BY HOLLI W. HAYNIE

Local cardiologist Dr. James Porterfield of Arrhythmia Consultants recently developed a method to fine-tune biventricular pacemakers in a more efficient manner by using an electrical optimization method. The biventricular pacemaker is an electronic, battery-powered device that is surgically implanted under the skin. The device has two or three leads (wires) that are positioned in the heart to help it beat in a more balanced way. The leads are implanted through a vein in the right atrium and right ventricle and into the coronary sinus vein to pace the left ventricle.

Traditionally patients with these pacemakers undergo echo optimization procedures in which physicians use an echocardiogram to measure pump function. A typical echo optimization procedure can take anywhere from 30 to 120 minutes and requires a manual interpretation by a technician. An echo is taken, then the timing interval on the pacemaker is changed, and then pump function is measured again by the echo and the process is repeated until optimization is reached. For those who have a pacemaker on the top and the bottom, a variety of changes would have to take place and the procedure could be even longer.

"We looked at what we were trying to achieve and came up with a way to measure (optimization) via the pacemaker, the electrical timing," explained Porterfield.

This new method utilizes the electro-algorithm of the pacemaker to optimize pump function via the QuickOpt™ Timing Cycle Optimization unit from St. Jude Medical. This method, which only takes a few short minutes, has proven in clinical trials to be as consistent as echo-based optimization 96 percent of the time, for both atrial-ventricular timing and ventricular-ventricular timing.

The principle investigator on the clinical trial, Porterfield worked with multiple centers to determine the effectiveness of electrical optimization versus echo optimization. Patients underwent the traditional echo/change, echo/change procedure, then they experienced the electrical optimization, which was monitored with an echocardiogram.

"We found out the electrical method was just as good and could be done at the bedside without the need for an echocardiogram," Porterfield said.

He said the benefits of electrical optimization are that it's quicker, cheaper (the cost of an echo is usually several hundred dollars) and more efficient. It not only saves time for the patient, but it gives physicians more time to learn how their patient is doing.

The FDA approved the Quick Opt unit for the market last fall. A new study has begun to determine the long-term effects. Ultimately the goal is for electrical optimization to become the standard of care. Any physician that implants pacemakers or has patients with pacemakers can have acquire this technology. An external programmer can set up the unit and software and teach the doctor or technician how to use it.

"We have quite a few patients report improvement in how they feel. Some are able to walk further," said Porterfield. "It's all about quality of life."



February 2007