For many of the 50,000 people in the UK who have a pacemaker each year, it is literally a lifesaver. Placed under the skin of the chest, they detect when the heart is beating too slowly or erratically and instantly emit an impulse to correct the rhythm.
But not all pacemakers are good news. While correcting your heart rhythm can reduce the risks of shortness of breath, fatigue, and even fainting in some cases, it can also increase the risk of heart failure; One theory is that the heartbeat initiated by a pacemaker is less coordinated than a normal heartbeat. , increasing the workload of the heart. Over time, this causes changes in the walls of the heart muscle that can ultimately lead to heart failure.
The regular checks currently carried out on pacemaker patients (around 500,000 in the UK) focus on ensuring that the wires connecting it to the heart and the attached battery are working properly. But research has found that monitoring a patient’s heart function at the same time can detect early signs of heart failure and possibly save lives.
Symptoms of heart failure include shortness of breath and fatigue, but because pacemakers are typically fitted to middle-aged or older people, it’s easy to dismiss them as simple aging.
The OPT-PACE trial, led by Leeds Teaching Hospitals NHS Trust and the University of Leeds, looked at whether heart checks themselves could detect signs of heart failure and, if found, whether this should simply be left to the GP. . , or whether patients should go to a clinic specializing in heart failure and pacemakers.
The three-year study enrolled 1,201 patients with pacemakers. Half were routinely screened for heart failure, while the other half were mostly screened for heart failure.
Dr Klaus Witte, consultant cardiologist and senior lecturer in cardiology at the University of Leeds, who was one of the leaders of the study, says the results, published in the journal Nature Medicine, could be a game-changer.
“Screening reveals that 30 to 40 percent of people (with pacemakers) have some degree of heart muscle weakness,” Dr. Witte tells Good Health, adding that some, at least, will develop heart failure.
At rest, a normal heart should have between 60 and 100 beats per minute. When the heartbeat slows below 50 beats per minute (a condition called bradycardia), not enough oxygen-rich blood is pumped throughout the body, which can cause tiredness, shortness of breath, and fainting.
“There are several reasons for this,” he explains. ‘Patients are usually older and may have other health problems, such as high blood pressure and previous heart attacks.
“This makes the heart more vulnerable to the detuning (the walls of the heart do not contract properly, reducing efficiency) that is seen with heartbeats,” he says. ‘In addition, if the pacemaker is used extensively, the out-of-tune beats can cause changes in the structure of the heart, with some areas of muscle becoming thicker and others thinner, eventually leading to weakness of the heart muscle.
“In general, people with pacemakers have a higher risk of heart failure than people without pacemakers.” Crucially, the trial found that referring patients with signs of heart weakness to specialist clinics (where medication was reviewed and adjusted) rather than simply sending the results to their GP, meant they were less likely to be admitted. in the hospital for the next five years with heart problems. related problems.
Dr. Witte hopes the study will lead to a routine screening program for pacemaker patients, using a heart scan and a blood test to detect a protein called B-type natriuretic peptide (BNP), elevated levels of which can indicate heart failure. , although more research is being done. needed to test this.
Ian Thompson, 77, a retired IT professional, was among those invited to participate 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 says he felt “absolutely terrible”.
“My left arm was tingling, hot and nauseous,” Ian says.
After going to his local hospital, he was sent to Leeds General Infirmary, where it was confirmed that he had had a heart attack and his heart rate was below 50 beats per minute; At rest, a normal heart should be between 60 and 100 beats per minute. 100 beats per minute. When the heartbeat slows to this point (a condition called bradycardia), not enough oxygen-rich blood is pumped throughout the body, which can cause tiredness, shortness of breath, and fainting.
Ian had a pacemaker fitted under local anesthetic in December 2009 – “a Christmas present,” he jokes.
“My pacemaker was checked every six months and then annually to confirm that it was working properly,” he adds. “But my heart was never examined for the next seven years.”
In March 2016, Ian was offered the opportunity to participate in the OPT-PACE trial and had his heart examined with a 30-minute ultrasound.
“The scan revealed I had a narrow aortic valve,” says Ian.
The valve controls the flow of blood out of the heart; Ian’s was not working 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 detected and that steps were being taken to monitor the valve.”
Doctors increased his dose of bisoprolol, a medication that treats high blood pressure, to relieve the strain on his heart.
But in the years that followed, Ian became out of breath, especially when climbing stairs.
Dr Mark Dayer, Consultant Cardiologist and Clinical Director of Heart Failure at Mater Private Hospital Dublin.
“Christine also had to go to the mailbox because I had trouble getting a letter there, even though it was only 400 meters away,” he says.
In December 2020, he underwent surgery to replace his defective aortic valve with a synthetic one.
“I soon went back to how I was a few years before,” says Ian.
‘I went to football matches to watch my team Middlesbrough play. I could run up the stairs or back to the mailbox without having to fight. “It was a big improvement.”
Dr. Witte says, “Heart failure is very gradual; people might think, ‘I’m old, I have a pacemaker, I’m short of breath.’ That’s just the way it is.” Our point with this study was that it could be, but we don’t know for sure.
“A third of people with pacemakers suffer from insidious heart failure, and in many cases it is due to the pacemaker itself.”
Commenting on the study, Dr Mark Dayer, consultant cardiologist and clinical director of heart failure at Mater Private Hospital, Dublin, said: “I think ultrasound screening is probably beneficial, but we need to do a larger trial.” in many centers that use a more solid methodology, to confirm the benefit.