Nearly 6 million people in the U.S. suffer from heart failure, which occurs when the heart cannot pump enough blood and oxygen to support other organs. Some patients qualify for cardiac resynchronization therapy (CRT), a type of pacemaker that doctors program to send electrical impulses through the leads to help the heart contract better and improve blood flow. Physicians traditionally have placed these leads randomly on a patient’s left ventricle and responses to this therapy have varied with approximately one third of patients not benefitting from it.
“This study changes the way we practice device implantation for cardiac resynchronization therapy and the way we take care of our patients. This new, non-invasive imaging approach guides the lead placement to the optimal site and results in better overall outcomes for patients,” said Samir Saba, M.D., UPMC’s director of cardiac electrophysiology and principal investigator on the study, which was funded by the American Heart Association. Dr. Saba presented the study’s findings at Heart Rhythm 2012, the Heart Rhythm Society’s 33rd Annual Scientific Sessions in Boston on May 11.
Study researchers used a special cardiac ultrasound technique, known as “speckle tracking echo,” which was pioneered at UPMC Presbyterian by co-investigator John Gorcsan, M.D., to map the optimal site of left ventricular lead placement. CRT patients were randomized either to have the left ventricular lead placed according to echo guidance or routine lead placement by X-ray alone. Researchers then followed patients to determine whether they had been hospitalized for heart failure, had a ventricular assist device implanted, had a heart transplant or died.
Of the patients in the study, 110 had the echo-guided left ventricular placement and 77 were done randomly as per the current standard of clinical care. During a mean follow-up period of about 1.8 years, patients implanted with the echo-guided approach had significantly fewer deaths or heart failure hospitalizations and exhibited more improvement in echocardiographic parameters over time compared to the control patients.
“Echo guidance of left ventricular lead positioning is an exciting new advance in the delivery of pacing therapy for heart failure patients. Patients who had their pacemaker leads directed toward the optimal region based on echo activation mapping improved response rates and important patient outcomes in this study,” said Jagmeet Singh, M.D., a cardiologist and pacing therapy expert at Massachusetts General Hospital in Boston who was not involved in the study.
Other collaborators on the study were David Schwartzman, M.D.; Sandeep Jain, M.D.; and Evan Adelstein, M.D.; Josef Marek, M.D.; Pamela White, R.N.; Olusegun A. Oyenuga, M.D.; and Prem Soman, M.D., all from the University of Pittsburgh School of Medicine.
Heart Rhythm 2012 is the most comprehensive educational program for heart rhythm professionals, featuring more than 200 educational sections and more than 130 innovative products and services.
Jennifer C. Yates