A team of Emory researchers (from ECLH's Carlyle Fraser Heart Center and Emory University School of Medicine Divisions of Cardiothoracic Surgery, Cardiothoracic Anesthesia, and Cardiology) have successfully employed an innovative alternative technique for biventricular resynchronization that can be successfully performed in this high-risk patient group with minimal risk and no exposure to potentially harmful ionizing radiation.
Considered the first major therapeutic breakthrough for heart failure patients since the development of specialized heart failure drugs, biventricular resynchronization therapy uses a special pacemaker to stimulate the heart's ventricles to beat at the same time. A small pulse generator (about the size of two stacked silver dollars) is implanted beneath the skin in the shoulder region and delivers synchronized electrical stimulation to three chambers of the heart through insulated wires (leads), allowing more efficient pumping of blood throughout the body.
The result for many patients is a dramatic improvement in exercise capacity, quality of life and functional status, allowing those who previously had limited ability to perform common tasks to resume a more normal daily routine. Some patients who were waiting for heart transplants have been taken off the transplant list due to their improvement.
" However, although the device can be successfully placed this way in most patients, technical difficulties may preclude establishing a connection to the left ventricle in some people because of the difficulty in getting the pacing wire into the vein of the heart, " Dr. Lattouf explains. "We are very excited about our new technique because it allows us to overcome that problem using tiny incisions."
He explains that one incision only 1/2 inch long and two to three pencil-sized holes are made in the chest wall under anesthesia. Then a special camera and small grasping tool are inserted to allow visualization and connection of the lead to the heart.
"The advantages to this approach include no exposure to ionizing radiation through x-rays, and no exposure to dye -- which can damage the kidneys," says Dr. Lattouf. "Currently, we offer this technique to patients who failed the percutaneous (under the skin) route. However, some doctors are now considering this as a first option because it takes a lot less time to do."
Electrophysiologist Angel Leon, MD (a co-author of the paper presented by Dr.. Lattouf at the ACC meeting) implanted the first cardiac resynchronization therapy system, the Medtronic InSync device, following FDA approval at the ECLH Carlyle Fraser Heart Center in Atlanta in 2001. In all, more than 800 of these devices have been implanted in patients with CHF at Emory Hospitals - more than any other medical center in the world.
Other Emory cardiologists who participated in the research presented by Dr. Lattouf include: Vinod H. Thourani,MD; David B. DeLurgio, MD; Fernando V. Mera, MD; Kathryn L. Glas,MD and Robert A. Guyton,MD.