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Heart failure patients with worst heart function are good candidates for pacemakers

The pacemaker has taken on an increasingly important role in recent years. Originally used to fix electrical abnormalities in people with irregular heart rhythms, it is now in favor for heart failure patients as a way to "resynchronize" a weak and struggling heart.

In a study of 22 patients, Johns Hopkins researchers have found that those whose hearts have the largest amount of timing discord, and whose hearts are often weakest, are the ones that seem to benefit most from a pacemaker. Pacing therapy improved the heart's ability to contract and pump out blood by an average of 35 percent.

Study results were published in a recent issue of Circulation, an American Heart Association journal.

"The problem we set out to solve was determining which heart failure patients would respond best to pacemakers," says David A. Kass, M.D., lead author of the study and professor of medicine and biomedical engineering at Hopkins. "The devices are expensive and permanent, and the patients are so sick we can't afford to waste time."

In normal hearts, cells in the right upper chamber, or atrium, emit an electrical impulse that travels through the heart on a specified route through a small group of cells called the A-V node and along a track that divides into the right and left lower chambers, or ventricles. As the impulse travels down the right and left branches at the same speed, the muscle contracts, or beats, in a coordinated (nearly simultaneous) manner.

In some heart failure patients, however, there is a block in one branch, causing marked delay in contraction to a portion of the heart as the electrical impulse must now reach this region by a slow detour through the heart muscle itself. As a result, the heart "wobbles" and must struggle to send blood out to the body.

Kass' team likens the failing heart to an automobile engine. If the engine pistons aren't timed correctly, the car will still move but will have worse fuel econ
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Contact: Karen Infeld
kinfeld@jhmi.edu
410-955-1534
Johns Hopkins Medical Institutions
13-Jul-2000


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