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A Novel Therapy for Heart Failure

Published in Providence Heart Beat, Spring, 2012.

Providence Research is breaking ground in the study of spinal cord stimulation to treat certain heart conditions. Leading the investigation are John Hatheway, MD, (left) and Timothy Lessmeier, MD.
Providence Research is breaking ground in the study of spinal cord stimulation to treat certain heart conditions. Leading the investigation are John Hatheway, MD, (left) and Timothy Lessmeier, MD.

Heart failure is a serious, yet treatable condition. In fact, some cases can even be prevented.

Not every treatment is right for every patient, however, and that’s why centers around the world are involved in a study to investigate a new treatment option.

Providence Sacred Heart Medical Center is one of those centers, and was first in the country to perform this innovative procedure for heart failure.

Sacred Heart’s two principal investigators—Timothy Lessmeier, MD, an electrophysiologist, and John Hatheway, MD, an anesthesiologist and pain medicine specialist—explain this revolutionary new treatment option.

How is heart failure currently treated?

Dr. Lessmeier: Sometimes we use medical therapy or implant a device called a biventricular defibrillator to regulate the heart’s electrical system if it isn’t working properly. If those treatments don’t help, then we have to consider a left ventricular assist device (LVAD) or a heart transplant, which are both major procedures. This therapy looks at a new direction to treat heart failure.

What is the new therapy?

Dr. Hatheway: The therapy is spinal cord stimulation, which is already approved by the U.S. Food and Drug Administration for treating various types of pain, especially back pain. We think spinal cord stimulation may have beneficial effects on the heart, based on studies of its use to relieve angina [chest pain that’s a symptom of a heart problem].

How can spinal cord stimulation help with heart failure?

Dr. Lessmeier: The hope is that the stimulation will positively impact parts of the heart’s sympathetic nervous system. The sympathetic nervous system is the fight-or-flight response you get when someone startles you and you can feel your heart racing. In people with heart failure, that system is keyed up 24 hours a day, which doesn’t have good effects on the heart.

How does the treatment work?

Dr. Hatheway: We place a long wire and electrodes into the epidural area, which is right outside the spinal space, and steer them to a very specific location where it’s been found to do the most good in angina patients. The wire is attached to a battery implanted in the buttocks, which creates anelectrical system.

Dr. Lessmeier: The wire is hooked up to a device similar to a pacemaker, and it stimulates the nerves in the area of the spinal cord that goes to the heart. The stimulator is on for 12 hours a day, and the hope is that by controlling the sympathetic nervous system, it will help improve heart function and make people feel better.

Dr. Hatheway: Starting right after the outpatient procedure, the system is programmed and managed from then on by remote control. For the study, we’re testing three different settings, one of which is no stimulation. Patients don’t know which setting they’re receiving.

Why is an anesthesiologist involved in research about heart failure?

Dr. Hatheway: Every study team is made up of a cardiologist and an anesthesiologist and/or pain specialist who has experience in spinal cord stimulation procedures.

How many patients are involved in the study, how are they selected and what is the progress to date?

Dr. Hatheway: Providence Sacred Heart can enroll up to 19 patients and we completed three procedures in 2011. We’re identifying patients who can’t tolerate medical therapy, which means their choices would be limited to more aggressive treatment like an LVAD or transplant. Spinal cord stimulation gives them another option.

Dr. Lessmeier: We performed the first implant in June 2011 and that patient is doing very well. We’re hopeful the procedure can improve patients’ quality of life, and possibly their longevity.

Five Steps to a Heart Healthy Lifestyle

In people with heart failure—an increasingly common problem in kids and adults—the heart doesn’t pump blood as effectively as it should. That means the heart can’t supply enough blood to the body’s cells, which causes shortness of breath and fatigue that can make basic activities a challenge.

Fortunately, heart failure can be managed. Even more important, because heart failure develops over time, there are steps you can take to prevent it.

  1. Exercise. Simply walking for about 30 minutes most days has a host of benefits, including strengthening the cardiovascular system, improving circulation, lowering blood pressure and increasing energy.

  2. Eat right. What you eat is so important that a heart-healthy diet—one that’s low in fat and high in fruits, vegetables, whole grains and lean protein—can cut your risk for heart disease in half.

  3. Don’t smoke. Smoking causes the heart to beat faster, raises blood pressure and damages blood vessels, all of which increase the risk of developing heart failure over time.

  4. Drink alcohol only in moderation. Excessive—and especially chronic—alcohol consumption is linked to diminished heart function and failure.

  5. 5) Get regular checkups. Work with your doctor to manage your particular risk factors, such as high blood pressure, high cholesterol and diabetes.