Paul
Maccaro, MD, Director of Electrophysiology
Since the early 1990s, Huntington
Hospital's cardiologists have been involved in
clinical research leading to the development
of a treatment that has become the gold standard
for patients in the throes of a heart attack.
Their experience with these thrombolytic medications,
also known as "clot-busters," contributed
to the life-saving care received by countless
Huntington patients.
Huntington cardiologists continue
to contribute to medical knowledge by participating
in research studies. Paul Maccaro, MD,
Director of Electrophysiology, is overseeing three
studies related to cardiac arrhythmia patients
and those with congestive heart failure.
"Modern pacemakers have sophisticated
information storage capabilities," said Dr.
Maccaro. "Up until now, no one has collected
this information, which can give us insight into
the natural history of what happens to the heart
after a pacemaker is implanted."
Dr. Maccaro is enthusiastic about
participating in a clinical study that will attempt
to collect and analyze the data that pacemakers
record in patients with atrial fibrillation, the
most common form of tachycardia, or rapid heartbeat.
In atrial fibrillation, the upper chambers of
the heart may beat up to 450 - 600 times per minute
and the beats occur chaotically. A normal heart
beats 60 - 100 times per minute.
"In its least severe form, it
is a nuisance," said Dr. Maccaro about the
condition. "However, since the atria is not
contracting, blood can clot and cause a stroke
in the worst case scenario."
Pacemakers implanted in patients
with atrial fibrillation are akin to miniature
computers that are programmed to recognize an
episode of arrhythmia and record an electrogram,
in essence an electrocardiogram taken from within
the heart. Each pacemaker is equipped with a radiotransmitter
which is typically used during routine checks
of the device. In this study, the radiotransmitter
will be used to download the information from
electrograms, which will be electronically sent
to the study site where it will be collated with
information from thousands of other patients.
"Patients receiving new pace-makers
are eligible to participate in this study,"
Dr. Maccaro explained. "The nice thing is
that the data collection takes place during routine
checkups. No additional hospital visits are required."
The sophisticated nature of implantable
devices is making data collection a more objective
process for another clinical trial that Dr. Maccaro
is overseeing. This one is examining the potential
benefits of a new anti-arrhythmic medication in
patients with implanted defibrillators for ventricular
tachycardia.
"Many of the current anti-arrhythmic
drugs are potentially toxic, so we are constantly
searching for new ones with less toxicity,"
Dr. Maccaro noted. This study will test the effectiveness
of a new medication in reducing the number of
episodes of arrhythmia in patients with implanted
defibrillators. Recorded information on the incidence
of arrhythmic episodes will be downloaded from
the defibrillators in order to provide researchers
with an unbiased account of the drug's impact.
Neither the physicians nor patients
will know who is receiving the actual medication,
who is receiving a standard medication, and who
is receiving a placebo in this study.
"Ventricular tachycardia is
a potentially life-threatening arrhythmia,"
Dr. Maccaro said. "In these patients, medication
is the first line of defense, and the impantable
defibrillator is like the EMS squad should the
medication fail to control the arrhythmia."
Dr. Maccaro pointed out that no medication
is 100% effective in eliminating arrhythmic episodes,
however scientists are hoping that this study
will prove that this new medication is as effective
as currently available therapies, with fewer side
effects.
Lastly, Huntington Hospital physicians
are conducting a study of congestive heart failure,
which affects large numbers of patients at the
end of life, when the heart can no longer keep
up with the demands of the body. Congestive heart
failure typically occurs following a heart attack,
or it may be associated with a structural problem
such as a leaky valve, or a chronic problem such
as hypertension.
Three hundred hospitals across the
country are participating in this study, designed
to evaluate the management of congestive heart
failure by comparing treatment approaches at a
variety of institutions.
"All types of healthcare institutions,
including community hospitals like ourselves,
university hospitals, and teaching centers will
participate in this study," Dr. Maccaro explained.
"We will be looking at patient charts and
collecting data anonymously in order to accumulate
information on how people with heart failure across
the country are treated."
Dr. Maccaro expects the results to
reveal differences in treatment approaches based
on geography, but he says the study will also
provide healthcare practitioners with an opportunity
to benchmark patient outcomes.
"The primary objective is improved
quality of care within every institution,"
he concluded.
For additional information on cardiac
research at Huntington Hospital, call Dr. Maccaro
at (631) 351-2798.
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MARCH 2002
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