Advocate Good Shepherd Hospital is the first hospital in the northwest suburbs to implant a subcutaneous implantable defibrillator (S-ICD). The Boston Scientific S-ICD® System is the world's first and only commercially available subcutaneous implantable defibrillator for the treatment of patients at risk for sudden cardiac arrest (SCA).
The patient, Albert Wells age 44 from Hainesville, IL, has a condition called cardiomyopathy, which is a weakening of the heart muscle that predisposes a person to a SCA. In the event of an arrest, rapid treatment by an implanted defibrillator can be lifesaving.
Recently approved by the FDA, the S-ICD has advantages over the conventional implanted defibrillators in that it does not require a wire be inserted into the heart.
"The S-ICD system provides physicians with a new treatment option for patients who are at risk of sudden cardiac arrest," said Eric Kessler, MD, cardiac electrophysiologist at Advocate Good Shepherd Hospital. "The S-ICD is unique because cardiologists don't have to pass wires into the heart to deliver treatment. Those wires are often the weak link in defibrillator therapy since they have been known to fracture, dislodge from the heart, and experience other problems that can result in a loss of therapy or initiation of unnecessary shocks."
The Boston Scientific S-ICD® System has two main components. One is called the pulse generator, which powers the system, monitors heart activity and delivers a shock if needed. The other main component is the electrode. This enables the device to sense the heart rhythm and deliver shocks when necessary. Both are implanted just under the skin, providing protection without touching the heart and reliable defibrillation without transvenous wires.
"Albert's case was a bit more complicated due to his being on dialysis. Typical implantable devices require leads (wires) that descend though large veins into the heart. Patients on dialysis are at higher risk for having infections that attach themselves to the leads in the bloodstream. These infections are very resistant to cure with antibiotics and can be life threatening," said Dr. Kessler. "Another disadvantage of traditional ICD systems is that in the event of an infection or malfunction, physicians may be required to remove the equipment, a process which can on rare occasions lead to catastrophic internal bleeding from the areas where the leads are attached to the heart or veins. These issues can be avoided with the use of an S-ICD."
The S-ICD system's lead runs from the device, just under the skin, to an area near the breast bone. If the heart goes into a dangerous rhythm, the device delivers a life-saving shock that electrically resets the heart in the same way as the external defibrillators used by paramedics and other emergency response personnel.
The new procedure takes less than two hours to perform. Patients who have the S-ICD implanted require a day of monitoring and typically will be allowed to return to normal activity within three to four days.