The implant of a subcutaneous defibrillator (or S-ICD) this week gives a 68-year-old Jersey City man peace of mind that should he go into sudden cardiac arrest (SCA), the device will protect him – without the risks previously associated with the traditional defibrillator.
In a one-hour procedure in the Electrophysiology Lab at Jersey City Medical Center, while under “conscious sedation,” Abelardo Tadifa was one of the first patients in the New York metropolitan area to have the S-ICD implanted.
“It went very smoothly,” said Dr. Roy Sauberman, Director of Cardiac Electrophysiology at Jersey City Medical Center, who performed the procedure. “Mr. Tadifa was resting comfortably and returned home the following day.”
Sudden Cardiac Arrest
SCA is an abrupt loss of heart function. Most episodes are caused by the rapid and/or chaotic activity of the heart known as ventricular tachycardia or ventricular fibrillation. It is estimated that 850,000 Americans are at risk of this potentially fatal condition and in need of a defibrillator, but remain unprotected.
It is the largest cause of natural death in the U.S., causing about 325,000 adult deaths in the U.S. each year, and is responsible for half of all heart disease deaths.
Sudden cardiac arrest is not a heart attack (myocardial infarction), but can occur during a heart attack. Heart attacks occur when there is a blockage in one or more of the arteries to the heart, preventing the heart from receiving enough oxygen-rich blood. If the oxygen in the blood cannot reach the heart muscle, the heart becomes damaged.
In contrast, SCA occurs when the electrical system to the heart malfunctions and suddenly becomes very irregular. The heart beats dangerously fast. The ventricles may flutter or quiver (ventricular fibrillation), and blood is not delivered to the body. In the first few minutes, the greatest concern is that blood flow to the brain will be reduced so drastically that a person will lose consciousness. Death follows unless emergency treatment is begun immediately.
A New Device
According to Dr. Sauberman, the S-ICD system is designed to provide the same protection from SCA as traditional transvenous implantable cardioverter defibrillators. However, the S-ICD sits below the skin without the need for thin, insulated wires known as leads. With the traditional ICD, these leads are attached inside the heart chambers in order to conduct the charge. As a result, the S-ICD device avoids potential risks of puncturing the lung or the heart, major bleeding, or blood-borne infections.
With the new device, designed by Boston Scientific, such risks as puncturing the lung or the heart, or introducing bacteria that could cling to the defibrillator and cause a serious infection are avoided.
Dr. Sauberman and Dr. Muhammad Ahmad, the patient’s cardiologist, both felt that Tadifa was a good candidate for the surgery because he was at greater risk for sudden cardiac disease due to his weakened heart muscle following a heart attack.
“A defibrillator offers an insurance plan for those heart patients who are at risk of SCA,” said Dr. Sauberman. “The new device should become the option of choice for many qualified patients as it offers that same protection, doing its job silently, while providing far less risk.”
Available in Europe and New Zealand since 2009, the S-ICD received FDA approval in September 2012. To date, more than 2,000 patients around the world have undergone the procedure.