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 Emory’s 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 therapy—known as cardiac resynchronization—could 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 patient’s 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 I’m 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 world’s 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.