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Aug 5, 2015


Gioia Turitto, M.D., director of electrophysiology in New York Methodist Hospital

Gioia Turitto, M.D., director of electrophysiology in New York Methodist Hospital's Division of Cardiology, with a patient.

BROOKLYN—A new device now offered at New York Methodist Hospital (NYM) is providing patients with dangerous heart conditions a less invasive treatment option for life-threatening cardiac arrhythmias (irregular heart rhythms). The device is called a subcutaneous implantable cardioverter defibrillator (S-ICD). Like a traditional implantable cardioverter defibrillator (ICD), an S-ICD is capable of "jump-starting" the heart in the event that a patient's arrhythmia causes a sudden cardiac arrest. However, unlike a traditional ICD, an S-ICD requires no access to a patient's vascular (circulatory) system.

For some patients living with severe arrhythmia, an S-ICD is a welcome option. But for certain patients—who, in addition to cardiac arrhythmia, are also living with impaired kidney function and require kidney dialysis treatments—the availability of S-ICDs is a life-saving revolution.

Lawrence Stam, M.D., works with patients undergoing kidney dialysis at NYM.

Lawrence Stam, M.D., associate chief of nephrology at New York Methodist Hospital, works with patients undergoing kidney dialysis at NYM.

Lawrence Stam, M.D., associate chief of nephrology at NYM, explains: "The Hospital's cardiologists are experts at safely installing and maintaining traditional ICDs, and the devices have long been proven to be effective. Until recently, ICDs could function only via thin wires (called leads) which go from the device into the blood vessels of a patient's vascular system and directly into the heart's chambers. However, kidney dialysis treatments, which filter waste from the body's blood supply, also require regular access to a patient's vascular system. Though these effective treatments address two different conditions, using a patient's vascular system for both purposes at once can carry a high risk of clotting, making it very complex to implement them both at the same time. Thanks to S-ICDs, we are now able to avoid the risk of these complications altogether."

An implanted S-ICD is installed directly under the skin, just like a traditional ICD. But instead of going into a patient's blood vessels, an S-ICD's wire runs under the skin to an area of the chest directly over a patient's heart, ready to generate a heart-restarting electrical impulse if it is needed. Thus, a patient's vascular system can still be used for kidney dialysis, while he or she has the benefits of an implanted device that can prevent death due to a heart arrhythmia.

"It's important to note that an S-ICD doesn't do everything," cautions Gioia Turitto, M.D., director of electrophysiology at NYM. She and her team in the Hospital's Division of Cardiology install and maintain the cardiac devices. "The devices only have one wire—if a patient has a clinical condition that requires two or more wires, a different device that requires direct access to the heart will still be needed. But there are many potential benefits of S-ICDs that extend beyond the treatment of patients who also have kidney failure. The easy accessibility of an S-ICD's wire means that, in the event of an infection, the wire can be removed and replaced without accessing the patient's heart. In younger patients with a long life expectancy who need an ICD, a wire may simply wear out over time and need to be replaced—and again, no access to the heart will be required to do this. For patients with life-threatening cardiac arrhythmia, S-ICDs are the wave of the future. And for patients who are also living with kidney failure, the future has already arrived."

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