HEALTHBEAT: Getting some heart failure patients on their feet

Monday, May 29th 2000, 12:00 am
By: News On 6

WASHINGTON (AP) -- Jim Kent was the most avid of outdoorsmen, constantly golfing or fishing or hunting. Then a mountain hike left
him gasping for air. Heart failure, doctors said. Within a few years Kent's heart was so weak he was housebound and on the waiting list for a transplant.

Almost 5 million Americans have congestive heart failure, where their hearts gradually lose the ability to pump blood. Drugs help many, but those like Kent whose hearts worsen despite medication have few options.

Now scientists are experimenting with a new pacemaker-like device called a "ventricular resynchronizer" that promises to help these struggling hearts beat more normally.

Kent is one of the few Americans to try one -- and today the 60-year-old Louisiana man is back on the golf course and off the heart transplant list. Prompted by such early promising results, scientists are hunting 2,000 more heart failure patients for a study to prove how well the experimental treatment, made by Guidant Inc., really works.

"Right now there's not a lot you can do for these patients," said Dr. Eric Prystowsky, electrophysiology director at St. Vincent
Hospital in Indianapolis. "This is very exciting."

Heart failure is not a heart attack. Nor does it mean the heart suddenly stops.

Instead, a heart weakened by age, damage from a survived heart attack or some other disease gets flabbier as it struggles to push
blood out to the rest of the body. Lacking oxygen, patients feel dizzy or faint.

Eventually, they're pressed even to walk across a room. Their legs swell. Fluid seeps into their lungs, blocking breathing.

Just half of victims survive five years. When medications fail, they have few options.

Enter the ventricular resynchronizer.

It's basically a souped-up and redesigned pacemaker. But it doesn't speed up a sluggish heartbeat like regular pacemakers do.

Heart failure causes the opposite problem -- the struggling heart beats faster to compensate for weakened pumping. And the heart's two bottom chambers, the ventricles, don't pump together in rhythm like they're supposed to.

The idea: Resynchronize the right and left ventricles so they pump at the same time, making that pumping more forceful. Then the
heart might not wear itself out pumping so fast.

Doctors thread three separate pacemaker wires, "leads" that deliver electricity, into a vein near the collarbone. Two leads are
popped down to the heart's right side, just like a routine pacemaker implantation. The breakthrough came when scientists figured out how to put a third lead on the more vulnerable left ventricle, so both sides can be sparked to pump together. It's tricky, requiring threading into just the right spot in a vein
lying on the ventricle's wall.

It's not a cure. But early results are promising, German scientist Dr. Angelo Auricchio told a recent meeting of the North American Society of Pacing and Electrophysiology. In a study of 42 severely ill Europeans, a single month's use of the device improved the heart's pumping efficiency by 15 percent, and significantly
increased patients' ability to walk. Longer use seems to be reducing hospitalizations.

Dr. Scott Higgins of Scripps Memorial Hospital in San Diego has implanted 60 Americans with the Guidant device. He says people once too weak to get out of bed now go shopping and do other routine activities. Kent was his best patient, shooting a hole in one last summer months after the implant.

"They're enjoying life more. That's a key advance."

Indianapolis-based Guidant, which developed the device at its facility in St. Paul, Minn., just began selling it in Europe. The company is recruiting 2,000 Americans at 80 hospitals for the so-called "Companion" study to prove its usefulness here. (Check for information.)

It's a hot field: Medtronic Inc. is developing its own ventricular resynchronizer, also called "biventricular pacing."

St. Jude Medical is creating another pacemaker-like device especially for heart failure worsened by the irregular heartbeat
atrial fibrillation.

The devices' long-term impact isn't proven. But Kent, the Port Allen, La., man, calls his implant life-changing. "It's nothing worse in the world than not being able to breathe ... But right now, nothing's too strenuous."