The Birth of Cardiac Resynchronization Therapy

Genesis celebrates the 10th anniversary of a world first

Ten years ago, Donald Burman underwent a first-in-the-world heart procedure at Genesis Medical Center in Davenport and was home around dinnertime that day.

On Wednesday, a healthy Burman celebrated the significance of the day with electrophysiologist Michael Giudici, M.D., the Genesis Heart Institute doctor who gave him the first bi-ventricular pacemaker-defibrillator with a lead system that reached to the left ventricle of the heart. The day was Feb. 24, 1999.

A heart hospital in Davenport, Iowa, had made worldwide news. It wasn't the first time. Nor would it be the last.

At the time, Genesis Medical Center, Davenport was already one of the leading centers for heart pacing and remains so today.

"It was new technology; my doctor thought it would help me; and, I had great faith in him," recalls Burman, 54, of Davenport, who had dilated cardiomyopathy and a heart that worked at only 15 percent efficiency. He was too sick to care about being a medical celebrity. "Whether I was the first in the world or the second or last, it didn't make a difference to me. I was in such a weakened condition, I knew I wasn't going to be around much longer if it couldn't help me."

Setting the pace

The procedure signaled the advent of cardiac resynchonization therapy to help heart failure, a condition that affects a staggering 5 million Americans and costs $25 billion annually. This week, Boston Scientific, who makes the pacing devices, honored Dr. Giudici and Deb Paul, Genesis Cardiac Research Coordinator, at an event held at Duck City Bistro.

"It's an excellent opportunity to commemorate the contributions to heart failure therapy made by Genesis Medical Center," says Phil Schrumpf, RN, Field Clinical Engineer for Boston Scientific.

On the historic day in 1999, Burman received the Contak CD/Easy Trak system, a revolutionary device designed to help heart failure patients by stimulating both lower chambers of the heart to enhance its pumping efficiency. Previously, conventional systems provided pacing to stimulate only the right side of the heart and relied on the heart's normal conduction system to transfer that pulse to the left side of the heart.

"Until today, we had to open up the chest in order to pace the left ventricle," said Dr. Giudici of Cardiovascular Medicine, P.C., at the time. "It's a totally different concept than any pacing lead that has come before it."  Burman only needed a 3-inch incision.

The procedure helped Burman win back his long-lost energy and, most importantly, bought him time before he had a heart transplant in 2001, he says. His medical journey began at age 42, when his heart stopped without warning as he sat in his living room. He was given CPR by his wife, Kathy, and a neighbor; and was rushed to the hospital, where he eventually received a defibrillator. He suffered brain damage from the cardiac arrest; was in the hospital for two months; and, in full-time rehabilitation for four months.

"I played golf again. I rode my bike, and returned to work," Burman says. "The procedure bought me time until I had a heart transplant a couple of years later."

Just a year before in 1998, Genesis and Dr. Giudici made history by implanting the world's first bi-ventricular pacemaker-defibrillator, combining a pair of technologies that previously had not been electronically compatible.

Pride in Genesis research

Today, Dr. Giudici and Deb Paul, who coordinated the study at Genesis, take pride in contributions that Genesis has made to cardiac resynchronization therapy over years.

Cardiac resynchronization pacemaker-defibrillators deliver small electrical impulses that help synchronize contractions of the left ventricle, the heart's main pumping chamber, and give a lifesaving shock in the event the heart has potentially fatal rhythms. In this way, the therapy helps relieve some of the symptoms of heart failure, such as fatigue and shortness of breath.

"In the past, pacing was just to help hearts that beat too slow," Dr. Giudici says. "In the mid-90s, Genesis was one of the research centers to change the way the heart contracts. We started off by pacing into the normal conduction system of the heart by simply moving the pacing lead to a new location, closer to the base of the heart. This makes the heart pump more naturally. That approach has been adopted all over the world."

Deb Paul has been fascinated by the cardiac advancements underway at Genesis over the years, particularly because her own daughter suffers a serious heart defect. "This was a huge study," she recalls. "We were used to sending people to surgery for open-chest procedures. For me, the day was a real eye-opener to where the technology was going and the mountains that Dr. Giudici could move. I'm so fortunate to have worked with Dr Giudici over the years and to have played even a small role in this process."

On Friday, a camera crew from the medical journal "Heart Rhythm" will tape Dr. Giudici for an instructional video on a one-of-a-kind procedure done at Genesis to cosmetically implant pacemakers and defibrillators in women. He makes the incision under the breast, instead of the common practice of making an incision in a woman's upper chest.

Genesis is also one of 25 heart centers in the country participating in the Ablation Frontiers clinical trial for the treatment for persistent atrial fibrillation, giving its patients access to new technology and treatments long before the rest of the nation.

Donald Burman's son, Andy, is a research program coordinator at Genesis. "We have many studies going on at Genesis, and part of the reason is because there's a real team effort here and a dynamic Institutional Review Board with an interest in research and the benefits it can bring to our patients," Dr. Giudici says. "It's because of Genesis' reputation for research that these opportunities come to Davenport, Iowa, and the region."

      --- By Linda Barlow, Genesis