A Pulse Of Hope For A Failing Heart

COURTESY PHOTO

Robert Wimmer, 88, considers himself a native Floridian. He’s been living in the Sunshine State since he was 10 years old, when his family relocated to Miami. Robert later moved to Fort Lauderdale, where he spent the bulk of his career.

“When I was young, I served as a police officer for 12 years,” Robert shares. “After that, I went into the restaurant business. I owned a steak-and-seafood restaurant in Fort Lauderdale until I retired 20 years ago.”

Today, the octogenarian lives in Palm Bay and enjoys a laid-back lifestyle. He likes to watch television at the home he shares with his son, Jeff. But sometimes he leaves home to watch sports and play pool with Jeff and his friends at a local pub.

In recent years, however, even those casual activities became very difficult for Robert. A heart condition that grew worse with time was the reason.

“The problem goes back five years,” Robert elaborates. “It started off with breathing difficulties, and I was also really weak. I was diagnosed with heart failure. My heart doctor, Dr. (Enrique) Polanco, had his partner put a cardiac resynchronization pacemaker in me, and that helped for a while.”

Heart failure is a chronic condition in which the heart muscle is markedly impaired and cannot pump blood to the rest of the body efficiently. Symptoms of heart failure include shortness of breath; fatigue and weakness; swelling in the legs, ankles or feet; and decreased exercise tolerance. In short, patients with heart failure have a very restricted quality of life.

Over the years, Robert’s heart failure became increasingly severe, and the pacemaker was no longer enough to support his heart function.

“After I got the pacemaker I was put on medication,” Robert recalls. “At one point, I was taking milrinone as a continuous infusion through a port in my chest. I took that medication non-stop for two years.”

Milrinone can cause serious side effects and even leads to death, so it cannot be used as a long-term treatment for heart failure. Out of pharmacologic options, his cardiologist referred him to Dr. Ken W. Lee, a board-certified electrophysiologist, for one last intervention.

COURTESY GRAPHIC IMPULSE DYNAMICS
The Optimizer Smart Mini is implanted in the chest and has leads to the heart. The device applies a high electromagnetic field to the heart’s cells that augments calcium handling.

Exercising the Heart

Robert was confirmed to have severe left ventricle systolic dysfunction despite numerous oral medications, continuous intravenous medication, and cardiac resynchronization via his pacemaker.

The left ventricle is the heart chamber that pumps oxygen-enriched blood into the aorta, the main artery that carries that blood to the rest of the body. That systolic phase is when the chamber contracts and pumps blood.

A measurement of how much blood is pumped with each heartbeat is the ejection fraction, and while a healthy heart usually pumps at about 55 to 70%, Robert had an ejection fraction of 25 to 30%.

“As a result, Mr. Wimmer has advanced, chronic, systolic heart failure,” his cardiologist stated. “His heart cannot pump enough blood forward to meet his body’s needs. Ultimately, he was placed on a continuous intravenous medication to keep his body functioning.”

Because heart failure is a progressive disease, at some point, the heart will need support to keep going. To help Robert’s heart function more effectively, Dr. Lee implanted the Optimizer® Smart Mini, a pulse generation device developed by Impulse Dynamics. This is an innovative device that provides Cardiac Contractility Modulation (CCM) therapy.

“The Optimizer Smart Mini is an implantable device that reverses the biology of the failing heart,” describes Steven Diaz, a representative of New Jersey-based Impulse Dynamics. “Due to the symptoms of heart failure, these patients are not able to have the lifestyle they had before their diagnosis.

“There are only a few device treatment options available for heart failure. One is cardiac resynchronization therapy, which uses a device to help the left and right chambers of the heart beat in unison. But less than a third of heart failure patients are candidates for that device. The others had no options until the Optimizer Smart Mini was developed.”

The Optimizer Smart Mini is one of the few devices that treats patient with Class III heart failure and an ejection fraction from 25 to 45%. Patients with Class III heart failure continue to experience symptoms despite medication therapy, Steve educates.

“Patients who qualify for an Optimizer Smart Mini will undergo a minimally invasive, same-day procedure similar to a pacemaker implantation,” Steven explains. “The device is typically implanted under the skin in the upper chest. In most cases, patients immediately begin to see improvements in quality of life that the medications were unable to provide.”

The Optimizer Smart Mini improves heart function by delivering precisely timed electrical pulses to the heart’s cells during the absolute refractory period, a phase of the beating cycle just after the contraction.

“Like a pacemaker, the Optimizer Smart Mini CCM Device has leads that go to the heart, but it does not excite the heart,” Dr. Lee explains. “Instead, it applies a high electromagnetic field to the heart cells so as to augment calcium handling. Intracellular calcium is essential for the heart to contract.

“In addition, the Optimizer Smart Mini produces about 200 times the pulse output of a regular pacemaker. That kind of high energy output enables the heart cells to repair themselves.One can think of it as an electricity-based, cellular therapy for a failing heart.”

The Optimizer Smart Mini doesn’t affect the heart’s rhythm like a pacemaker, Steven adds. It sends electrical stimulation at the standstill of the contraction, which makes the next contraction more forceful.

“It essentially exercises the heart, which is a muscle,” he says. “The more you exercise a muscle, the stronger it becomes. As the heart becomes stronger, symptoms begin to alleviate.”

The Optimizer Smart Mini is rechargeable; from home patients charge it once a week with an external device for about an hour. The device lasts for more than 20 years before it must be replaced.

“After receiving the Optimizer Smart Mini CCM device, many patients return to the quality of life they had before their heart failure diagnosis,” Dr, Lee says.

-Dr. Lee

A “Trophy Patient”

Dr. Lee implanted an Optimizer Smart Mini in Robert’s chest in December 2022. The electrophysiologist is pleased with his patient’s progress.

“Robert is doing great,” his cardiologist reports. “He is currently off his milrinone intravenous medication, and is feeling much better than he was while taking that medication.”

Robert agrees with Dr. Lee’s assessment.

“Since Dr. Lee put the device in, I’ve been feeling pretty good,” he confirms. “I haven’t had shortness of breath for a while. My doctor calls me his trophy patient, and I recommend the Optimizer device for anyone who has a bad heart like I do.” Of note, Robert’s most recent ejection fraction is 55%, or back to normal.

Ken W. Lee, MD

Internal Medicine

Ken W. Lee, MD, MS, FACC, is board-certified in internal medicine, cardiovascular disease and clinical cardiac electrophysiology. He earned his Read more...

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