DATE: Thursday, November 27, 1997           TAG: 9711270690

SECTION: FRONT                   PAGE: A12  EDITION: FINAL 

SOURCE: BY MARIE JOYCE, STAFF WRITER 

                                            LENGTH:   76 lines

IMPLANTED HEART MONITOR CAN LENGTHEN LIFE MACHINE SHOCKS ABNORMAL HEART RHYTHMS BACK TO NORMAL PATTERN

A national study, conducted in part in Norfolk, showed that people with life-threatening heart-rhythm disturbances have a better chance of surviving if they are implanted with a defibrillator, a machine that monitors abnormal rhythms and shocks the heart back into sync.

The National Institutes of Health study, which involved more than 1,000 patients at 50 centers across the United States, looked at three-year survival and compared the small machines with the use of drugs that help control heart rhythm. It was published today in the New England Journal of Medicine.

The NIH recommended that patients with the two problems studied - serious ventricular fibrillation and ventricular tachycardia - talk to their doctors about getting the defibrillators.

In the study, directed by Dr. Douglas Zipes of Indiana University, 507 patients were randomly assigned to get defibrillators, while a comparison group of 509 received medicines, mostly amiodarone. Fifty patients were enrolled at Sentara Norfolk General Hospital.

``We just watched to see which group lived longer,'' said Dr. John M. Herre, a cardiologist who conducted trials in Norfolk.

After three years, 75 percent of those who got defibrillators were still alive, compared with 64 percent of those who took the medicines, The Associated Press reported.

That difference is medically significant, said Herre. But the issue is complicated by cost: The defibrillator is much more expensive than the medicines.

The machine, about the size of a cassette tape, is placed below the collarbone. It includes a wire that snakes through the heart. When a sensor on that wire detects an abnormal heartbeat, a jolt of electricity - up to 750 volts - is delivered to the heart.

``It stops it cold,'' Herre said. When the heart restarts in a second or so, it usually is beating normally. The machine is programmed to give up to six jolts at gradually intensifying levels of power.

It is used most often for patients who have scarring because of a previous heart attack, Herre said. The scars disrupt the normal electrical patterns in the heart.

The machine has been available since the mid-1980s, but it became more popular in the '90s after improvements made it smaller and longer-lasting, and the surgery to implant it became less invasive, Herre said.

As many as 50,000 Americans may be using defibrillators. Sentara Norfolk General implants them in about 80 new patients a year, Herre said.

Assessing the relative value of treatments can be difficult. Doctors sometimes compare costs by calculating how much it takes to make one person live for one more year. By that standard, Herre said, the defibrillator costs about $120,000 more than the medication - for a treatment that offers about a 10 percent better chance of survival. Currently, most insurance plans cover both.

``We are going to have to come to grips with this,'' he said.

The medicine still may be a better choice for some patients.

The device didn't seem to work any better than the drugs for people who had suffered a heart attack but had close to normal heart rhythms and had no scarring, he said. And for some patients, the surgery to implant the device is too dangerous.

Also, it doesn't seem to be useful in people with less clear signs of heart-rhythm problems, according to another study, also involving local patients, published in the journal.

Doctors looked at the benefits of the device in patients undergoing coronary bypass surgery who had abnormal electrocardiograms. The machine offered no improved survival in these cases, Herre said. MEMO: The Associated Press contributed to this report. ILLUSTRATION: Photo

HUY NGUYEN/The Virginian-Pilot

Nicholas George, photographed in his Norfolk office, has an internal

device the size of a cigarette pack implanted near his heart. A

national study shows that these devices, defibrillators, give people

with life-threatening heart-rhythm disturbances a better chance of

surviving.

Send Suggestions or Comments to webmaster@scholar.lib.vt.edu