Pioneering implant that can revitalise failing hearts
ANERVE-stimulating implant is to be offered to British patients with debilitating heart failure, giving hope to thousands for whom standard treatments offer no relief. The first British patient to be fitted with the pioneering electronic device had the surgery earlier this month. Within two weeks he was able to walk around the local store with his daughter, a simple task that the extreme fatigue and breathlessness caused by his condition had left him unable to manage before.
Three ‘massive’ heart attacks had left Kamar Zaman, 53, housebound due to heart failure and, despite being given the highest doses of standard drug treatments, doctors had been unable to improve his symptoms.
Speaking of his health before the operation, the former taxi driver and father-of-three from Luton said: ‘I could barely walk as far as the kitchen – I even struggled for breath while talking.’
His condition is now improving. He says: ‘My breathing is easier and I can walk further – last week, I was able to go to the supermarket and walk around.’
The battery-powered implant, called Barostim Neo, sits within the chest, below the collarbone.
A wire coming from a credit cardsized generator is threaded up beneath the skin so it sits beside one of the two carotid arteries, the main blood vessels in the neck.
This delivers electrical impulses to nerves in the neck known as baroreceptors, which regulate blood pressure. This stimulation is key in easing the strain on the heart caused by heart failure, leading to an improvement in symptoms.
Heart failure – when the heart does not pump blood around the body sufficiently – affects approximately 500,000 Britons.
The problem usually develops because the heart muscle is damaged, often by a heart attack. To compensate for reduced pumping power, the chambers within the heart respond by stretching to hold more blood.
This keeps the circulation moving, but in the long term the muscle weakens and loses more power.
In a healthy person, the baroreceptors measure blood flow, sending signals to the brain to adjust blood pressure accordingly by inducing the heart to beat faster, among other things. In people with heart failure, the baroreceptors sense a sluggish circulation as a fall in blood pressure and compensate by attempting to raise it.
This results in increased pulse and further strain and damage on an already weakened heart.
Patients are given medications to lower blood pressure and pulse, but in a minority this is not effective.
Worsening heart failure means blood is pumped through the lungs too slowly, starving the body of oxygen and leading to extreme fatigue and breathlessness. Inadequate oxygen triggers the release of hormones that make the blood clot, raising the risk of a fatal stroke or heart attack.
By targeting the baroreceptors, the Barostim Neo is able to regulate the blood pressure and reduce the pulse, allowing a ‘significant’ improvement in symptoms of heart failure, according to US and European studies. Patients reported less fatigue and breathlessness, and improved quality of life. Tests also indicate that heart function improves. Now, a major international clinical trial running at five UK hospitals will offer suitable NHS patients the treatment.
Dr Rebecca Lane, consultant cardiologist at Royal Brompton & Harefield NHS Foundation Trust in London, says: ‘This device is for patients who have exhausted all other treatment options. A few months back, we would simply have had to tell them to accept a miserable life, often stuck in their homes.
‘Now there is something which could help them feel better, to walk around, and perhaps live longer.’
The implant is fitted while the patient is under general anaesthetic. The surgeon makes an incision in the neck and exposes the artery, before stitching the wire to it.
A second incision is made below the collarbone and a pocket is created under the skin to fit the generator. The surgeon then connects the wire to the generator and closes the incisions. The operation lasts 45 minutes, with patients often able to return home the same day.
The device can be controlled by an external programmer which enables doctors to alter stimulation and turn it on or off. The battery lasts five to six years, after which a new device is inserted via a short procedure under local anaesthetic.
David Barnard, 75, from Phoenix, Arizona, who received his Barostim Neo in the US seven years ago, said: ‘Within two months, the breathlessness disappeared and I had more energy. Now, I play golf and go to the gym three times a week – and I’ve lost three stone.’