New Subcutaneous Cardiac Defibrillator Device Implanted for First Time

Intermountain Heart Institute makes heart history: New subcutaneous cardiac defibrillator device is implanted for the first time in Utah.

Cardiologists at the Intermountain Heart Institute at Intermountain Medical Center made Utah heart history last week by implanting the state’s first subcutaneous implantable cardiac defibrillator. The recipient was South Jordan resident Brandon England, 20, who suffers from heart failure and is at risk for sudden cardiac arrest

Brandon was diagnosed last April with dilated cardiomyopathy, which affects the ability of the lower (ventricle) and upper (atria) chambers of the heart to effectively pump blood throughout the body. This type of heart disease places patients at risk for sudden cardiac arrest or an abrupt loss of heart function.

How the new device works. Rather than placing insulated wires into the chambers of the heart, which is part of implanting a traditional implantable cardioverter-defibrillator, or ICD, the new subcutaneous implantable cardioverter-defibrillator, or S-ICD, is placed under the skin across the ribcage. It has two main components: The pulse generator, which powers the system, monitors heart activity, and delivers a shock if needed, and the electrode, which enables the device to sense the cardiac rhythm and serves as a pathway for shock delivery, when necessary.

During the procedure, a pocket is made in the skin below the left armpit, which allows the pulse generator to sit up against the ribcage. A durable electrode is tunneled under the skin along the ribcage to the center of the chest, then turns 90-degrees and follows the breastbone toward the neck.

The new technology was used for the first time in Utah last week at Intermountain Medical Center. “We’ve been using traditional ICDs for many years to treat cardiomyopathy with great success,” says Jeff Osborn, MD, a cardiologist with the Intermountain Heart Institute. “But having wires placed directly into the heart has its risks, including broken wires and life-threatening infections we sometimes see five to seven years after implantation. This new device offers less risk with the same life-saving benefit.”

Benefits of the new device. “The S-ICD system would be similar to having the two AED paddles placed on the chest at all times, monitoring the heart and providing a shock, if necessary, to reset any chaotic heart rhythm, but with all the equipment buried under the skin,” he says. “In a young patient like Brandon, this new procedure will allow him to have a life-saving system close at hand, without the risks associated with wires running into his heart.”

More than 359,000 Americans suffered an out-of-hospital cardiac arrest in 2013, with a 9.5 percent survival rate, according to the American Heart Association. Most episodes of sudden cardiac arrest are caused by the rapid and/or chaotic activity of the heart known as ventricular tachycardia or ventricular fibrillation, says Dr. Osborn. Recent estimates show approximately 850,000 people in the United States are at risk of sudden cardiac arrest and would benefit from an ICD device, but remain unprotected.

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