Pacing the Beats

Patients with heart failure may benefit from minimally invasive interventional treatments involving implantable devices that do not require major surgery. These devices - defibrillators, pacemakers, and biventricular pacemakers - aim to correct a heart rhythm that is irregular, too slow, or too fast.

"Our goal is to help our patients feel better, no matter what their age," says cardiac electrophysiologist Tina Sichrovsky, M.D., who has implanted devices into patients in their 90s. "These devices are not a replacement for medications but can be used as an adjunct to them."

The patient is anesthetized with conscious sedation while the incision area under the collarbone is numbed with a local anesthetic. The procedure does not require a large chest incision; the device and wires are placed into the heart via the veins. Typically, patients stay just one night in the hospital.

Each type of device is specialized to treat a certain type of rhythm abnormality:

• A pacemaker is used to treat a very slow heart rate by sending small painless electrical impulses to start each heart beat.
• An implantable cardioverter defibrillator (ICD) is used to treat very fast life-threatening heart rates by delivering either painless pacing impulses or, if necessary, a moderately painful shock.
• A biventricular pacemaker combines a pacemaker and defibrillator by adding an extra pacing wire into the coronary sinus vein. This device sends impulses to the right and left sides of the heart to synchronize the pumping action of the left and right ventricles and improve symptoms of heart failure.

The latter two devices can be monitored remotely by a patient's cardiologist via a small machine left on the nightstand that is programmed to record information while the patient sleeps. A computer notifies the physician if the patient experiences any rhythm abnormalities, defibrillation (delivered shock), lead malfunction, or excess fluid. The patient usually sees his/her physician every eight months for a check-up.