DEC. 18, 2000 | Physicians at the University of Arkansas for Medical Sciences (UAMS) Medical Center are investigating an innovative new therapy for advanced heart failure that is intended to make sick hearts beat more effectively. If successful, the new heart
resynchronization therapy could augment medications in treating the debilitating symptoms of heart failure, such as fatigue, difficulty in breathing, dizziness and an uncomfortable swelling of feet and ankles.
Joe K. Bissett, M.D., is professor of internal medicine at UAMS. Jacob Joseph, M.D., is assistant professor of internal medicine, director of the Heart and Lung Center, and director of the Heart Failure Program at UAMS. Drs. Bissett and Joseph also are staff physicians at the Central Arkansas Veterans Healthcare System (VA).
Their therapy involves an implanted device that delivers tiny electrical impulses. Implantation of the InSync device, under the skin in the chest area, is done with a small incision and local anesthesia, not the major open-chest surgery used in earlier procedures to access the left side of the heart. Two insulated wires from the device are then threaded through veins to contact points inside the right atrium (upper chamber) and ventricle (lower chamber). A third wire is maneuvered through a vein on the heart’s surface that leads to the left ventricle.
The device stimulates the right and left chambers of the patients’ hearts to beat in a synchronized fashion in an effort to supply more freshly oxygenated blood to meet their bodies’ metabolic needs. At the same time, the patients continue on current drug therapy to treat other aspects of the disease.
Drs. Joseph and Bissett are offering heart resynchronization therapy to selected patients in this region as part of a national clinical trial. A team led by Tamin Antakli, M.D., a cardiothoracic surgeon, and Dr. Bissett perform the procedure of implanting the device. Patients enrolled in the clinical evaluations will receive the new Medtronic InSync device that is specially designed to provide the impulses that restore synchronous contraction of the right and left sides of the heart. However, the clinical plan provides that some patients will not receive the resynchronization impulses from their devices for several months so that their conditions can be compared with those of patients who do.
The first such device implantation in Arkansas was recently carried out successfully at the VA hospital in Little Rock. A second device was recently implanted successfully at UAMS Medical Center.
The medical need for heart resynchronization therapy to treat advanced heart failure is a serious one. Heart failure today affects five million people in the United States, with 75 percent of this group over the age of 65. About 500,000 heart failure cases are newly diagnosed annually. U.S. hospitalizations for heart failure total more than 6.8 million days a year, with the cost of treating this disease reaching more than $38 billion annually. Up to 50 percent of those with advanced heart failure develop abnormalities of the heart’s electrical impulses which control the heart’s contractions and it is those patients who the Medtronic InSync device is designed to help. The therapy has been shown to benefit many patients in European clinical evaluations which began in August, 1997.
UAMS Medical Center is nationally recognized for providing comprehensive care for heart diseases including advanced heart failure, as indicated by the 29th ranking in a recent U.S. News and World Report ranking of the best heart programs in the country. Participation in the resynchronization study is a reflection of that commitment, says Dr. Joseph.
Three pacemaker wires threaded through veins pace the right upper, and right and left lower chambers of the heart in therapy in clinical trials at UAMS.
Links in this Article
UAMS Medical Center: www.uams.edu/medcenter
UAMS Heart Failure Program: www.uams.edu/cardiology/realpage.htm
U.S. News and World Report Hospital Rankings: www.usnews.com/usnews/nycu/health/hosptl/tophosp.htm