KEEPING UP THE PACE



D

Dr. Jai Maharaj

Guest
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.

Read the complete news at:
http://www.dailypioneer.com

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