Around a million Britons have heart failure, where the heart is unable to pump blood properly around the body.
But a new type of device can help patients who don’t respond to standard treatments.
Retired hotelier Peter Jenkins, 79, from Locks Heath near Southampton, has benefited, as he tells SOPHIE GOODCHILD.
THE PATIENT
My hobby is yacht racing, so I’ve always been fit and active. But the stress of working long hours triggered type 1 diabetes which damaged my blood vessels.
This led to four heart attacks; the first in 1991, the last in May 2012.
The fourth time, my wife Pat, 69, found me unconscious on the floor.
I needed six small mesh tubes (stents) put into my blocked arteries to open them up.
Retired hotelier Peter Jenkins, 79, from Locks Heath near Southampton, has benefited from a new device called an implantable cardioverter defibrillator
I also needed a pacemaker because I had heart failure — the heart attacks had caused scarring to my heart muscle, so it was too damaged to pump blood properly around the body and the lower chambers of my heart were beating out of sync.
The pacemaker sends electrical impulses into my heart to correct my heartbeat.
Despite taking prescription drugs to make my heart muscle contract better, my breathing got gradually worse after each attack.
The pacemaker should have improved my symptoms, but five weeks after my fourth heart attack, I was still in hospital because my breathing was so bad — I couldn’t even get out of bed and when I was discharged, I had to depend on Pat to take me to the loo.
Are YOU stressed out by the election?Try yoga, therapists…
Is your bread REALLY gluten-free? 1 in 8 items designed for…
Student who was left unable to walk or talk following a…
Teenager with an ingrown toenail pays £5,000 to have her leg…
I also had fluid retention because the heart failure meant my legs were permanently swollen. I was virtually bed-bound.
A test in September 2012 confirmed how bad my heart failure was and I was scared I might die.
The doctors replaced my pacemaker with an implantable cardioverter defibrillator (ICD), which is like a pacemaker but if my heart stopped, it would restart it using electric shocks.
However, my health didn’t improve and by October 2014, I could only walk 50 yards.
My GP referred me to a consultant at University Hospital Southampton, Andrew Flett, who said he could give me a special new ICD that would make the blood pump through my heart more efficiently because it had three leads going into the heart instead of the usual two.
Peter has suffered four heart attacks; the first in 1991, the last in May 2012. The fourth time, his wife Pat, 69, found him unconscious on the floor
Plus, one of the leads fired out electrical pulses from two points, not just one, treating a wider area of the heart muscle. I had the 80-minute procedure on December 4, 2014. I was sedated, but awake.
I immediately noticed the difference in my breathing — it was like a switch had been turned on. I was discharged later that day.
My ICD has given me my life back: my breathing is normal and my legs are no longer swollen. My life has improved beyond comparison.
THE SPECIALIST
Dr Andrew Flett is a consultant cardiologist at University Hospital Southampton NHS Foundation Trust.
The most common trigger for heart failure is a heart attack: the blood supply to the heart is compromised, damaging the muscle and causing scar tissue.
The remaining healthy muscle has to pump harder to compensate, triggering symptoms such as shortness of breath, swollen legs, fatigue and lethargy.
Drugs are the first-line treatment.
Although drugs are very effective in treating heart failure, two-thirds of patients may not get better using drugs alone
There are three types: beta blockers, which reduce any increase in heart rate, ACE inhibitors, which reduce high blood pressure, and diuretics, which remove excess fluid (the body tries to retain fluid to try to make blood flow faster).
Although these drugs are very effective, two-thirds of patients may not get better using drugs alone.
The standard approach is to try drug therapy for six months; then we run tests to check the amount of blood the heart pumps in a beat.
A healthy person pumps out 50 to 70 per cent of the blood in the heart.
If it’s less than 35 per cent — as was the case with Peter -—then the heart failure is severe. The patient is at risk of a cardiac arrest where the heart stops pumping or just quivers uselessly.
That’s because the heart’s electrical rhythms can ‘short circuit’ around scarred heart muscle triggering an abnormally rapid heart rate (tachycardia) and then a cardiac arrest.
NICE recommends anyone with severe heart failure has an implantable defibrillator device (ICD) — essentially a minicomputer that is continually checking for abnormal beats.
Like a pacemaker, an ICD corrects abnormal rhythms using tiny pulses of energy to ‘pace’ the heart normally — the pulses are emitted by an electrode positioned on the tip of each of the ICD’s two thin leads.
An ICD differs from a pacemaker in that it can also kick start the heart in the case of a cardiac arrest.
NICE recommends anyone with severe heart failure has an implantable defibrillator device (ICD) — essentially a minicomputer that is continually checking for abnormal beats
The leads are positioned via a vein into the right side of the heart — one goes into the top chamber, the right atrium, the other goes into the lower chamber, the right ventricle.
If the heart skips beats, pulses of energy are delivered to the heart wall. The ICD can sense the top chamber contracting and — if the lower chamber fails to respond — will send out pulses to the right lower chamber.
But in some patients, the left lower ventricle also beats out of time with the lower right. So treating just the right side is insufficient to get their heart beating normally.
For these patients we use cardiac resynchronisation therapy or CRT.
This is an ICD with an extra lead placed in the left ventricle which has to pump blood around the whole body — the right ventricle only sends blood to the lungs.
The other difference between this ICD and a standard device is that the third lead has four electrodes at its end, rather than one, spaced 45mm apart.
We decide which one of the four electrodes will be most effective by testing each during surgery and the ICD is configured to send pulses down this one.
If the heart skips beats, pulses of energy are delivered to the heart wall. The ICD can sense the top chamber contracting and send out pulses to the right lower chamber
Even with CRT, a third of patients still don’t respond, possibly because scar tissue is still preventing the electrode from functioning properly.
For this group of patients, we can use a new approach called multipoint pacing (MPP). Instead of sending pulses through one electrode, we activate two.
This increases the chance of them being positioned in a good place and means we can stimulate a much wider area of the left ventricle.
WHAT ARE THE RISKS?
As with all operations, there is a risk of bleeding or infection.
The battery life is reduced with a CRT-D with MPP technology.
‘The battery in a standard implantable cardioverter defibrillator or pacemaker lasts around seven years,’ says Dr Flett.
‘With this it’s about six because you’re delivering more energy.
‘So you may need another procedure to replace the device when the battery runs out.’
Commenting on the technology Dr Mike Knapton, associate medical director of the British Heart Foundation says:
‘MPP is an improvement on existing technology and needs to be adopted more widely by the NHS for everyone suitable to benefit.’
We test all four electrodes during surgery and switch on the two that give the best results.
To implant the new device first we removed the ICD Peter already had. But the existing two leads (one to the right ventricle, one to the right atrium) were left in place, then the third lead was positioned into a vein that lies over the surface of the left ventricle.
We positioned the lead with the help of X-ray images and connected it to the CRT-D. As soon as the two electrodes on the lead went live, his blood pressure rose from low (90/60) to normal (110/70).
Peter was also given a wireless device that he plugs in at home — this device ensures the CRT-D is working properly and feeds information via a phone network to technicians who check the data daily, so patients do not have to visit hospital for check-ups.
The response rate to traditional CRT is around 70 per cent. But a study published this year showed that CRT-D with MPP when placed in the best position worked effectively in nearly nine in ten patients. Improvements included being able to walk further and decreased breathlessness.
A CRT-D procedure costs between £12,000 and £25,000.