June 11, 2001
Leon uses new therapy to put sick hearts in sync
By Shannon Cloud
Heart failure is a debilitating illness that afflicts nearly 5 million
Ameri-cans, with 400,000 new cases diagnosed each year. Once the disease
reaches advanced stages, approximately half its victims will die within
a year, and the remainder face an uncertain prognosis.
Angel Leon, David DeLurgio, Jonathan Langberg and Andrew Smith, cardiologists
at Emorys Carlyle Fraser Heart Center, are leading investigators
in an innovative therapy for advanced heart failure. The team collaborates
with other heart specialists worldwide on a therapy intended to make sick
hearts beat more effectively.
If successful, the new therapyknown as cardiac resynchronizationcould
complement medications in treating the symptoms of heart failure, such
as fatigue, difficulty in breathing, dizziness and uncomfortable swelling
of feet and ankles.
The technique uses an implanted device similar to a pacemaker to deliver
tiny electrical impulses that stimulate both the left and right chambers
of a patients heart, allowing it to beat in a more synchronized
fashion. The patient continues current drug therapy to deal with other
aspects of the disease.
The pacemaker/cardiac resynchronization system consists of an implantable
pacemaker and electrical conduction wires, known as leads, to stimulate
both heart chambers. The newest version of the device can control the
contractions of the right and left sides of the heart independently and
features special diagnostic capabilities.
Results from the first large-scale investigation of cardiac resynchronization
support the novel therapy. Investigators presented the results of the
trial at the American College of Cardiology meeting in Orlando, Fla.,
in March. The Crawford Long/ Emory team led the country in enrolling patients
in the landmark study.
Leon was the first physician in Georgia to implant the newest version
of the resynchronization device, the InSync III system. Along with William
Abraham of the University of Kentucky, Leon heads a team of investigators
at 30 leading U.S. medical centers who are using the new pacemaker to
gather clinical data for consideration by the U.S. Food and Drug Administration.
Physicians at selected European and Can-adian medical centers also will
evaluate the new system.
I can tell you that before I received the device, I experienced
fatigue, difficulty climbing stairs and chest pains whenever I faced stressful
situations, said Roger Seklecki, a physician at University Hospital
in Augusta, Ga., who himself has been implanted with the device.
My cardiac status has improved greatly, Seklecki said. I
have a great deal more energy, and Im so much more capable of handling
physical and emotional stress.
The cardiac resynchronization idea seems simple but actually involves a challenge within a challenge.
Physicians have long been skilled at sending electrical impulses to the
right side of the human heart, but to stimulate and resynchronize both
sides, an additional lead must be maneuvered from a vein near the collarbone
into the right upper heart chamber, then into a vein that goes behind
the heart to the left lower chamber.
In December, Leon performed the worlds first implant of a new over-the-wire
lead for use in small and tortuous heart veins.
The small size of the new lead and use of the over-the wire system allowed me to position it precisely where I wanted, and much more quickly and effectively, Leon said.