FRIDAY, April 11, 2003 (HealthDayNews) -- Thirty-five years ago, a revolutionary event occurred in New York City's Montefiore Hospital: the debut of the world's first intravenous pacemaker.
The pacemaker itself rested outside the body. A wire connected to the device was passed through one of the patient's veins and into the chambers of the heart, where it made sure the organ beat normally.
The first patient to use it was a 76-year-old man. He had a 50-foot extension cord plugged into an electrical outlet so he could, and did, walk up and down the hospital hallway, pushing his pacemaker on a cart in front of him and becoming something of a celebrity in the process. With the help of the
device, the man made tremendous progress and was discharged, without the pacemaker, three months later.
"It was very exciting, the result of an accumulation of disparate little contributions, which I was fortunate in having the opportunity to sort of lock together," says Seymour Furman, the doctor who developed the device. He is now an attending physician at Montefiore Medical Center in New York City.
Many more "disparate little contributions" have accumulated since that day to streamline one device that saves so many lives. Today's pacemaker is about the size of three silver dollars placed side by side, lasts inside the body for seven to 10 years, and not only keeps pace but also analyzes heart rhythm and stores information for future reference.
Over the past three decades, advances like this have caused dramatic decreases in the death rates from heart disease and stroke, a feat the U.S. Centers for Disease Control and Prevention calls "one of the most important public health achievements of the 20th century."
Nevertheless, heart disease still remains the No. 1 killer in the United States. And scientists are working feverishly to change that. The National Institutes of Health has more than doubled its funding for heart disease from $685 million in 1991 to $1.6 billion in 2001. Here are some of the more exciting fields of research today, areas that hold promise for slashing the death rate even further:
- Drug-eluting stents will be the next big thing in cardiology, probably starting this month. Stents are routinely used to prop open arteries that have been cleared by angioplasty. But they also provoke inflammation and scarring, which can cause the artery to close over again. The new stents are coated with a drug that fights the inflammation and scarring. A large U.S. trial (SIRIUS) recently demonstrated a 75 percent reduction in the restenosis, or renarrowing of the vessel.
"It's looking like in many, many cases these will be as durable as surgery. That's big," says Dr. Jeffrey Moses, chief of interventional cardiology at Lenox Hill Heart and Vascular Institute in New York City and one of the investigators of SIRIUS. The drug-eluting stents, however, are expensive. "It's a great scientific step, but we haven't figured out how to pay for them," acknowledges Dr. Edgar Lichstein, chairman of the department of medicine at Maimonides Medical Center in New York City.
- Pharmaceuticals continue to be developed at a rapid pace. According to the Pharmaceutical Research and Manufacturers of America (PhRMA), 76 companies are working on 123 new medicines to prevent or treat heart disease and its cousin, stroke. One medicine may one day enable patients to grow their own bypasses. A vaccine in development would prevent the transfer of "good" cholesterol to "bad" cholesterol.
"We're building a knowledge base but we're also learning a lot of pragmatic things, like inexpensive drugs that do what expensive drugs do,", says Dr. Richard A. Stein, a spokesman for the American Heart Association and chief of cardiology at Brooklyn Hospital Center in New York City.
- Genetics will provide most of the big excitement in the coming years . "We're beginning to understand how [genes] relate to disease, and we're looking at them as possible targets, either through genetic manipulation or through altering their means of expressing themselves," Stein says. "Maybe three to five years down the road we'll begin to see some clinical results."
Scientists have already identified genes that characterize which people with high blood pressure are going to do worse and which patients are more likely to have heart failure. Many of the genes involved in familial diseases have also been identified. "The hard money, the money's that's going to buy us knowledge, a lot of it is going there," Stein says.
- Technology is making possible advances from defibrillators in homes and airports to hand-held, portable electrocardiogram (EKG) machines. Microprocessors may one day allow the opening of arteries from the inside without the worry of them closing up again.
- Surgery could eventually be a thing of the past, thanks to innovations such as the drug-eluting stent and the ability to repair or replace valves without an operation. Still, progress continues to be made. Bypasses are now being done without the heart-lung machine, and robotic arms can do very precise stitching through tiny holes, minimizing consequences for the patient, Stein says.
- Muscle cells are being grown in the laboratory then injected back into a patient's heart through the coronary arteries. This regenerates the damaged heart of people who have had heart failure, Lichtstein says.
There's still one frontier that remains to be conquered, and it may be the toughest one of all.
"The barriers we run into are not in heart science but in the science of the mind," Stein says. "We're not any better at getting people to eat right, and all of science will not overcome a terribly unhealthy lifestyle. One of the things I look forward to is behavioral therapy being able to assist folks."
More information
For historical information on electricity and the heart, visit the North American Society of Pacing and Electrophysiology.
For more on heart health, visit the American Heart Association or the National Heart, Lung, and Blood Institute.
