A new, life-saving device is now available at St. Mary’s Hospital in Athens for people at risk of sudden cardiac arrest – a condition in which the heart abruptly stops beating, leading to death or disability if the heart cannot be restarted quickly.
In a 60-minute procedure performed today in St. Mary’s Cardiac Catheterization Laboratory, cardiologist John Layher, M.D., implanted the area’s first S-ICD cardiac defibrillator, a miniature electronic device created by Boston Scientific and recently approved by the FDA for general use.
“S-ICD” stands for subcutaneous implantable cardioverter defibrillator. Defibrillators restart the heart by passing a powerful electric shock through it. External defibrillators are often shown in movies and on TV, shocking people back to life. Implantable defibrillators do the same thing, but they are tiny, implanted under the skin, and ready to rescue the patient within seconds 24 hours a day, 7 days a week.
Like other implantable defibrillators, the S-ICD detects when the heart’s main pumping chambers – the ventricles – develop a dangerous rhythm or stop beating altogether. It then automatically delivers a powerful electrical shock to re-start the heart.
Unlike current implantable defibrillator models, the S-ICD does this without any electrical wires – known as leads – going directly into the heart or through blood vessels leading to the heart. Instead, an electrode is placed under the skin next to the breastbone, making the device safer and more durable.
“The advantages of this system are primarily that there are no leads placed into the heart,” said Dr. Layher, a board-certified cardiologist with Oconee Heart and Vascular Center and a specialist in cardiac devices. “Most of the failures of ICD systems are related to wear and tear on the leads. This eliminates that concern.”
Dr. Layher, who also implanted the first ICD in Athens in 2003, went on to say, “It is exciting for me to also be the first to implant this new generation of medical devices here at St. Mary’s. Our goal is to be on the forefront of bringing the highest quality of cardiac care to patients in the Athens area.”
The recipient of Athens’ first S-ICD, Louise Condron of Bogart, received the device after complications of congestive heart failure sent her to St. Mary’s last fall, feeling weak and struggling to breathe. As part of her diagnosis and treatment, her primary cardiologist, Clay Chappell, M.D., conducted a cardiac catheterization study to look for blockages in her coronary arteries that might put her at risk of a heart attack.
“He only found one little blockage,” Mrs. Condron said. But he recognized that her heart was dangerously weak, putting her at high risk of ventricular tachycardia or fibrillation. In this condition, the muscles of the ventricles twitch or quiver without squeezing the chambers and pumping blood effectively. Dr. Chappell referred her to Dr. Layher for implantation of an ICD.
A retired businesswoman – Louise and her husband, Ronnie, ran several businesses in the Athens area over the years, including Burman Printing, Good Buddy Radio, and Martel’s Restaurant – she set out to do her homework. She soon found an article about Boston Scientific’s S-ICD device and took it with her when she went to see Dr. Layher.
“As it happened, that was the one he wanted to implant for me,” she said.
She has no illusions about how it works. “If your heart stops beating, it shocks the fool out of you, “ she said. “But with my heart being so weak, it’s something I really need, and I like the idea that it doesn’t require putting wires into my heart.”
The procedure, which required less than an hour to perform, consisted of implanting the main portion of the device just under the skin of the chest near the left arm. The second part of the device was then tunneled under the skin across the chest and upward alongside the breastbone. No portion of the device actually sits inside the chest cavity, but rather outside the rib cage.
“The procedure went as planned,” Dr. Layher said Monday afternoon. “Now, she has a potentially life-saving device monitoring her heart rate every second of the day and night, ready to instantly administer a shock that can stop fibrillation and restore normal sinus rhythm.”
Dr. Layher notes that the S-ICD is useful for a wide range of people who are at risk of sudden cardiac arrest.
“For example, it may be a good option for a young person who needs a defibrillator but not a pacemaker,” he said. “When we start placing leads in the heart at a young age, and later some of those leads fail, we have to extract them or insert new leads and leave the old ones in place. Neither of those options is ideal. Leads can become infected or sometimes even cause perforation of the heart. Removing them is dangerous and requires transfer to a tertiary center. In good hands, the chances of death are 1-2 percent to extract leads. Having access to a device that does not require us to implant leads in the heart is an important step forward.”
If you would like more information about the S-ICD implantable defibrillator, contact Oconee Heart and Vascular Center at 706.389.3440 or visit http://www.bostonscientific.com/s-icd/clinical-evidence.html.