University of California San Francisco investigators determined early monitoring and lifestyle changes could eliminate the need for a pacemaker. In fact, blood-pressure and glucose control may be effective in preventing heart block, a common form of arrhythmia, and the subsequent need for a pacemaker, according to the research team.
The team analyzed more than 6,000 Finnish patients, appearing online May 24, 2019, in JAMA Network Open. The UCSF researchers found that more than half of the cases of heart block resulted from high blood pressure or elevated blood sugar.
Of those factors, two directly modifiable risk factors were identified: every 10 millimeter increase in systolic blood pressure resulted in 22 percent greater risk, and every millimeter increase in fasting glucose resulted in 19 percent greater risk. Taking into account the prevalence of these modifiable risk factors in the population and assuming causal relationships, they estimated that 47 percent of AV blocks in the 58 patients would have been avoided with ideal blood pressure and 11 percent with normal fasting glucose.
The authors note the study occurred in a solely Caucasian population and advised caution in applying findings to other populations.
Atrioventricular (AV) block occurs when electrical conduction is impaired between the heart’s four chambers, most often by fibrosis or sclerosis. It is often felt as the heart skipping a beat.
An estimated 3 million people worldwide have pacemakers and 600,000 pacemakers are implanted annually. Although it is a common treatment and low risk procedure, it can result in serious complications. Generator charges also carry a high risk of infection in and around the heart. However there has been limited research on whether behavioral modifications can present heart block and which ethnicities are most at risk.
Gregory Marcus, MD, MAS, a UCSF Health cardiologist and associate chief of cardiology for research in the UCSF Division of Cardiology, noted “It is perhaps precisely because pacemakers so successfully and immediately address cases of heart block that we have failed to devote more attention to prevention of this important disease.”
The pacemaker market has been lucrative so prevention perhaps was a secondary consideration—at least for some.
Estimates vary but one analyst firm estimates the global pacemaker market size to reach $10.3 billion USD by 2025, exhibiting a 7.2% CAGR during the forecast period according to one report.
Gary Marcus. MD, MAS, UCSF