Cardiac Rhythm Management

Business Definition

Boston Scientific’s Cardiac Rhythm Management (CRM) Group is a leading developer of implantable devices used to treat cardiac arrhythmias, sudden cardiac arrest and heart failure.

Background

Abnormalities in the heart’s rhythm or function have a wide variety of causes. Bradycardia is a condition in which the heart beats too slowly and does not deliver enough blood oxygen for the body’s needs. Bradycardia can affect the very young to the very old, though it is most commonly diagnosed among the elderly. More than 600,000 people worldwide receive treatment each year for bradycardia.

Tachycardia, in which the heart beats abnormally fast and often cannot fill adequately with blood between contractions, also can deprive the body of oxygen and may lead to sudden death. Sudden death due to cardiac arrest affects approximately 350,000 people each year in the U.S., and almost 1,000 die from it each day.

Heart failure, in which parts of the cardiac muscle weaken and lose systolic (contraction) function over time, sometimes causes the ventricles to beat in an uncoordinated or dyssynchronous way. People with heart failure usually die of either pump failure – when the heart is simply too weak to continue pumping blood – or sudden cardiac death. Heart failure is a significant health issue in the U.S. and will be increasingly so as the population ages. About five million Americans have heart failure, and approximately 550,000 new patients are diagnosed each year.

Implantable cardiac devices are often used in conjunction with other therapies, such as medications, to manage cardiac arrhythmias and heart failure. They include:

• Pacemakers treat bradycardia by serving as a sophisticated timer that monitors the heart’s intrinsic rhythm for any delayed or missing beats and helping the heart beat when necessary.
• Implantable cardioverter defibrillators (ICDs) treat tachycardias by monitoring heart activity and either pacing or shocking when the heart’s rhythm is dysfunctional. In the event of lethal arrhythmias, the device delivers a shock to cardiovert the heart back to normal sinus rhythm.
• Cardiac resynchronization therapy (CRT) devices treat heart failure by helping to restore synchrony to the heartbeat and thereby improving pumping efficiency. A patient may receive a CRT system that also offers defibrillation capability in case the patient’s heart exhibits life-threatening ventricular arrhythmias—which can lead to sudden cardiac arrest and death.

While specific systems vary according to therapy, all implantable systems include a pulse generator – which contains the circuitry and the battery – as well as leads (wires) that connect the pulse generator to the heart. Clinicians use external programmers to communicate with an implanted device and retrieve a wide variety of stored data. Wireless remote monitoring, which enables patients and physicians to conduct wireless, automatic uploads of device and condition information from the convenience of the patient’s home, is a pioneering development now available.

Fast Facts

• The CRM group introduced the world’s first market-released implantable cardioverter defibrillator, providing the lifesaving technology of an external defibrillator in a miniature, implantable form that can constantly monitor and automatically treat dangerous abnormal rhythms.
• The CRM group developed the world’s first endocardial defibrillation lead that could be threaded through a vein instead of attached to the outside of the heart via thoracotomy. Prior to the lead’s development, a patient underwent an open-chest procedure for a defibrillator implant instead of the simpler, less-invasive procedure of today.
• Pioneering the basic research and science around cardiac resynchronization therapy (CRT) with defibrillation, and recognizing that almost 50 percent of heart failure patients die as a result of sudden cardiac arrest, the CRM group introduced the first market-released CRT device with lifesaving ICD backup capabilities.

Boston Scientific

Boston Scientific (NYSE: BSX) is a worldwide developer, manufacturer and marketer of medical devices with approximately 25,000 employees and revenue of $8.3 billion in 2007. For 25 years, Boston Scientific has advanced the practice of less-invasive medicine by providing a broad and deep portfolio of innovative products, technologies and services across a wide range of medical specialties. The Company's products help physicians and other medical professionals improve their patients' quality of life by providing alternatives to surgery that minimize risk, cost, trauma, aftercare and procedure time.