
the combined devices seems to work well," says Dr. David J. Bradley,
a cardiology fellow at the Johns Hopkins University School of Medicine
and author of an editorial accompanying the JAMA article.
Although the latest study was not designed to detect
a reduction in death rates with the combination treatment, Dr. Bradley
says previous studies hint that one exists, at least in the short-term.
"There are some encouraging findings from uncontrolled
trials, and patients seem to tolerate this therapy for more than two
years. But what we want to see is a long-term randomized trial,"
he adds.
Always consult your physician for more information.
Online
Resources
American
Heart Association
Centers
for Disease Control and Prevention (CDC)
Journal
of the American Medical Association (JAMA)
National
Heart, Lung, and Blood Institute (NHLBI)
National
Institutes of Health (NIH)
|
July 2003
Two
Pacemakers Better For Some Heart Patients
People
with Heart Failure Can Stay Active
Combined
Pacemakers Not for Everyone
What
You Want to Know about Pacemakers
Online
Resources
Find
a St. John's Mercy Physician
In
Other News About Your Heart Health:
What
You Want to Know about Pacemakers
What
devices may put my pacemaker at risk?
Today's
pacemakers are engineered to withstand interference from analog
cellular phones. However, in some cases, digital cellular phones
may interfere with pacemakers. According to the American
Heart Association (AHA), a group of cellular phone companies
is studying the newer cellular phones with new frequency and their
effect on pacemakers.
Metal
detectors like those used at airports are unlikely to cause clinically
significant problems, the AHA says. It does recommend
that an individual with a pacemaker not stand near the metal detector
or allow the scanner to hold the device close any longer than necessary.
Do
pacemakers need to be adjusted periodically?
Some
pacemakers may need to be adjusted if a person's medical condition
or lifestyle changes. Your physician will instruct you about the
schedule of follow-up visits you should keep based on your condition
and type of device.
In
addition, you may participate in telephonic assessment of your device
on a periodic basis.
When
replacing a pacemaker, are the leads also replaced?
Leads
are the actual wires that carry the electrical charges to areas
of the heart.
If
the original leads are functioning properly, in most cases, they
can be left in place and reattached to the new pacemaker.
When
do I have to replace my pacemaker?
Most
pacemakers will last between 8 and 10 years, after which the entire
pacemaker or its battery and/or wire(s) need to be replaced.
Replacing
a pacemaker may be done on an outpatient basis or may include an
overnight stay in the hospital.
Can
I travel with my pacemaker?
Yes,
you can travel with your pacemaker and drive a car. You should be
sure to always have your pacemaker identification card with you
wherever you go.
Can
I exercise with a pacemaker?
Upon
consulting your physician, you may be able to enjoy moderate exercise
with your pacemaker, including housework and yard work.
Will
I feel the pacemaker?
At
first, you may feel the weight of the pacemaker in your chest. However,
over time, most people become accustomed to the pacemaker.
The
generator is very small, about the size of two silver dollars stacked
on top of each other, and weighs about an ounce or less, depending
on the make and model of the device.
Always
consult your physician for more information.
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