Defibrillator Surgery Procedure Available at Cayuga Medical Center
By Malcolm Brand, MD, FACC
An estimated 300,000 Americans die each year from
sudden cardiac death (SCD). This occurs when ventricular tachycardia or
ventricular fibrillation cause the heart to beat so rapidly it cannot function
properly, causing a sudden dangerous drop in blood pressure. This condition,
called arrhythmia, can lead to
cardiac arrest within minutes. It is treated with an electrical shock to the
heart to disrupt the arrhythmia and restore a normal heartbeat.
People with known coronary artery disease, a history
of heart attack, and congestive heart failure are at risk for SCD because scar
tissue from previous cardiac events can disrupt the normal electrical signals
inside the heart. Individuals with significantly reduced heart function are at
the highest risk.
What is an implantable cardioverter defibrillator
An implantable cardioverter defibrillator (ICD) treats
abnormal arrhythmias that can lead to sudden cardiac death. The ICD is a small
computer that is planted under the skin, with wires that attach to the inside
muscle tissue of the heart (much like a pacemaker does). The defibrillator
monitors every heartbeat, detects significant arrhythmia, and delivers a shock
to the heart to disrupt the abnormal rhythm with the goal of restoring normal
When do cardiologists recommend ICD implantation?
Patients with significantly reduced heart function are
at the highest risk, as are patients with documented abnormal rhythms. Studies
have shown that patients in the high-risk category for sudden death benefit
from having an ICD, regardless of whether they have had any symptoms or any
documented abnormal rhythms. ICDs save lives.
Implantable defibrillators have been around since the
early 1990s. Originally a person had to survive two out-of-hospital cardiac
arrests to qualify to receive this device. However, the odds of surviving these
arrests outside the hospital are less than five percent, so those guidelines
have changed. There are about 300,000 people in the United States with a
history of heart attack, congestive heart failure, and low pump function who
would benefit from an ICD, and less than ten percent of those people have ICDs.
What are the symptoms preceding sudden cardiac death?
Symptoms for SCD include profound palpitations of the
heart and sudden syncope, which is the loss of consciousness due to sudden loss
of blood pressure.
Is the ICD always able to re-establish a normal heartbeat?
Sometimes the abnormal rhythm is so malignant the ICD
can’t shock the heart to a normal rhythm, but this is not a likely scenario.
Does Cayuga Medical Center have a support group for
people with ICDs?
Yes, we do have a support group for people with ICDs
(for more information, call 607-274-4498). Individuals with implanted defibrillators often have
anxiety over the occurrence of abnormal arrhythmias and the potential shock
from the defibrillator. ICD shock can be painful and sometimes incapacitating.
People often worry about what will happen if they receive a shock when they are
driving a car, for example. But without the device, a person driving who goes
into arrhythmia will surely pass out. The majority of times people with ICDs
receive shocks to the heart, the device has saved their lives.
Where is the implantation procedure performed?
We implant ICDs in the Cardiac Catheterization Center
at Cayuga Medical Center. The procedure is performed under local anesthesia
with the patient moderately sedated. It takes sixty to ninety minutes and
requires one night in the hospital.
Dr. Brand is director of
Cardiac Catheterization at Cayuga Medical Center. He is board certified in
cardiovascular disease and internal medicine, and performs ICD implantation. He
is a Fellow of the American College of Cardiology, a Diplomate of the
Certification Board of Nuclear Cardiology, and has Special Certification in
Pacing and Defibrillation (NASPEX). Dr. Brand is in practice with Ithaca
Cardiology Associates, where he can be reached at 607-272-0460.