Pacing to Treat Congestive Heart Failure

The use of pacing therapy to treat congestive heart failure (CHF) is under investigation. Because CHF is not an approved indication for pacing, Guidant does not recommend the use of pacemakers to treat CHF patients.

Treatment for congestive heart failure (CHF) currently is a subject of intense interest because CHF is such a widespread problem, according to Leslie A. Saxon, M.D. CHF, affecting more than 3 million people in the United States, "is the single most frequent cause of hospitalization in patients over age 65," she said. "Each year 400,000 new cases are diagnosed and 40,000 people die from this disease. These numbers continue to rise as patients are living longer, because we are better able to treat their hypertension and myocardial infarction."

Dr. Saxon noted that medical therapy for CHF has advanced significantly in the past 10 years from offering palliation to prolonging survival. The medications most frequently used are angiotensin-converting enzyme (ACE) inhibitors, diuretics, digoxin and nitrates. "Most recently, in a subset of patients with CHF, beta blockers appear to prolong survival.1 However, even with all the advances in drug therapy, mortality remains very significant, at about 10% to 20% annually. And it’s important to mention that even patients who receive maximal medical treatment – and whose survival is prolonged – continue to be symptomatic.

"Once a patient’s function is severely compromised, left ventricular assist devices [LVADs] can of course be of some help. Transplantation is another option, but only for a small minority, since patients on the waiting list outnumber donor hearts by about 20 to 1."

Dr. Saxon explained that because LVADs and transplantation are reserved for – but can help only a minority of – the most debilitated patients, and because drug therapy cannot alleviate all the symptoms of CHF, researchers continue to look for better answers. "We need to improve both cardiac performance and quality of life for all CHF patients. This is why many of us are turning our attention to pacing – to see whether novel pacing modalities will benefit patients who are already on optimal drug therapy.'' Leslie A. Saxon, M.D.,