The Grim Reaper isn't a happy
fellow these days as technology
and medicine continue to
keep people around. When you
usually hear about someone coming
back from the dead and getting
a second chance at life, you
assume it was dreamt up in Hollywood.
Yet thanks to technology
from Boston Scientific, people like
my friend Tim can continue ticking
for the foreseeable future.
Diagnosed with congestive heart
failure (CHF) many years ago, Tim
has had several heart attacks. In
fact, he was declared clinically dead
when he saw his cardiologist a little
over a year ago because his heart
wasn't sending the proper electrical
signals to beat in a normal rhythm.
This left Tim with two choices: imminent
death or a chance for life with
new technology.
Tim is one of the more than
1500 CHF patients who qualified
for the Contak Renewal 3RF cardiac
resynchronization therapy
defibrillator (CRT-D). This device is
implanted in the pectoral region of
the chest with gold contacts placed
in three of the heart's four chambers
(Fig. 1).
The CRT-D primarily functions as
a pacemaker. But it also can stop
and restart a heart using a 41-
Joule burst of energy when the pulse is too
high or low. Additionally, it includes RF communication
capabilities via the industrial scientific
and medical (ISM) band in the 902-
to 928-MHz range.
The CRT-D works with the Internetconnected
Latitude Communicator
(Fig. 2). The Latitude device sits
under Tim's bed and continuously
monitors and awaits
data from the CRT-D at times
specified by his physician during
the CRT-D's original programming.
(The CRT-D normally
is programmed when it is
implanted.)
A Bluetooth-enabled scale and a
sphygmomanometer monitor Tim's
weight and blood pressure daily.
Subsequent to each reading, the
data is transmitted to the Latitude
device. When the system finds a
pulse, weight, or blood pressure
anomaly, it lets the patient know. In
fact, Tim heard from the machine
after a particularly stressful night.
"The next morning, out of the
blue, a female voice says, 'You have
questions to answer,'" Tim
explained. The voice startled him
until he realized it was the Latitude
device, which continued to ask
questions such as "How bad is your
vision on a scale of one to four?"
and "How many pillows did you use
last night?"
Cardiologists working with Boston
Scientific developed this set of quality-
of-life inquiries based on the kinds
of questions physicians would ask
patients who are feeling uncomfortable
and go to the doctor's office for
a diagnostic visit.
"In the recent ACC/AHA guidelines
for heart failure, close monitoring
of a patient's weight and activities
of daily living are a Class I
recommendation. There is ample
evidence that this type of approach
can result in fewer hospitalizations
for heart failure patients," said Greg
Ewald, MD.
Each day, the Latitude device
takes the information it collects and
sends it via modem to a secure
server accessible through the Latitude
Web site. The combined technologies
not only keep Tim and similar
patients alive longer, they also
keep physicians informed. Doctors
can use the data to more quickly
react to anomalies that may indicate
an impending crisis - and prevent
a visit from Mr. Reaper.
Boston Scientific
www.bostonscientific.com