6,000 more to get built-in def ibrillators

MORE patients with potentially fatal heart conditions can now have internal defibrillators due to new guidelines south of the Border from the National Institute for Health and Care Excellence.

Nearly 6,000 patients with heart failure who are at high risk of an episode of rapid heartbeat, known as ventricular tachycardia, or a heart attack will become eligible for the life-saving devices as an ‘insurance policy’.

The change could cut deaths from heart failure by up to 40 per cent, according to the Association of British Healthcare Industries (ABHI).

Until now, these patients were given only preventative treatment such as betablockers, which decrease heart activity but do nothing to help should an episode of abnormal activity occur.

Before the NICE criterion was changed, the implantable devices were available only to those who had actually had ventricular tachycardia – a major cause of cardiac death – and a minority of patients who’d had a heart attack.

‘There have been many clinical trials over the past five or six years that have demonstrated this will save lives,’ says Dr Simon Williams, a consultant cardiologist at Manchester’s Wythenshawe Hospital and treasurer of the British Society for Heart Failure. ‘It’s proven to be cost-effective and we’re going to see a massive increase in the numbers of these devices fitted. Cardiologists have been waiting for these guidelines for years.’

The devices are miniature versions of external defibrillators, placed under the skin and connected with wires to the heart. They are able to recognise if the heart is beating too fast and deliver an electric shock, which returns its rhythm to normal.

‘The new guidelines allow us to put internal defibrillators in more of those patients,’ says Dr Williams. ‘They can now have one fitted as an insurance policy.’

The broadening of the guidelines will also make more heart-failure patients eligible for implantable biventricular defibrillator pacemakers – a combination of a pacemaker and defibrillator.

One patient to have benefited from the implantable defibrillator is 19-year-old Ainsley Mantack, who collapsed on a football pitch last month and was diagnosed with Arrhythmic Right Ventricular Cardiomyopathy (ARVC), a disorder of the heart muscle that can cause life-threatening heart rhythm problems. Paramedics who carried out an ECG found he had ventricular tachycardia and his heart was beating at a rate of 200 beats a minute.

The sports coach from Baguely, Manchester, a former semi-pro football player, was taken to A&E where doctors used a manual defibrillator to jumpstart his heart and restore normal rhythm. A week later, he was fitted with an internal defibrillator in an hour-long operation under local anaesthetic.

‘I was conscious after collapsing but I couldn’t move and my vision and hearing were starting to go,’ he says. ‘My heart felt as though it was trying to punch its way out of my chest. I thought I was going to die. Apparently I’ve had this condition all my life but I didn’t know about it. I’ve recovered from the operation really well and I feel fine now – I feel like some sort of iron man. I think it’s great that more people are going to benefit.’

Dr Williams, who fitted Ainsley’s device, says ARVC is a potentially fatal condition. He believes Ainsley’s prognosis is good, adding: ‘Although the average age of patients with heart problems is in their 60s, Ainsley is a really good illustration of the fact that anyone can have these conditions.’