Heart Implant Offers an Option to Select Patients

Extended treatment of atrial fibrillation, irregular contraction of the atrial chambers of the heart, with an implantable atrial defibrillator (IAD) is feasible in patients whose symptoms persist despite drug treatment, German cardiologists report in the December issue of the European Heart Journal. Previously thought to have little choice, now this new treatment is offering sufferers a genuine option.

Extended treatment of atrial fibrillation, irregular contraction of the atrial chambers of the heart, with an implantable atrial defibrillator (IAD) is feasible in patients whose symptoms persist despite drug treatment, German cardiologists report in the December issue of the European Heart Journal. Previously thought to have little choice, now this new treatment is offering sufferers a genuine option.”It was known before this study that this type of aggressive therapy is safe and effective in the short-run, but there were a lot of questions regarding long-term tolerance of repeated (and sometimes frequent) cardioversion shocks,” Dr. J. Christoph Geller from University Hospitals of Magdeburg told Reuters Health.Geller’s team followed 106 patients with recurrent, symptomatic atrial fibrillation that did not respond to drug therapy who were implanted with the METRIX atrioverter (Guidant Corp, St. Paul, MN) for an average of 40 months.At last follow up, 50 percent of patients continued to use the device to treat or to monitor atrial fibrillation. The remaining 50 percent of patients had the device turned off or removed.Frequent recurrences of the irregular heart rhythm and patient discomfort with the repeated cardioversion shocks generated by the device “were the main limitation of this type of therapy and the main reason for discontinuation,” Geller said.”Therefore, further improvements of technical aspects of these devices and additional drug therapy will likely be needed to allow more patients to benefit from this type of therapy,” he added.Dr. Andrew R. Mitchell from John Radcliffe Hospital in Oxford, England writes in an editorial that choosing the right patient for the IAD is “vital for long-term success.” The ideal candidate is “motivated patient” who has recurrent, drug-resistant, highly symptomatic, persistent atrial fibrillation that requires frequent hospitalizations.”With careful patient selection, the use of the atrial defibrillator empowers patients to ‘take charge’ of their condition and liberates them from the fear of recurrent hospitalization,” Mitchell writes.(Source: European Heart Journal, Reuters Health, Dec 2003