Emory Report

February 14, 2000

 Volume 52, No. 21

New pacemaker another option for patients

By Lillian Kim

A new type of pacemaker that stimulates both sides of the heart has greatly improved the quality of life of its recipients and, in some cases, eliminated the need for a heart transplant.

Doctors at Emory are using a biventricular pacemaker that connects to both ventricles of the heart, instead of only one, to treat congestive heart failure--with impressive results. People who previously depended on intravenous drugs to keep their hearts going, or who couldn't so much as walk around the house without getting winded, now are able to discontinue medication and enjoy normal daily activities.

"It's the most dramatic treatment I've seen in cardiology in the last decade," said Jonathan Langberg, professor of medicine and director of cardiac electrophysiology. Langberg is studying various versions of the biventricular pacemaker along with cardiologist Andy Smith, director of Emory's Center for Heart Failure Therapy, and electrophysiologists Angel Leon and Dave DeLurgio from Crawford Long. The pacemakers being studied are manufactured by Guidant, Medtronic and Pacesetter.

Traditional cardiac pacemakers use one electrical lead to prevent the heart from pausing or beating too slowly. People with congestive heart failure have more serious problems, however; their heart muscle is weak, and the electrical system that regulates the heart is damaged.

As a result the ventricles--the chambers of the heart that pump blood into the lungs and the rest of the body--do not contract in sync, greatly lessening the force of the heart's pumping action.

The biventricular pacemaker sends electric impulses to both ventricles, coordinating their pumping action and making the heart more efficient.

A modified version of the biventricular pacemaker, the implantable cardiac defibrillator (ICD), not only paces the heart but can actually restart it if it goes into arrest. The ICD is used in people at risk of developing life-threatening heart arrhythmia.

Implanting the biventricular pacemaker requires two to three hours of surgery and a 24-hour hospital stay, Langberg said. Doctors have implanted the device in 50 patients at Emory Hospital and Crawford Long with excellent results. One of Langberg's patients, a woman who previously required an electric wheelchair because of her seriously weakened heart, now walks two miles a day.

"It's hard to describe how gratifying it is to see these patients get their lives back," Langberg said. "These patients, by and large, have been treated with the best medications we have and, despite that, have disabling symptoms. Other than continuing their limited existence with the best medicines, the only other alternative is heart transplant. So this offers an important option to people who otherwise don't have many options."

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