21 October 2015
A novel pacemaker that connects to multiple locations in the heart and provides a new treatment option for thousands of patients with abnormal heart rhythms, has been implanted by cardiologists at Royal Brompton & Harefield NHS Foundation Trust.
Experts at the Trust were the first in the UK to fit patients with the new cardiac resynchronisation therapy pacemaker (CRT-P), which enables multiple locations in the main pumping chamber of the heart (the left ventricle) to be paced. Pacemakers work by sending regular electrical pulses to the heart to help it achieve a normal rhythm and this process is known as pacing.
CRT-P devices deliver tiny pulses of electricity to ensure the heart chambers pump together in synchrony. When a heart is failing the chambers work independently of each other, making the heart ineffective. This causes breathlessness and oedema (swelling) due to fluid overload.
The new device, the Quadra Allure made by St. Jude Medical, is the first CRT-P to use leads with four electrodes to deliver electric signals to the heart, allowing different locations within the left side of the heart to be paced. This gives clinicians more options to adjust the therapy for each individual patient.
This quadripolar pacing system means clinicians can better manage the changing needs of heart failure patients without having to reposition the lead surgically.
Dr Tom Wong, consultant cardiologist and electrophysiologist at Royal Brompton & Harefield NHS Foundation Trust, said: “A third of patients don’t respond to normal CRT-P devices. It’s not known why this is the case, but this group of patients may be more likely to respond to a device that paces a number of locations in the left side of the heart at the same time. Multi-point pacing technology is already used in implantable cardioverter-defibrillators (ICD) but this is the first pacemaker to feature it.”
A study published in the European Heart Journal last year compared the technology with conventional bi-ventricular pacing therapy – with these devices, the leads are placed in the right atrium, right ventricle and left ventricle.
The research showed that the proportion of patients who responded to the multi-point pacemaker, and therefore experienced clinical benefits, improved by 19 per cent after 12 months. This could suggest that the technology may be of particular use to patients who do not respond to standard CRT-P devices. It also means that this novel pacemaker may improve the ability to tailor the pacing of the heart to the individual which might lead to fewer revision procedures.
The study also found there was an improvement in left-ventricular (LV) function in patients who were already classified as responders to CRT-P therapy.
Albert Derox, 85, was one of the first patients to have the device implanted at Royal Brompton Hospital. He had a conventional pacemaker fitted in 2011 but it failed to stop his breathlessness, which was caused by the unco-ordinated contraction of the chambers of his heart.
Mr Derox, from Surrey, said: “There’s been a definite improvement in how I feel now compared with how I felt with the previous pacemaker. Then, I’d become breathless climbing more than ten steps or walking up steep roads. I’d have to stop to take deep breaths before carrying on.
“Now walking and climbing up the stairs is much easier. I can walk 400 yards to the shops without having to stop to take a breath, which I could not have done before.
“Thanks to the improvement in my breathing, I have recently been able to restart the physiotherapy sessions I used to have in a swimming pool for unrelated back pain.
“A couple of months after having the new device implanted, I saw my consultant for a check-up and he commented on how my colour had improved. He is very impressed with the results from recent tests on my heart and said the pacemaker is working well.”