New implantable defibrillator for heart patients is less invasive

Greenville NewsMay 27, 2014 

— After suffering a major heart attack and enduring six bypass surgeries, Arthur Craig lived with the terrifying prospect of sudden cardiac death.

Doctors told him the best course of action was to implant a device in his chest that would jolt his heart if it stopped. And he was on board with that.

But he had to decide if he should get the conventional implantable cardiac defibrillator, which has leads that go directly into the heart, or be a guinea pig for the next generation of the device, whose lead stays outside the heart.

For the 68-year-old Greer man, the choice was easy.

“With the new device, you do not have to enter the heart ... and have a chance of fewer complications,” said Craig, who was the first patient in the Upstate to get the device.

“So I wasn’t worried about being the guinea pig.”

The Boston Scientific subcutaneous implantable cardiac defibrillator eliminates a lot of the risks that can occur during the surgery to implant a defibrillator, such as perforating the heart or damaging the blood vessels, Dr. Donald Rubenstein, medical director of cardiovascular research at Greenville Health System, told The Greenville News.

“This does provide a lot of extra safety, at implant and over the course of its life,” he said. “With this, we don’t have any risks to the heart at all.”

Restoring rhythm

About 424,000 people have a sudden cardiac arrest outside of the hospital each year in the U.S., according to the American Heart Association. Just over 10 percent survive.

And 97,000 cardiac defibrillators were implanted in 2010, according to the association.

With the conventional surgery, a small incision is made in the upper chest, the defibrillator is implanted and then leads are guided through a blood vessel and attached to the heart chambers, Rubenstein said.

The wires send information about heart rate to the defibrillator, which delivers a shock to the heart to restore normal function if a life-threatening arrhythmia is detected, he said.

While the new device also is implanted under the skin, it’s located a little more to the side, he said. And the lead is tunneled along the breastbone and loops about 2 inches from the heart, where it performs the same function, he said.

“The wires are not in the heart, but are at enough of an angle that it provides this life-saving shock to get heart rhythm back,” he said. “So you don’t have to worry about any potential risks of serious complications of the procedure putting the wire into the heart chamber.”

Those complications also can occur during removal of a defibrillator or lead, Rubenstein said.

The new defibrillator can be used for any patient who has severe heart disease, either from a prior heart attack or who is at risk of developing a sudden life-threatening rhythm, he said.

It will also be useful for people who’ve had prior infections or have narrowed blood vessels, and in children because the lead can pull out of the heart chamber as they grow, he said.

Though the titanium device is the size of a pager, most patients adjust to having it in their body it within a few weeks, he said.

Round the clock

Craig, who had his implanted in March about 2 inches below his left armpit, said he doesn’t even know it’s there.

“For the first couple of weeks, you’re sore,” said the retired chemical sales representative. “But it does not get in the way of your golf swing — no matter how bad your swing is.”

The defibrillator works round the clock, whether the patient is awake or asleep, and delivers a shock that restores normal rhythm in 5 to 10 seconds, Rubenstein said.

Patients describe that jolt as feeling like they’ve been kicked in the chest by a horse, he said.

“This acts in seconds, but as soon as you feel it, it’s over,” he said. “It beats the alternative. And I don’t see any patients who say, ‘Take this out of me.’”

Having the defibrillator offers patients susceptible to sudden cardiac death peace of mind, he said.

“When you talk to patients who’ve got a 20- or 30-percent chance of dying, and may be 50, 60 or 70 years old, they still have a lot of life left,” he said. “I’ve heard it many times describedit as a paramedic inside you, being able to detect these and treat as soon as possible.”

Without one, he said, if something happens at a place without an automatic external defibrillator, or AED, “you’re hoping somebody sees you go down, that somebody can do CPR and that the paramedic can get there in 4 to 5 minutes, otherwise you risk brain injury.”

Insurance policy

Craig, who suffered a heart attack in 2006, said his heart is so weak that he feared EMS wouldn’t be able to get to him in time should he suffer a cardiac arrest.

“It hasn’t gone off on me, and I hope it never does,” he said. “But it gives you peace of mind. Plus, you have a built-in insurance policy.”

The surgery, which takes 45 minutes to an hour, is performed under a kind of general anesthesia, Rubenstein said. And patients typically go home the same day, he said.

Information about the heart rhythm and how often the defibrillator kicks into action can be downloaded from the device in the doctor’s office, enabling medication adjustment or recalibration, if necessary, he said.

The next generation should allow for remote transmission of that data, he said, and as technology advances, the devices should get smaller.

The device is being reviewed by Bon Secours St. Francis Health System, said Johnna Reed, vice president of business development and heart and vascular services.

A former Clemson University football player, Craig said that since the surgery, he’s been working on restoring his house, treasuring time with his two grandchildren, and relaxing at the beach. And having the device allows him to it all without fear.

“I may not be running marathons, but I’m doing really well,” he said. “Having this device just takes some of the worry out of it.”

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