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
(Our Organization
is not responsible for the content of Internet sites.)
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)
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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
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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