Given a jolt by the pacemaker ...with a heart

AGROUND-breaking pacemaker that is able to detect emotions and add extra heartbeats in response to joy, fear or excitement is being trialled in the UK.

Conventional devices – fitted in patients suffering from heart rhythm abnormalities such as atrial fibrillation – use electrical pulses to ensure the heart beats at a healthy rate, and are able to detect increased physical exertion such as walking.

They respond with additional beats to pump more blood around the body.

However, it is estimated that 70 per cent of pacemaker patients struggle to respond to emotional events, such as the joy of seeing a favourite football team score a goal, or being given a jolt in a scary scene during a film.

This condition, called chronotropic incompetence, is not lifethreatening, but can have a major impact on quality of life.

The Biotronik Closed Loop Stimulation (CLS) pacemaker is able to receive signals from the brain sent via the nervous system in response to emotional stress.

It can even adjust the heart rate when the patient is not moving.

Heart rate and stroke volume – the amount of blood pumped in one beat – is controlled by the nervous system, which adapts to both physical and emotional stress to regulate these.

Biotronik’s CLS pacemaker has a ‘rate-adaption’ algorithm which means it can respond to signals from the nervous system.

In a trial carried out by Biotronik in Germany of more than 700 patients, doctors reported that 80 per cent of CLS patients had ‘excellent’ results.

Chris Tandy, a cardiac physiologist at Lincoln Hospital, who programs and tests pacemakers after they have been fitted by cardiologists, says there is a major unmet need for the devices to better respond to the needs of patients.

He says: ‘When you are excited or anxious, your heart rate should increase to allow the extra oxygen needed to function effectively. In patients with chronotropic incompetence, this doesn’t happen.

‘A lot of our patients with pacemakers are in their 50s and 60s and still want to be able to enjoy life. A CLS device won’t give you back a normal heart but it will make life a lot better for many patients.’

Mercia Cromar, 79, from Lincoln, had her conventional pacemaker changed to a CLS device last month. She says: ‘With my old pacemaker, even when I wasn’t exercising I’d feel exhausted. My son Kevin likes to play practical jokes and give me a fright. As I’m quite a nervy person, I’d jump with surprise and then feel faint and breathless. Now I know why – it was a shock to my heart and it wasn’t responding.

‘I’ve only had this pacemaker for a month and it’s already changing my life and giving me more energy. I’d virtually stopped gardening and dancing because I was so exhausted.

‘Mr Tandy says the next time Kevin plays a practical joke on me, I won’t feel awful like I have done in the past. And I can look forward to pulling crackers with my grandchildren at Christmas and knowing the sound won’t make me dizzy.’

Mr Tandy adds: ‘Patients with pacemakers are leading more active lives than they did in the past when expectations of what you could do with a pacemaker were not so great.

‘We should now be aiming to get the pacemaker to meet the demands of the patient and not vice versa.

‘We now have better skills and know how to give pacemaker patients a better quality of life so that when they have an emotional moment or need that extra back-up, their heart pacemaker gives them that boost in beats.’

Some 25,000 pacemakers are fitted in the UK every year – about 500 a week.