St. Bernards Medical Center marked another ‘first” in terms of heartcare this month when Dr. Devi Nair, electrophysiologist with Cardiology Associates, became the first physician in Arkansas to treat a heart patient using a new cardiac resynchronization therapy defibrillator (CRT-D) developed by Boston Scientific.
Approved by the U.S. Food and Drug Administration in November, the new device is one of three new Boston Scientific implantable defibrillators now available to help patients who are at risk for sudden cardiac death (SCD) as well as those who suffer from heart failure.
A recent survey by the Heart Rhythm Society showed that more than 70 percent of Americans not only underestimate the seriousness of sudden cardiac arrest (SCA) but also believe SCA is a type of heart attack. Because they don’t know the difference between SCA and a heart attack, they can overlook and miss warning signs that may indicate the risk of SCA.
Nair explains that SCA occurs when the heart stops working and no blood can be pumped to the rest of the body; the heart’s “electrical system” malfunctions. A heart attack – a condition technically known as a myocardial infarction (MI) – is a “plumbing problem” in which a blockage in a blood vessel interrupts the flow of blood to the heart, causing an area of dead heart muscle.
The Progeny line of cardiac resynchronization therapy defibrillators (CRT-Ds) and implantable cardioverter defibrillators (ICDs) are the newest implantable devices specially trained cardiologists known as electrophysiologists can use to help prevent sudden cardiac death and in some cases improve cardiac function.
Nair, one of two electrophysiologists on staff at St. Bernards, uses the devices to treat patients who are at risk for sudden cardiac death as well as those who have heart failure. “The new devices are not only the smallest and thinnest implantable defibrillators on the market, but also they have advanced battery technology with excellent longevity,” Nair says. “They are backed by the longest warranty in the industry – up to 10 years. That’s huge for my patients.”
Up to 460,000 people in the U.S. alone die from sudden cardiac death every year – more people than from lung cancer, breast cancer and AIDS combined. Nearly 22 million people worldwide suffer from heart failure, with approximately one million new cases diagnosed each year, making it the most rapidly growing cardiovascular disorder.
The most common cause of SCD is a heart rhythm disorder (arrhythmia) known as ventricular fibrillation. Nair explains that a healthy heart pumps blood because electrical impulses run along pathways in the heart causing it to contract in a regular, rhythmical way. With each contraction, blood is pumped throughout the body.
However, in ventricular fibrillation, the electrical signals that control pumping become rapid and chaotic. The result is that the lower chambers of the heart – the ventricles – begin to quiver (fibrillate) rather than contract. They no longer pump blood to the rest of the body. When the brain is deprived of oxygen-rich blood, the person loses consciousness in a matter of seconds, and in the absence of an emergency shock to the heart, the person will die within minutes – a victim of sudden cardiac death.
Surgically implanted under the skin on the chest below the collarbone, the compact CRT-Ds and ICDs have wires that run from the ICD to the heart, allowing the device to monitor the heart for abnormal rhythms. If a dangerous rhythm is detected, the ICD delivers an electrical shock to restore the heart’s normal rhythm and to prevent sudden cardiac death.
“These new devices give me excellent choices of premium high-energy devices to treat patients who have a variety of electrical problems with the heart,” Nair says. Based on the medical history, all clinical data including ECG and echo and sometimes electrophysiology studies, Nair determines whether a patient needs a defibrillator device with one, two or three wires placed in appropriate chambers of the heart.
The devices also are used to help manage patients who have heart failure, a condition in which
the heart becomes so weak it has trouble pumping a normal amount of blood. If the heart
cannot keep up with the volume of blood returning from the body, the blood backs up in
pulmonary veins, resulting in a fluid buildup in the lungs and causing shortness of breath. One
of these implantable devices can not only control arrhythmias that may result from heart
failure but also can regulate heart rates that are too slow or too rapid. Above all, they can
improve the ability of the heart to pump blood by synchronizing muscle contractions in the ventricles.
“The take-home message about these new devices is they help us save lives,” Nair stresses. They are smaller, thinner and longer-lasting than the older units, which not only increases patient comfort and reduces the number of battery changes required, but also makes the implant procedure faster and easier for physicians.
Nair completed her medical school in University of Kerala in India. She earned her M.D. degree from Columbia University College of Physicians & Surgeons in New York City at St. Luke’s Roosevelt Hospital Center. She completed her fellowships in cardiology and electrophysiology at Case Western Reserve University at MetroHealth Campus in Cleveland, Ohio. She is board certified in cardiac electrophysiology, cardiovascular disease and internal medicine.
St. Bernards Medical Center is the region’s only medical center designated as a Blue Distinction Center for Cardiac Care by Blue Cross Blue Shield. The leading provider of cardiac services in Northeast Arkansas, St. Bernards has been providing heart services for three decades, with most heartcare services provided in the 77,000-square-foot Heartcare Center on the main St. Bernards campus. That facility houses cardiac catheterization labs, an electrophysiology lab, noninvasive cardiology services and nuclear medicine services.