Pacemakers Better for Some Heart Failure Patients

Patients with non-systolic heart failure may benefit more from pacemakers than from continual, long-term use of beta blockers, according to a new study.

Researchers at Johns Hopkins University (Baltimore, MD, USA) compared 19 men and women with initial symptoms of non-systolic heart failure to 17 patients with no early signs of the disease. All the patients pedaled at increasing levels on a stationary bike; however, the hearts of participants in the non-systolic group failed to keep up, beating on average 44% less quickly during exercise than those of participants without heart failure. Additionally, heart vessels in the heart-failure group did not dilate or expand as much to meet the increased energy demands from the body's muscles. The corresponding resistance to blood flow dropped 28% in controls as blood vessels relaxed, but only dropped 19% in the heart-failure group.

Based on the results of the study, the researchers suggest that a combination of drugs--usually beta-blockers--and a pacemaker may be better than drugs alone in patients with non-systolic heart failure. This combination may work best to control the disease, speeding up the heartbeat at times, slowing it down at other times. The study was published in the November 6, 2006, online edition of the journal Circulation.

"Cardiologists are constantly being forced to rethink heart failure because one size does not fit all,” said senior study investigator David Kass, M.D., a professor at Johns Hopkins University School of Medicine and its heart institute. We also need to understand all facets and manifestations of the disease because we are seeing ever-increasing numbers of older adults who have heart failure, mostly women over age 50, whose heart pumping appears to be normal.”

Non-systolic heart failure, sometimes referred to as heart failure with preserved ejection fraction or heart failure with normal ejection fraction, is characterized by fairly normal function of the heart's pumping action when the patient is at rest. However, once daily physical activity begins, the heart becomes increasingly unable to squeeze out sufficient blood flow to energy-starved muscles.



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