When your heart's natural pacemaker or electrical circuit malfunctions, the signals sent out may become erratic: either too slow, too fast, or too irregular (arrhythmia). An implantable defibrillator may be advised if you are at risk for potentially fatal arrhythmias.
Hakeem Jibawi, DO, a cardiac electrophysiologist with Specialty Physicians of Illinois who chooses to practice at Franciscan Health, recently explained the subcutaneous implantable cardiac defibrillator, a defibrillator that can be implanted under the skin.
Franciscan Health Offers Less-Invasive Alternative To Traditional Implantable Cardiac Defibrillators
Q: What Is A Subcutaneous Implantable Cardiac Defibrillator (S-ICD)?
A: The S-ICD is an implantable defibrillator that can save a person's life by shocking their heart out of a dangerous rhythm.
The cardiac defibrillator is implanted entirely beneath the skin. Its battery fits under the armpit area, and an electrode rests on top of the sternum near the heart to deliver an electric shock when it detects potentially lethal heart arrhythmias.
When those in cardiac arrest are not shocked, their chance of survival decreases by about 10 percent every minute. Implantable defibrillators can recognize dangerous rhythms and respond in less than 30 seconds.
Q: Who Is A Candidate For The S-ICD?
A: The S-ICD is an option for heart patients who have had a prior cardiac arrest or a ventricular arrhythmia, or those with heart failure, which puts them at high risk for cardiac arrest.
I performed Franciscan Health's first S-ICD implant last year for a heart failure patient with an ejection fraction of less than 35 percent, putting him at risk for sudden cardiac arrest due to a lethal ventricular arrhythmia. The ejection fraction refers to the ability of the left ventricle of the heart to pump blood with each heartbeat.
Q: How Is The S-ICD Different From The Traditional Implantable Defibrillator?
A: Traditional implantable defibrillator leads are inserted through a large vein, positioned inside the heart and are connected directly to the heart muscle.
While both devices shock the heart out of a dangerous rhythm, the traditional ICD is also able to potentially pace the heart. This benefit, however, comes at the cost of compromising the blood vessel beneath the collarbone, which can no longer be used for things like hemodialysis.
Also, in the event of malfunction or infection, the traditional device must be surgically removed at an extraction center, while the subcutaneous ICD does not.
Q: What Are The Advantages Of The S-ICD?
A: Since the S-ICD leaves the heart and blood vessels untouched, the risk of injury to the heart and blood vessels is eliminated. This is especially beneficial for patients who need their blood vessels for dialysis. For many, this device is the only way to give them an ICD, and prevent sudden cardiac arrest.
This defibrillator implant is also good for active, younger patients who do not want to compromise their blood vessels. Cosmetically, the procedure leaves no scarring in the chest area, and the device is concealed under their arm.
Q: What Is Involved In Implanting This Device?
A: The patient receives a general anesthetic for the procedure, which takes about an hour. The patient remains hospitalized overnight for pain control and observation and is discharged the following morning. Soreness at the insertion site subsides after a few days.
The benefits of defibrillators for preventing sudden cardiac arrest and prolonging life are proven. If you think you may be a candidate for an implantable defibrillator, make an appointment with your cardiologist to discuss your options.
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