A new less invasive option for patients at risk for Sudden Cardiac Arrest
Langhorne, PA, February 17, 2014 — An Electrophysiologist at St. Mary Medical Center recently implanted a subcutaneous implantable defibrillator (S-ICD) system, the first and only ICD that provides defibrillation therapy without touching the heart. Dr. Scott Burke, Medical Director of the Electrophysiology Lab at St. Mary, performed the procedure on a 33-year-old male with a long history of life-threatening ventricular tachyarrhythmia that can result in sudden cardiac arrest.
The implantation of a defibrillator has become an increasingly used procedure in recent years because sudden cardiac arrest — which defibrillators can correct with a powerful electric shock — is a leading cause of death in the United States. Defibrillators are designed to correct a deadly electrical malfunction of the heart by restoring a normal heart rhythm that CPR alonecannot do, although CPR remains part of the process used to treat cardiac arrests.
Traditional implantable cardioverter defibrillators (ICDs) require thin, insulated wires – known as leads – to be precisely positioned into the heart using image-guided fluoroscopy, an x-ray procedure.
The new S-ICD System effectively performs the defibrillation needed to shock the heart back into normal rhythm without having to implant wires directly into the heart. The less invasive
S-ICD device had two main components: a pulse generator, which powers the system, monitors heart activity, and delivers a shock if needed; and an electrode, which enables the device to sense the cardiac rhythm and serves as a pathway for shock delivery when necessary. Both components are implanted just under the skin — the generator at the side of the chest, and the electrode beside the breastbone. Implantation with the S-ICD System can be done without x-ray imaging using only the anatomical landmarks of a person’s body structure.
The S-ICD system is considered a revolutionary alternative to transvenous ICD therapy in that without the wires touching the heart, potential complications associated with lead implantation or extractions are avoided, including infection or vascular injury. “Not only is the S-ICD device a safer alternative for certain patients at risk of sudden cardiac arrest, it also shortens recovery time, can feel more comfortable to the patient, and can provide a better cosmetic look post-operatively,”says Dr. Burke.
The SICD does not provide pacing therapy, so it is not indicated for patients who need the pacing function of a traditional defibrillator. Although the minimally invasive feature of the new S-ICD is appealing to patients, the electrophysiologist will recommend the best defibrillation device to protect a patient from sudden cardiac arrest with consideration to how the electrical system of the patient’s heart is performing and other medical circumstances.
Craig Farber, of Ewing N.J., received the first S-ICD device implanted at St. Mary. At age 33, Farber previously had four implanted ICD devices since his heart unexpectedly stopped beating and caused him sudden cardiac arrest at age 15. The leads implanted in his heart broke twice. Lead extraction, to remove the wire connectors from his heart, is a somewhat risky procedure. So the implantation of a new device that does not require any leads in his heart veins seemed to be a great improvement that would benefit him.
Farber was in the hospital for two days: one to have surgery to remove the old leads and ICD; and the next day to have the new S-ICD placed. He reports there was more discomfort with the lead extraction than in the implantation of the new device. “This new procedure was much easier – very straightforward,” says Farber. “And to think they did not have to go through a vein and leave something in my bloodstream – sweet! That makes me very happy.”