Working to beat heart failure

Dr. Jacqueline Joza loves to fix things, especially things that seem hopeless.

The Montreal cardiologist remembers one of her patients, an artist in his early 70s who had given up his dream of ever seeing his homeland, India, again. He was experiencing heart failure; his reduced heart function meant that his kidneys were not receiving enough blood, oxygen and nutrients. He would soon need dialysis to stay alive.

“I looked at his electrocardiogram and I said, ‘Actually, we might be able to help you,’” says Dr. Joza, an assistant professor of medicine at McGill University. 

The ability to transform lives is a big reason she was drawn to the sub-specialty of electrophysiology, which focuses on disorders that affect the heart’s electrical system. 

By implanting a device or performing a procedure to stabilize heart rhythm, she can improve the quality of life for many people with heart failure, atrial fibrillation and other diseases. “We can make them feel less symptomatic from shortness of breath and improve their day-to-day functioning.”

But when it comes to heart failure, Dr. Joza is not content to just reduce the symptoms. She wants to prevent it from happening in the first place.

About 25,000 pacemakers are implanted every year in Canada, most in people over age 60, to prevent slow heartbeats. Dr. Joza herself performs hundreds of these procedures a year.

Pacemakers solve an important problem. But in a strange twist, they can cause a bigger one: heart failure.

In up to one-quarter of people with pacemakers required to pace the lower chamber of the heart, these life-saving devices eventually weaken the heart’s function by overriding its natural electrical system. 

“What if we could prevent that from happening?” Dr. Joza says. With support from Heart & Stroke donors, she is leading research on a new implantation technique called conduction system pacing. This innovation aligns the device with the heart’s own electrical system. The goal is to keep it beating and prevent the onset of heart failure.

While the pacemaker itself has not changed, she explains, “we are implanting it in a different region of the heart that we never thought possible before.” She is teaching the new technique to colleagues across Canada in preparation for a clinical trial starting in 2022.

Why target heart failure? Because it’s such a difficult condition to manage, even with improved treatments, Dr. Joza says. 

Heart failure can leave people breathless and exhausted by everyday activities like climbing stairs. It requires frequent medical appointments and hospitalization. An estimated 750,000 people in Canada live with heart failure, and most die within five years of being diagnosed.

“We're really hoping to get in there before heart failure develops, so we don't have to deal with this terrible disease,” she says. 

Her clinical trial will test the new technique against pacemakers implanted the traditional way. The team will follow patients for up to three years, monitoring their health, hospitalizations and other factors. 

Most important to Dr. Joza, the research will track how participants feel, and their quality of life. She is passionate about giving people in their later years the chance to feel well and share everyday joys with family and friends. 

It was that kind of transformation she saw in the Indian-born artist she treated. After she implanted a resynchronization pacemaker that stabilized his heart function, he was able to travel again and create more paintings — a few of which he gave to Dr. Joza in gratitude. 

While this patient is managing his heart failure thanks to treatment, Dr. Joza believes the new research will mean many more people can avoid the condition entirely.

If the clinical trial is as successful as she believes, the new pacemaker technique will eventually be used widely. “We're very excited. And we think that this is going to be the future.”

She’s ready to beat heart failure.