Pacemakers make life better for many people with heart problems, but in some patients, they put so much strain on the heart that they actually trigger heart failure symptoms.
Electrophysiologists and medical-device makers have known the phenomenon for years. It even has a name — pacemaker-induced cardiomyopathy — a condition that will eventually affect thousands of the 200,000 Americans who will get a pacemaker to stimulate the right ventricle this year.
The realization that traditional pacing can trigger new heart problems has fueled a long-simmering debate in the cardiac-medicine community about the best place inside the heart to attach the pacemaker's wire.
An increasingly vocal group of doctors believes that a clever but somewhat challenging technique called "His bundle pacing" may hold the answer for how to pace the heart's right ventricle without placing the strain on the left ventricle that leads to pacer-induced heart failures.
Using this alternate method creates a more natural heart beat and is also cheaper than the most common way to treat pacer-induced problems, which is with a more expensive machine and more wires.
"It's to save patients and their families from the specter of heart failure," said retired Medtronic engineer Terry Williams, whose home office is festooned with patent plaques including for two His bundle pacing devices still sold by Medtronic today. "Also, heart failure is expensive and we don't need that burden in this country. And more importantly they don't need that burden in developing countries. They can't afford to deal with it."
About 100 heart doctors around the U.S. — including a handful in Minnesota — are trained to use a standard pacemaker to stimulate a nontraditional place in the heart near a structure called the His bundle, which is named for Swiss cardiologist Wilhelm His Jr. (1863-1934).
At the annual Heart Rhythm Society meeting this month in Chicago, proponents of His bundle pacing said educational sessions about the technique attracted capacity crowds, with proponents tweeting the hashtag #DontDisTheHis.