When Hearts Beat Too Rapidly; Chest Implants and Treatments Cut Number of Fatalities

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Jerome Ramsey, who spends his winters in Bethesda, knows what it feels like to be knocked literally off his feet. Due to a rapid heart rate, he has been shocked on multiple occasions through a medical device implanted in his chest.

"In September 1997, as I was gardening, without any kind of forewarning, I was suddenly knocked to the ground," says Mr. Ramsey, who lives in Johnson City, N.Y., the rest of the year. "I was puzzled for a moment, then realized it must have been my device. ... I realize the device is like having my own ER with me all the time. And that's a good thing."

Multiple therapies are available for people with irregular heartbeats, including various treatments and implantable medical devices. These options help to reduce the number of deaths from sudden cardiac arrest. Approximately 400,000 such deaths occur in the United States annually.

In 1995, doctors placed an implantable cardioverter-defibrillator inside Mr. Ramsey's chest after a severe episode of ventricular tachycardia, which is when the heart's bottom chambers beat too quickly. Mr. Ramsey's heart had reached a rate of 200 beats a minute.

When the heart experiences ventricular tachycardia, less blood is pumped to the body and the brain. If the condition isn't treated properly, it can be life-threatening. Now, Mr. Ramsey, 73, relies on the implantable cardioverter-defibrillator, the same type of device Vice President Richard B. Cheney has, to shock his heart if it starts to beat too quickly.

The device, which is a little smaller than a beeper, also contains a pacemaker, which stimulates the heart if it beats too slowly. Pacemakers also can be implanted as separate devices.

So far, Mr. Ramsey's implant has gone off about eight times, which has undoubtedly extended his life. However, since being shocked is the equivalent of being kicked in the chest or hit with a baseball bat, it has not been a pleasant experience.

Sudden cardiac death is now the No.1 fatality in the United States, more than heart attacks, says Dr. Cynthia Tracy, chief of the division of cardiology at Georgetown University Hospital in Northwest. According to the American Heart Association, approximately 225,000 people die of heart attacks per year in the United States.

Sudden cardiac death can occur in the presence of a heart attack, but also may result from a variety of cardiac reasons and is generally related to a lethal heart rhythm problem. When experiencing a heart attack, one of the coronary arteries that supplies the heart muscle with blood closes. This results in damage of the heart muscle.

Signs that a patient needs an implantable cardioverter-defibrillator include prior heart attacks or decreased function of the left ventricle, the heart's main pumping chamber. These symptoms are found in about 4 million people in the United States.

In fact, hardening of arteries, which is associated with certain types of heart disease, can lead to heart muscle damage that becomes the catalyst for serious arrhythmias. This could cause sudden cardiac death, which is caused by rapid heartbeats, without a heart attack taking place. Further, serious arrhythmias also can occur before or after a heart attack. They can happen for a number of other reasons as well, some of which are more serious than others.

For instance, a person with a structurally normal heart experiencing arrhythmias may have idiopathic ventricular tachycardia, which may be caused by irritable areas in the right or left ventricle.

In general, the condition is not life threatening. Most patients don't lose consciousness during episodes when their heart rates increase. Also, the risk of losing effective heart pumping function is low with this condition.

"A lot of those people can be very nicely treated with medication, or it will spontaneously go away," Dr. …