New Defibrillator Offers Options, Advantages

Stern physician implants recently developed systemThe old way was no longer an option. To live, the patient needed something new.Over the years, doctors had placed conventional defibrillator implants in his chest twice. Each device had done its job, monitoring the patient’s disease-weakened heart and providing a jolt if necessary. But infections related to kidney problems forced removal both times and prohibited a third try with the previous approach.That left the man, an Arkansas resident in his 60s, at great risk of cardiac arrest. By extension, it also rendered him ineligible for a kidney transplant, amplifying another threat to his life.A workable new solution was out there, but it was so new that few doctors had access to it.Fortunately for this patient, Chris Ingelmo, MD, at Stern Cardiovascular Foundation was among the few.Last month, Ingelmo’s implant of a recently developed defibrillator called an S-ICD® System was thought to be the first in Tennessee.The S-ICD® doesn’t require direct contact with the heart and surrounding blood vessels. That’s a big advantage for patients on dialysis or dealing with other health risks, such as cancer or past infections.“Also, it’s a fairly good option just from a cosmetic standpoint,” Ingelmo said.The S-ICD® is bigger than a traditional defibrillator, but its placement just under the skin on the left side of the chest makes it less obtrusive.“Particularly young women with certain medical conditions might not want that old-style defibrillator where it’s in the top of their chest and visible all of the time,” he said. “This can be inside the bra. So you still have a bump, but it’s not as conspicuous.”The new device, which the FDA approved in 2012, is not in wide distribution yet. Demand has exceeded supply, and the manufacturer – Boston Scientific – has given priority to doctors who gained experience with the S-ICD® during clinical trials.Ingelmo observed one S-ICD® implant procedure and performed another while in fellowship at Cleveland Clinic in Ohio before joining Stern. To prepare for January’s procedure, he sought further training and certification through Boston Scientific.Other doctors with Stern will train for the S-ICD® procedure in the next few months, enabling access for more patients. Ingelmo estimated that 20 percent or more of patients in need of a defibrillator implant could be considered for the S-ICD®.Stern’s success with the S-ICD® comes on the heels of another procedural first. In December, doctors at Stern performed one of the region’s first LARIAT procedures – a surgery that cuts the risk of stroke for patients who can’t take blood thinners.Stern’s efforts to make new technology and procedures available to patients as soon as – or before – they are FDA-approved or widely available is in keeping with a proud tradition of innovation that goes back to founder Neuton Stern, who brought Memphis’ first EKG machine to the city in 1919.At any given time, Stern is involved with 20 to 25 clinical trials, said Frank McGrew III, MD, who coordinates much of that involvement.“Almost all aspects of how we treat cardiovascular disease need improvement,” McGrew said. “So we’re always looking for new things. In fact, the number of clinical trials we do really compares quite favorably to that of major medical centers.”