New Hope for an Ailing Heart

By Christine Gorman

This year, some 550,000 Americans will learn that they have congestive heart failure. While that might sound like a death sentence--particularly if you fixate on the word failure--it's not. Cardiologists have got pretty good at treating the degenerative condition with drugs that prolong life and reduce symptoms.

Now comes word, from a report in last week's New England Journal of Medicine, that almost a third of patients with heart failure may also benefit from having a pacemaker implanted in their chest. But before we get into that, we need to clarify what heart failure is--and what it is not.

First what heart failure is not. It's not a heart attack, in which something, usually a clot, blocks the flow of blood through one or more of the coronary arteries--though the damage from a heart attack can be severe enough to cause heart failure. It's also not cardiac arrest, in which the electrical signals that govern the heart become so disorganized the heart can no longer pump blood through its chambers--though patients with heart failure are at much greater risk of dying from cardiac arrest.

Heart failure occurs when the heart muscle becomes so weakened--either by infection, untreated high blood pressure, heart attack or aging--that it no longer pumps blood efficiently. "The heart can't pump enough blood to meet all the body's needs," is how Dr. Joshua Hare at the Johns Hopkins Medical Institutions in Baltimore, Md., describes it. The problem usually develops over several years, leading to fatigue, shortness of breath and a buildup of fluid, or congestion, in the body. When the degenerative process is sufficiently advanced, a heart transplant may be called for.

In about 30% of heart-failure patients, the damage to the heart also interferes with the electrical signals that coordinate the contraction of the left and right ventricles--its main pumping chambers. The timing is off--as can be measured on an electrocardiogram--but the blood is still moving. Would synchronizing the electrical signals with a pacemaker, doctors wondered, reduce the problems associated with heart failure in these patients?

The answer, according to the New England Journal study, is yes. Heart-failure patients with a resynchronizing pacemaker are less likely to wind up in the hospital than their counterparts who receive medication alone. "The device does not replace drug therapy," says the study's principal investigator, Dr. William Abraham of the University of Kentucky College of Medicine. "But we have seen patients who improved so much that they didn't need a heart transplant."

Getting the resynchronizing pacemaker implanted is expensive--about $20,000--and there can be serious surgical complications. Moreover, studies to determine whether it prolongs life won't be ready for another couple of years. But at least congestive-heart-failure researchers are moving in the right direction. Now if only they could come up with a less scary name for it.

For more info, search for "heart failure" on medlineplus.gov