Keeping up the pace By Aparna Kher The Pioneer Wednesday, September 27, 2000 About 22.5 million patients worldwide suffer from congestive heart failure, a condition where the heart loses it's pumping action. Around a million new patients are added to this growing list of patients each year. Heart failure patients can be classified into four categories depending on the symptoms. The first category patients, also known as Class I patients, complain of breathlessness while doing regular exercises. Class II patients experience breathlessness during any physical activity other than routine while Class III patients may suffer from breathlessness while performing minor routine activities like changing clothes, walking in the house. Patients in the last stage experience shortness of breath even while doing nothing. These patients are also known as refractory heart patients. While patients in the class I and II category can be operated upon successfully, the only logical long-term solution for class III and IV patients is a heart transplant. Though heart transplants in foreign countries have been carried out successfully, such transplants in India are as of yet a theoretical possibility. The infrastructure and the kind of expertise needed to carry out such operations is lacking, says Dr Tarlochan Singh Kler, senior consultant cardiologist and head of department of electrophysiology and cardiac pacing at the escorts heart institute and research centre. Even in advanced countries , 90 per cent of heart patients die waiting for a donor heart. After a transplant, there are high chances of infection and the receiver s body rejecting the donor heart. This can prove fatal. Until very recently, Class III and IV patients or End Stage Heart Disease (ESHD) patients were doomed. Not anymore. Research in several countries has come up with a special kind of pacemaker, also known as a bi-ventricular pacemaker or a heart failure device. How is it different from a normal pacemaker? A bi- ventricular pacemaker has an extra lead while the former has only two. Patients with ECG abnormalities will benefit most from this path-breaking technology. In such cases, the left and the right ventricles contract at different times as opposed to a normal heart where they do so simultaneously. In worst cases, the delay in contraction between the upper and lower chambers of the heart increases. Estimates show that roughly 40 per cent of heart failure patients suffer from ECG abnormalities. The bi-ventricular pacemaker is introduced in much the same manner as the normal pacemaker. The third and extra lead of the new pacemaker is introduced in the left ventricle so that the normal physiology of the heart is restored. Studies have shown that 30 to 40 per cent of discomfort was reduced after the introduction of the bi-ventricular pacemaker. This new pacemaker was implanted for the first time in South Asia at the Escorts Heart Institute and Research Centre by Dr Kler. So far only six patients have benefitted by the procedure which costs around Rs 3 lakh. A normal pacemaker costs around Rs 1.5 to 2.5 lakh over and above the cost of operation and medical care. A bi- ventricular pacemaker costs around Rs 3 lakh over and above the cost of operation. Heart patients, who cannot afford, can look out for pacemaker donations. Often pacemakers in working condition are taken off the dead, sterilised and re-used. The leads of the pacemaker are changed. This procedure is carried out on a voluntary basis and the pacemaker company does not provide any warranty to the second receiver of the pacemaker. The incidence of infection is also high as compared to that of a normal pacemaker. Such a process is, however, illegal in foreign countries. The operation is simple and similar to that of implanting an ordinary pacemaker. The patient is given local anesthesia. The batteries of the pacemaker work for five to seven years. The bi-ventricular pacemaker may just be in it s infancy, but it may just be the answer to hundreds, whose hopes had died an untimely death. 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