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Radical approach to cardiac resynchronization shows promise

Correcting the timing of heart contractions through cardiac resynchronization therapy can be a lifesaver for people with advanced heart failure. But the procedure, as it is done today, fails in about 15 percent of patients.

Using a minimally invasive approach that may startle heart specialists, a medical-student researcher developed a technique that--at least in pigs--overcomes the procedure's main shortcomings. Steven Mickelsen, a third-year medical student at the University of New Mexico School of Medicine, performed the research during a year away from medical school as a Howard Hughes Medical Institute-National Institutes of Health research scholar at the National Heart, Lung, and Blood Institute.

Proper timing of the pumping action between the lower chambers of the heart, which send blood to the lungs and the rest of the body, is important for the heart to work effectively. When this timing goes awry in patients with heart failure, implantation of a cardiac resynchronization device can help.

A critical step in cardiac resynchronization therapy is the placing of leads--thin wires that resynchronize the beating of the left and right ventricles--onto the heart itself. The standard approach to lead placement on the left ventricle is through the blood vessel on the heart's surface, which is technically challenging in some patients and limits lead placement to where blood vessels are. A substantial number of cardiac leads fail to work because they are positioned poorly, or they become dislodged. When lead placement fails, the most common next step is open chest surgery to place the lead--an invasive procedure that requires a surgeon and general anesthesia.

Under the mentorship of Elliot McVeigh of NHLBI's Laboratory of Cardiac Energetics, Mickelsen searched for a better way to position the critical leads, testing his new technique in small pigs whose hearts are about the size of a human's. Using a catheter inserted through the pig's jugula
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Contact: Jennifer Donovan
donovanj@hhmi.org
301-215-8859
Howard Hughes Medical Institute
18-Oct-2005


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