The simple check that can save your life if you have a pacemaker

For many of the 50,000 people in Britain who get pacemakers every year, they are literally life-saving. Placed under the skin of the chest, they detect when the heart is beating too slowly or irregularly and immediately deliver an impulse to correct the rhythm.

But pacemakers are not all good news. While correcting heart rhythms can reduce the risk of shortness of breath, fatigue, and in some cases even fainting, they can also increase the risk of heart failure. One theory is that the heartbeat initiated by a pacemaker is less well coordinated than a normal heartbeat. , which increases the workload of the heart. Over time, this leads to changes in the heart muscle walls, which can ultimately lead to heart failure.

The regular checks currently carried out on patients with pacemakers – around 500,000 in Britain – are aimed at ensuring that the cables connecting the pacemaker to the heart and the connected battery are working correctly. But research has shown that monitoring the patient’s heart function at the same time can detect early signs of heart failure and potentially save lives.

Symptoms of heart failure include shortness of breath and fatigue, but because pacemakers are often fitted to middle-aged or older people, they can be easily dismissed as simply aging.

The OPT-PACE study, carried out by Leeds Teaching Hospitals NHS Trust and the University of Leeds, looked at whether checks on the heart itself could detect signs of heart failure and, if found, whether this should simply be left to the GP. or if patients need to attend a specialist combined heart failure pacemaker clinic.

The three-year study recruited 1,201 patients with pacemakers. Half were routinely screened for heart failure, while the other half continued to undergo mainly equipment checks.

Dr. Klaus Witte, a consultant cardiologist and senior lecturer in cardiology at the University of Leeds who was one of the study leaders, says the results, published in the journal Nature Medicine, are potentially groundbreaking.

“Research shows that about 30-40 percent of those people (with pacemakers) have some degree of heart muscle weakness,” Dr. Witte tells Good Health, adding that at least some will develop heart failure.

“There are a number of reasons for this,” he explains. ‘The patients are generally older and may have other health problems, such as high blood pressure and previous heart attacks.

“This makes the heart more vulnerable to the dysregulation (the walls of the heart do not contract properly, reducing efficiency) that you see with an accelerated heart rate,” he says. ‘Additionally, if the pacemaker is used extensively, the out-of-tune heartbeats can lead to changes in the structure of the heart, with some muscle areas becoming thicker and others thinner, which can ultimately lead to heart muscle weakness.

‘In general, people with a pacemaker are at greater risk of heart failure than people without a pacemaker.’ Crucially, the study found that referring patients with signs of heart weakness to specialist clinics – where medication was assessed and adjusted – rather than just sending the results to their GP, meant they were less likely to be in the were hospitalized for cardiovascular disease for the next five years. related problems.

Dr. Witte hopes the research will lead to a routine screening program for pacemaker patients, using a heart scan and a blood test for a protein called B-type natriuretic peptide (BNP), elevated levels of which can indicate heart failure, although more research is needed . necessary to prove this.

Ian Thompson, 77, a retired IT professional, was among those invited to take part in the OPT-PACE trial. The grandfather-of-three, who lives with his wife Christine, 75, in Pontefract, West Yorkshire, suffered a heart attack in 2009 after a day when he said he felt ‘absolutely terrible’.

“My left arm was tingling, I felt hot and nauseous,” says Ian.

After going to the local hospital, he was referred to Leeds General Infirmary where it was confirmed that he had suffered a heart attack and his heart rate was below 50 beats per minute. At rest, a normal heart should be between 60 beats per minute. 100 beats per minute. When the heart rate slows to this extent – ​​a condition called bradycardia – not enough oxygen-rich blood is pumped around the body, which can cause fatigue, shortness of breath and fainting.

In December 2009, Ian had a pacemaker fitted under local anesthesia – ‘a Christmas present’, he jokes.

“My pacemaker was checked every six months and then annually to make sure it was working properly,” he adds. “But my heart itself was never checked for the next seven years.”

In March 2016, Ian was given the opportunity to take part in the OPT-PACE trial and had his heart checked with a 30-minute ultrasound scan.

“The scan showed I had a narrowed aortic valve,” says Ian.

The valve controls the flow of blood out of the heart – Ian’s was not functioning properly and blood was not flowing freely from the heart to the organs and tissues.

If left untreated, it can lead to heart failure.

Ian says: ‘Although it wasn’t 100 per cent good news, it was a relief to know that a problem had been identified and steps were being taken to monitor the valve.’

Doctors increased his dose of bisoprolol – a drug that treats high blood pressure – to relieve pressure on his heart.

But over the next few years Ian became increasingly breathless, especially when climbing stairs.

Dr. Mark Dayer, a consultant cardiologist and clinical lead for heart failure at the Mater Private Hospital in Dublin

“Christine also had to go to the mailbox for me because I had difficulty getting a letter there, even though it was only 350 meters away,” he says.

In December 2020, he underwent surgery to replace his defective aortic valve with a synthetic valve.

“I was soon like I was a few years earlier,” says Ian.

‘I went to football matches to watch my team play Middlesbrough. I could run up the stairs or go back to the mailbox without difficulty. It was such an improvement.”

Dr. Witte says: ‘Heart failure is very gradual – people might think, ‘I’m old, I have a pacemaker, I’m out of breath – this is just the way it is.’ Our point with this study was that it might be so, but you can’t know for sure.

‘A third of people with a pacemaker actually suffer from insidious heart failure, and in many cases due to the pacemaker itself.’

Commenting on the study, Dr Mark Dayer, cardiologist and clinical lead in heart failure at the Mater Private Hospital in Dublin, said: ‘I think screening using ultrasound scans is likely to be useful, but we need a larger study . many centers are using a more robust methodology to confirm benefit.”