2012 Articles and Releases

Finding Better Ways to Get the Heart in Sync

Finding Better Ways to Get the Heart in Sync
Cutting-edge imaging system could optimize outcomes for children with heart failure.

Heart failure occurs when the heart can no longer pump enough blood to the rest of the body, resulting in fatigue and shortness of breath. In adults, this condition is often caused by coronary artery disease, high blood pressure, or diabetes. But it also can occur in newborns and children and sometimes is the result of structural defects in the heart that are present at birth.

In some individuals with heart failure, the two ventricles of the heart beat slightly out of phase. These patients can benefit from cardiac resynchronization therapy (CRT)—a technique that electrically stimulates the ventricles to make them beat in a synchronous fashion and allows the heart to pump blood more efficiently. Although CRT is effective in most patients, it requires surgery and can cause heart rate abnormalities in some individuals, making it important to figure out which patients will most likely benefit from the procedure.

To select the best candidates for CRT, Jennifer Silva, MD, a Washington University pediatric electrophysiologist at St. Louis Children’s Hospital and assistant professor of pediatrics, is evaluating patients using a non-invasive technique called electrocardiographic imaging (ECGI). This method involves placing hundreds of electrodes on a patient’s body to measure the electrical activity of the heart. Clinicians can use the information produced by ECGI to assess the effects of CRT on heart rhythms.

Dr. Silva and her team are using ECGI to identify patients who have significant electrical dyssynchrony in the heart, because these individuals are more likely to improve following CRT. They also are using ECGI to monitor outcomes in patients undergoing CRT, and determine which positions on the ventricles should be stimulated during CRT to produce the best outcomes. “The use of CRT has dramatically changed the way we take care of kids with heart failure, but it’s a powerful tool that we haven’t known how to wield,” Dr. Silva says. “Using ECGI will help us use CRT in an effective way in these patients.”

The use of ECGI in children was recently pioneered by Yoram Rudy, PhD, the Fred Saigh Distinguished Professor of Engineering at Washington University; and George Van Hare, MD, Washington University pediatric cardiologist and the Louis Larrick Ward Chair in Pediatric Cardiology at St. Louis Children’s Hospital; who are collaborating with Dr. Silva on this project. Funding from the Children’s Discovery Institute allowed them to acquire the equipment necessary to carry out their research. “Our institution is the only one in the world that has the capability of using ECGI in pediatric patients,” Dr. Silva says.

In a related initiative funded by an Institute award, Dr. Silva is collaborating with Charles Canter, MD; Dr. Van Hare; and Pamela Woodard, MD; at Washington University School of Medicine, as well as researchers at other institutions across North America, to develop a registry of pediatric patients’ responses to CRT. This registry will accumulate information over the next few years, including data about the heart’s structure, function, and biochemical responses.

“The goal is to prove that CRT makes a significant difference in pediatric patients with heart failure,” Dr. Silva says.

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