Sunday, June 7, 2009
Cardiac patients get new hope in cardiac resynchronization therapy (CRT)
New therapy set to bring smiles for cardiac patients
Chandigarh, June 7 ( ).Till six months ago 45-years-old Radhe Shyam, businessman from Karnal, was bed-ridden and dependent on others to take him for daily ablutions or even move around house.
Today he is an affluent businessman running his poultry business, goes to office, climbs up to 3 stairs and can easily walk for 2 to 3 km.
All this happened after he successfully underwent biventricular pacemaker implant, a cardiac resynchronization therapy (CRT) at Fortis Hospital under Dr HK Bali, MD, DM, Director, Cardiology Fortis Hospital and ex PGI cardiologist.
He adds that biventricular pacemaker is a type of implantable pacemaker designed to treat heart failure. This therapy becomes necessary when small chamber of Heart and two lower chambers of heart do not pump in unison. Such pacemaker helps these chambers to contract more efficiently. This pacing is called cardiac resynchronization therapy (CRT).
Biventricular pacemakers are relatively new. Previous pacemakers were used to pace only right side of heart. They were used when heart beat too slowly. By contrast, biventricular pacemakers pace the atrium and both right & left sides of heart.
They do not increase heart rate, but rather stimulate left and right chambers simultaneously. This helps left chamber pump blood more efficiently. These pacemakers do not increase heart rate unless needed when heart rate slows below a certain level.
Dr HK Bali says, “The CRT has offered a new hope of life for heart patients. Especially those, who have severe heart failure despite optimum medication and have certain echo and ECG criteria.
Quoting case of 70-years-old Kuldeep Kaur, a resident of Panchkula, Dr Bali says that she was admitted at Fortis hospital, Mohali three times in span of three months with severe heart failure. Twice she was required to be put on ventilator for treatment of lung congestion. Treating doctors diagnosed that she was suffering from symptoms of severe heart failure.
“Chambers of her heart were not synchronized. This reduced pumping efficiency of heart thereby reducing blood supply to various parts of body. Like Radhe Shyam, she too was treated with CRT,” says Dr Bali.
In Kuldeep’s case, biventricular pacemaker combined with an implantable cardioverter defibrillator (ICD) was used. This is for heart failure patients felt to be at high risk of sudden cardiac death due to some types of abnormal heart rhythms (ventricular tachycardia, ventricular fibrillation).
Unlike Kuldeep, Radhe Shyam had undergone angioplasty 10 years ago after suffering a heart attack. After symptom free seven years he again developed symptoms of worsening heart failure due to multiple asymptomatic small heart attacks.
Over next two years, he visited a number of leading hospitals in Delhi. “He was told that his heart had become extremely weak and there was not much hope for him. His symptoms continued to worsen and he became completely bed ridden,” tells Dr Bali.
He became dependent on others even for daily chores. Over span of few months he was admitted for 8 times in different hospitals for treatment. Each time he was given some treatment, discharged from hospital, only for the cycle to be repeated.
Six months ago, he was recommended CRT by having bi ventricular pacemaker implanted in his chest. Within fortnight of implant, his condition improved substantially. CRT has come as a boon and savior of people suffering from heart ailments.
Heart failure worse than cancer:
Dr Bali adds that heart failure is a problem worse than cancer. US analysis reveals that heart failure are estimated to afflict approx 5 million Americans and this number is expected to double within next five years. Also heart failure accounts for nearly 1 million hospitalizations annually, which are more than all forms of cancer combined.
“We Indians are at high risk population due to higher incidence of diabetes and hypertension. More patients survive short-term events and hence number of people who are at risk for developing heart failure subsequently is on rise,” says Dr Bali.
Another cause of worry for India is increasing life expectancy. Risk of heart failure increases dramatically with age. Heart failure affects approximately 10 of every 1,000 people over age of 65.
A word about CRT:
In CRT treatment an implantable device i.e.biventricular pacemaker is used to improve pumping efficiency of heart and increase blood flow to body. By improving blood flow, CRT may help to reduce heart failure symptoms and improve quality of life. CRT is intended to complement standard drug therapy, and dietary and lifestyle modifications.
The devices are implanted under skin in chest. Procedure is done under local anesthesia, so patient remains conscious. Device works silently, while patient can lead normal life.
Studies have shown that heart failure patients are at a higher risk for sudden cardiac arrest. Special CRT devices stop life threatening very fast heart rates by delivering mild electrical shock to patient.
As per study, patients with CRT implants had a 36% reduction in all-cause mortality, over 18 months, as compared with patients in control group.
These devices have come as boon for severely symptomatic patients of heart failure and in coming years their implantation is likely to increase markedly in our country, remarks Dr Bali.
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