New device does weight training in the hearts of cardiac patients – 04/27/2023 – Health

InCor (Instituto do Coração, Hospital das Clínicas, Faculty of Medicine, University of São Paulo) is carrying out a study with an innovative device for the treatment of heart failure in patients with Chagas disease.

Similar to a conventional pacemaker, the cardiac contractility modulator exercises the heart weakened by the disease, as a form of bodybuilding.

A typically Brazilian disease, Chagas, which is caused by the protozoan trypanosoma cruzi and transmitted by the kissing bug, affects 1.2 million people in Brazil and another 5 million in the rest of the world, according to data from PAHO (Pan American Health Organization). And although it also affects the digestive, vascular and neurological systems, about 30% of patients end up suffering from heart failure.

Data from the Brazilian Society of Cardiology indicate that around 2 million people live with heart failure in the country, with 240,000 new cases per year. The disease is among the main causes of heart-related mortality and directly affects the quality of life, causing kidney failure, extreme fatigue, swelling, difficulty breathing and performing physical exercises.

The study, called Fix Chagas, will last for six months and will include 60 patients with heart failure, in which the strength of the heart can still be recovered, to improve the pumping of blood to the body. There will be 30 patients with the new device and another 30 in the control group with a type of pacemaker called a resynchronizer. Currently, nine patients are already being monitored with the device.

These two groups will be compared through clinical and imaging evaluations and specific questionnaires to assess the quality of life and the amount of physical activity requested by specific exams.

“The results may pave the way for a new and unprecedented treatment option for heart failure in patients with the disease, which is effectively a Brazilian problem”, explains Professor Martino Martinelli, director of the clinical unit of cardiac stimulation at InCor.

He says that while other devices serve to correct arrhythmias and are integrated into the heart’s electrical process, the contractility modulator serves to make the heart’s musculature increase its contraction force.

“Cardiovascular disease that affects the muscle leaves the healthy areas intermingled with the diseased areas and, when you stimulate it in general, it will cause the healthy cells to increase their ability to contract. Some others that are not so healthy, but who do not have a very advanced degree of disease, also respond to this situation. So, what we have is a recovery of the contractile capacity of the sick cells”, says the professor.

The device is installed on the right side of the patient’s chest and connected to the heart by two cables, passed through the veins. These cables are connected to the muscular septum, the structure that separates the right and left ventricle, where they discharge the electrical impulse as the heart contracts, stimulating the muscle and reinforcing the contraction.

The device has an internal battery that is recharged every seven to ten days through a plate placed on the chest. “It works seven hours a day, but it’s not because of its limitation, it’s because of a physiological characteristic of giving the muscle rest, so it doesn’t get tired. Other attempts with devices were seen as an absolute success and they often stimulated the skeletal muscle of the heart, the back muscle, but what we saw is that it stimulated and stimulated and nothing came of it because the muscle got tired”, says Martinelli.

Despite the high energy —7.5V, against a maximum of 5V for the pacemaker— the pulse is not bothersome. According to the patient Geraldo Aroldo de Queiroz, 57, who has been using the modulator since March 7, it was only in the first few days that he felt a slight pressure in his chest, but that soon disappeared. “It doesn’t interfere at all. I still can’t feel the difference, but my son already said that I went up a hill faster and without getting tired.”

This, by the way, is the main benefit of the device, according to the professor. Of the patients monitored, two attracted the most attention. “The first observations of patients are impressive. A patient saying that he is going up the ramps of his house in a community like never before and a lady who did not climb stairs and went up the stairs of her building, even exaggerated a little”, he jokes.

“These people are young people who are in the productive phase in terms of work and social life, but have few resources and depend on the SUS (Unified Health System). Heart transplantation is the gold standard of treatment, but it has its limitations, such as availability of donors, waiting list for an organ and specialized hospitals. Not here. Here you put the device on and guide a family member to carry it and things tend to be very good.”

To carry out the studies, the 30 devices, which cost up to US$ 50 thousand (R$ 252 thousand) each, were donated by the American company Impulse Dynamics.

The final objective of the study, says the professor, is to prove the hypothesis that the device is useful for the regression of heart disease in patients with Chagas disease. Only in this way will the treatment be included in the list of the ANS (National Supplementary Health Agency), which buys high-cost medications to be used in the SUS.