A year ago, while jamming with his son’s band, Eric Robinson went into cardiac arrest.
“I have two birthdays now: the day I was born, and the day I was reborn,” Robinson told Ivanhoe.
CPR and a portable defibrillator helped keep Robinson alive. And now a newly FDA approved Biotronik implantable cardiac defibrillator, or ICD, constantly monitors his heart.
Unlike traditional ICDs, the new system uses a single lead with sensors to detect changes in the top chamber of the heart. Antony Chu, MD, FACC, Director of Complex Ablation and Arrhythmia Services Section in the Division of Cardiology at the Rhode Island and Miriam Hospital, says this technology does the job of two leads, and allows physicians to monitor for atrial conditions, such as A-fib.
“The biggest benefit is that the defibrillator gets much more electrical information about what’s happening to the heart so the decision making process that it undergoes is much more accurate,” Dr. Chu told Ivanhoe.
That helps minimize the chance of someone getting shocked for the wrong reason. Plus the one lead reduces the patient's exposure to radiation and decreases procedure time.
Follow up visits are important, but the ICD also allows for home monitoring. Wherever there is cellular coverage, Robinson’s ICD can be monitored by a special device anywhere in the world to monitor the device status.
BACKGROUND: Implantable cardiac defibrillators (ICD) are implanted into a patient to monitor the heart. According to the FDA, the ICD is surgically implanted just beneath the skin near the collarbone. It shocks the heart into normal rhythm when the device senses dangerous abnormal heart rhythms. The CDC reports:
* About 600,000 people die of heart disease in the United States every year; that’s one in every four deaths.
* Heart disease is the leading cause of death for both men and women.
* More than half of the deaths due to heart disease in 2009 were in men (Source: www.cdc.gov)
CAUSES: The ICD is used for patients who have heart failure and are at risk of sudden cardiac death. The candidates typically have:
* abnormally fast heart arrhythmias
* exhibit related heart failure
* take congestive heart failure medicines
* have high blood pressure, diabetes, or hyperthyroidism (Source: American Heart Association)
NEW TECHNOLOGY: The new implantable cardiac defibrillator uses a single lead filled with sensors. It detects changes in the top chambers of the heart. When there are changes, the ICD shocks the heart back to normal. This helps doctors get more information about what's happening to the heart so their decisions can be more accurate. The new device reduces the patients’ exposure to radiation and post op infections. Until now the only option was implanting multiple leads, which can lead to more complications. (Source http://jama.jamanetwork.com/article.aspx?articleid=1687578&resultClick=3)
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Antony Chu, M.D., Director of Complex Ablation at the Rhode Island Miriam Hospital with Brown University School of Medicine, talks about a new kind of implantable defibrillator.
What’s new about this device?
Dr. Chu: This particular device is the newest technology that exists for defibrillation and it is a device that effectively has one wire that does the job of two. In the world of implantable defibrillators, the DX System is very revolutionary because the time it takes to implant one wire along with the associated morbidity and potential risks are substantially less than that of a two wire system.
How much time does this save you during the procedure?
Dr. Chu: It varies depending on the anatomy, but roughly since there is one wire instead of two, at least 50%.
What does a defibrillator do for someone?
Dr. Chu: Well a defibrillator has a number of different functions. One is that it can treat both slow heart rates and it can treat very fast heart rates.
What’s the difference between the device and a regular defibrillator?
Dr. Chu: Well, it does all of the functions of the defibrillator. But the real difference is that it has what we call a passive atrial sensor. So when you have two wires in the heart, one in the top right chamber of the heart and one in the bottom right chamber of the heart, that information is typically sent to the defibrillator to make its decisions about what is happening electrically in the heart. And again, that system has required two wires. This particular system is one wire, but it has multiple sensors on it. So it’s able to detect and send that information to the defibrillator in a way that in the past wasn’t possible.
From a patient’s point of view, what are the benefits?
Dr. Chu: The biggest benefit is that the defibrillator gets much more electrical information about what’s happening in the heart. So the decision making process that it undergoes is much more accurate. And why is that important? Well because if the defibrillators can decide whether or not it’s going to deliver energy, a so called shock, it needs to have as much information as possible. One of the biggest advantages of this particular technology is that, because there is more electrical information provided to the machine, it’s able to make much more informed decisions about the therapies it delivers and therefore, minimize the chance that someone might get a shock for the wrong reasons or inappropriately.
Who is a candidate to get this new device?
Dr. Chu: Well, anyone who is a candidate for a defibrillator. So there are no special criteria from that standpoint. This particular technology offers a more thorough or comprehensive electrical, sort of evaluation of the heart in real time.
Does the patient feel any difference between this and the traditional?
Dr. Chu: No.
Are there any downsides to this?
Dr. Chu: No, there really aren’t. I mean, it’s sort of like asking is there a downside to having GPS in your car? That’s partly why, if anything, this technology should have been around years ago, but it’s only just coming to be available now.
Now, with defibrillators, it’s not just this one in general, what are some of the things that patients should not being doing once they have a defibrillator in them?
Dr. Chu: Well, there is really nothing you can’t do with a defibrillator. There are only a few things that are very esoteric like welding, but otherwise, there are very common urban myths that people say you can’t have a microwave or a cell phone and that’s not true at all. You can do everything and anything. There are even Olympic athletes that have defibrillators. So it’s not something that limits your overall activity at all. It’s really a technology that is there and is constantly monitoring your heart and if you need it, it kicks in.
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