On March 31, Manoj Panday, M.D., a UT Health Science Center San Antonio cardiologist, implanted a subcutaneous internal cardioverter-defibrillator (S-ICD) into a patient at University Hospital. The patient, who is at high risk for sudden cardiac arrest, was the first University Health System patient to be treated with this new device. The surgery lasted two hours.
Dr. Panday, professor of medicine, performed two S-ICD implantations in February and March at the South Texas Veterans Health Care System, the first being on February 26.
Like other defibrillators, the S-ICD system is a battery-powered device implanted underneath the skin, allowing to save a patient’s life by delivering a shock to the heart. What distinguishes it is the electrical lead for the S-ICD, which is implanted within the chest wall, eliminating the need to screw one or more leads into the heart itself.
As Dr. Panday explains, this method reduces the risk of puncturing the heart or lungs, or injuring blood vessels through which doctors have had to track the leads. “This reduces the patient’s risk of contracting a systemic infection, such as endocarditis. It is advantageous that the new approach does not involve touching the heart or blood vessels,” he said.
Dr. Panday, with the UT Medicine cardiology practice, is one of the first physicians in South Texas to be trained on how to implant this device, both a new technology and a new procedure that is not done yet in many parts of the country.
Developed by Boston Scientific, the S-ICD system only recently gained U.S. Food and Drug Administration approval for treating patients who are at high risk for sudden cardiac death.
The patient Dr. Panday treated at University Hospital has a cardiomyopathy, a weakening of the heart muscle with a low ejection fraction, which is a measure of heart pump function. “The patient has scarring in the heart that puts him at risk of developing ventricular fibrillation (quivering of the heart without organized electrical activity). This type of rhythm results in sudden death if not shocked quickly. Unfortunately, these patients often do not survive their first episode,” he explains.
The S-ICD system detects abnormal heart rhythms and can quickly deliver an 80 Joule shock to restore a normal rhythm. The device’s generator is implanted under the skin and contains a battery that generally lasts five years and can be replaced with an outpatient procedure.
This is the first time that an implantable device can prevent sudden cardiac arrest and save someone’s life without having a lead implanted inside the vascular space and heart.
“With a defibrillator implanted, survival can be increased by 30 percent in high-risk patients,” Dr. Panday said. “There is less overall procedural risk to the patient, but there is similar life-saving benefit with the S-ICD.”