By Lauren Johnson
In May, Sean Dunn, MD, a cardiac electrophysiologist at UAB, became the first physician in the state of Alabama to successfully implant the newest extravascular defibrillator technology, which will be used to treat cardiac patients. This device provides another option for patients at risk of heart failure, arrhythmia and sudden cardiac arrest.
The Aurora Extravascular Implantable Cardioverter Defibrillator (EV ICD), developed by Medtronic, is the first of its kind because the lead is placed under the breastbone instead of through veins and into the heart.
“Traditional defibrillator systems have leads implanted through the blood vessels, which can have lots of issues as patients age. Leads implanted through blood vessels are at risk for fracturing or even becoming dislodged so we’ve tried to develop systems that don’t have these limitations,” Dunn said. “The first device that came out was called a subcutaneous ICD, which was a lead implanted under the skin on top of a breastplate, but that also had limitations. Whenever you’re outside the chest, it requires a lot more energy, so it’s a bigger device.”
Because the EV ICD is implanted under the breastbone and on top of the heart, it’s capable of sending energy to the heart in a smaller, compact form. This new technology can also pace the heart, which can potentially stop an arrhythmia and correct a dangerously abnormal heart rhythm.
“The typical treatment is to shock the heart back into rhythm, which can be uncomfortable, but if we’re able to pace the heart, we can pace the heart faster than the arrhythmia and stop it in a painless fashion. This is one of the nice parts about this device,” Dunn said.
If pacing the fast heartbeat is unsuccessful, the device would then deliver a shock to reset the heart’s rhythm. For a slow heartbeat, the device can stimulate the heart through pacing to get it beating again.
In the EV ICD Pivotal Study, conducted by Medtronic, researchers recorded that the Aurora Ev ICD had a success rate of 98.7 percent. A total of 299 patients received an implanted system, and according to the study, all discrete spontaneous arrhythmias were successfully treated.
In addition to a high success rate, this device is also expected to have a longer battery life than other ICD systems. The subcutaneous ICD battery life typically lasts about seven years while the Aurora EV ICD battery is expected to last 11 years.
“I think this would be a great option for people who are at risk for an infection, and we want to try to avoid being in the bloodstream, or perhaps for those patients who don’t have blood vessel access to the heart. It’s also a great option for younger, more active patients who don’t want to have the long-term kind of risks related to having things inside the blood vessel,” Dunn said.
Implanting the device involves a minimally invasive procedure where physicians insert it below the left armpit under the breastbone, which has shown to have good cosmetic results, according to Dunn.
“There’s a growing population of people with cardiovascular disease, especially in the South, so the general trend is that more patients are requiring therapies like these,” Dunn said. “Arrhythmias are being detected more often now as we continue to have an increase in people wearing smart devices.”
Sudden cardiac arrest (SCA), which is caused by rapid or abnormal heart rhythms, claims the lives of approximately 475,000 Americans every year. This makes SCA the third-leading cause of death in the U.S. Only one in 10 patients who experience SCA survive, according to research provided by Medtronic. The Aurora EV ICD system is the latest technology that is expected to combat these statistics and improve care for at-risk patients.
“I’m glad we’re able to offer this therapy to patients,” Dunn said. “I think it shows that UAB is really at the cutting edge and trying to offer the most advanced care to Alabamians.”
