New Algorithm May Aid in Adoption of Better Heart Pacing Method
BALTIMORE—(February 15, 2019)—An algorithm created by cardiac electrophysiologist Aditya Saini, MD, of MedStar Heart and Vascular Institute at MedStar Union Memorial Hospital, may pave the way for a superior method of installing pacemakers to become more widely adopted around the world.
In an article published in the medical journal Circulation- Arrhythmia and Electrophysiology released last week, Dr. Saini proposes an algorithm that solves a practical barrier to the adoption of a method of pacemaker installation, known as His bundle pacing (HBP). His bundle pacing takes advantage of the natural conduction fibers to pace the heart, allowing a coordinated and perfectly timed contraction of the heart, as opposed to traditional pacing, which simply paces from one spot in the heart, leading to an uncoordinated contraction. This electrically coordinated- or synchronized- contraction makes all the difference when it comes to mechanical properties of the heart pump.
Recent studies have found HBP to be a safe, feasible and superior pacing technique, reducing the combined endpoint of death, hospitalizations for heart failure or need for future pacemaker upgrades when compared to traditional cardiac pacing.
However, HBP increases the complexity of routine patient follow-up, adding time and effort and disrupting busy clinics because lengthy device interrogations are needed while correlating them with simultaneously recorded electrocardiograms (ECGs). Moreover, no existing device algorithms specific to HBP can accurately diagnose device malfunction or guide adjustment of pacemaker settings, making remote monitoring of patients challenging.
The algorithm, which was developed as part of a multicenter effort and in collaboration with Medtronic, which manufactures His Bundle Pacemakers, can be incorporated into the devices. It can also be used immediately in clinics, allowing doctors to ensure the devices are performing properly –even without an EKG. When the algorithm is incorporated into the devices, doctors can monitor patients remotely and accurately diagnose and treat potential pacemaker problems. The application of the algorithm may help make patient follow-up safe and efficient, removing a principal obstacle to widespread adoption of HBP.
“As His Bundle Pacing becomes prime time, there were certain challenges, including the time-consuming and cumbersome nature of the follow up,” said Dr. Saini, who is the first author on the Circulation article. “Those challenges definitely acted as a barrier for His Bundle Pacing to become widely adopted. This study is the first novel step toward an algorithm that can resolve those issues.”
Pacemakers control slow heart rhythms by generating electric currents. The traditional device is implanted in the chest and sends current through wires embedded in the upper and lower chambers of the heart. With a His Bundle pacemaker, one of the wires that would normally be implanted in the right ventricle (lower chamber) of the heart is implanted into the bundle of His, a collection of cells which are part of the normal electrical wiring of the heart.
With a traditional pacemaker, the constant electrical current can cause the heart to wear out, resulting in heart failure and also increase risk of development of atrial fibrillation. His Bundle Pacing, by comparison, results in a more natural method of restoring regular heart rhythm by essentially ‘rewiring the heart’ .
“The electrical activation is natural, and in the ideal case can look exactly like it would without a pacemaker,” Dr. Saini said. “It should not give you heart failure that can develop with a traditional pacemaker, and is also a superior pacemaker if you already have heart failure.”
About the MedStar Heart & Vascular Institute
MedStar Heart & Vascular Institute is a network of highly acclaimed and nationally recognized cardiac experts and care programs spanning all 10 MedStar Health hospitals in the mid-Atlantic region. In the Baltimore area, MedStar Heart & Vascular Institute experts are accessible at MedStar Franklin Square Medical Center, MedStar Good Samaritan Hospital, MedStar Harbor Hospital, MedStar Union Memorial Hospital, and more than a dozen community locations. MedStar Heart & Vascular Institute at MedStar Union Memorial Hospital is allied with the Cleveland Clinic, the nation’s #1 heart program, giving patients accelerated access to the most advanced research, technologies and techniques in cardiology and cardiac surgery. This alliance also strengthens excellent clinical care and enables high-level collaboration on research.
About MedStar Health
MedStar Health is a not-for-profit health system dedicated to caring for people in Maryland and the Washington, D.C., region, while advancing the practice of medicine through education, innovation and research. MedStar’s 30,000 associates, 6,000 affiliated physicians, 10 hospitals, ambulatory care and urgent care centers, and the MedStar Health Research Institute are recognized regionally and nationally for excellence in medical care. As the medical education and clinical partner of Georgetown University, MedStar trains more than 1,100 medical residents annually. MedStar Health’s patient-first philosophy combines care, compassion and clinical excellence with an emphasis on customer service. For more information, visit MedStarHealth.org.