Texas Health Dallas Patients Receive Implantable Defibrillators

DALLAS — After beating breast cancer last year, 76-year-old Nancy Killion was looking forward to getting back on the tennis court. However, half-way through her chemotherapy treatments she suffered a stroke and major heart damage.

Dr. Brian Le is the first surgeon in Texas to perform the implant procedure.
Dr. Brian Le is the first surgeon in Texas to perform the implant procedure.
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She subsequently was diagnosed with congestive heart failure and dilated cardiomyopathy, a condition where the cardiac muscle becomes weakened and enlarged and can’t pump enough blood to the rest of the body.

Because of her underlying heart condition, she was at high risk of having sudden cardiac arrest. Killion never dreamed she’d pick up a tennis racket again. But thanks to a new device offered to patients at Texas Health Presbyterian Hospital Dallas, she’s feeling optimistic.

“I knew I needed to do something to try and have a normal life again,” said Killion. “I don’t have much energy these days but I’m hoping that’s going to change.”

For patients like Killion who are at risk for sudden cardiac death, a subcutaneous implantable-cardiac defibrillator is now an option for treatment. The device, called a major technological advancement in implantable defibrillators, is placed under the fat of the skin and does not touch the heart — making more individuals candidates for implantable defibrillators and reducing the risk of complications.

“She tried a wearable defibrillator that fits like a vest around the chest, but that didn’t last long because it was uncomfortable and heavy for her while she regained her strength,” said her husband, Charles Killion. “I was always concerned for her when she’d have to take it off because I knew that meant her heart was not monitored. But this device will always be with her.”

Physicians say that’s one of the potential issues with defibrillation vests worn around the chest: people periodically take them off, for cleaning or to bathe or swim.

“The fact is, we never quite know when sudden cardiac arrest is going to strike,” said Dr. Brian Le, cardiologist and director of electrophysiology at Texas Health Dallas. “So the patient is at risk — they’re essentially without this life-saving net — whenever it’s off.”

And traditional implantable defibrillators, while not something patients can take off or deactivate like a vest, aren’t options for all patients with heart problems.

The subcutaneous ICD is similar to a traditional defibrillator in that it delivers an electric shock to the heart if it detects abnormal cardiac rhythm. But the new subcutaneous ICD does so without the electrical leads placed directly into the heart.

“In many patients with an ICD the leads are the most common component that could fail,” Le said. “Some of the complications from the leads include fracture, insulation failure, and infection. When the leads need to be removed, the adherence of the leads inside the heart creates scar tissue making extractions difficult.”

He added that extractions carry the risk of serious complications from cardiac perforation or vascular tear.

The subcutaneous ICD is placed on the left side of the chest just below the arm pit. The device serves as the pulse generator and is connected to a thin electrode which is implanted along the rib cage next to the breastbone. If ventricular tachycardia or ventricular fibrillation is detected, the electrode delivers the shock and the subcutaneous ICD then provides post-shock pacing therapy when needed — without direct contact with the heart.

“For patients with a high risk of developing device infection, or they may have vascular access issues such as cancer patients with mediports in their vasculature or dialysis patients with access issues, this new device is a life-saving option,” said Le, the first surgeon in Texas to perform the implant procedure. “In fact this device is an option for any patient at risk for sudden cardiac arrest who does not require pacing of the heart due to slow heart rate or special pacing to retune the heart in congestive heart failure.”

Katona Martin, 56, another patient of Le’s, fits into this category. Since 2001 she’s suffered seven heart attacks which left her with only 30 percent of her heart functioning.

“I had a traditional ICD put in on my right side but it became infected so they had to take it out,” said Martin, a resident of Kenefic, Okla. “They couldn’t make a deep enough pocket on my left side so my only option was the vest defibrillator.”

She was transferred from Oklahoma to Texas Health Dallas for this particular device.

While her lifevest provides temporary protection from sudden cardiac arrest, she does admit that it will be more comfortable without the vest and heavy battery pack attached to it.

“I live alone and I know my children worry but I think this device will give them a peace of mind and it’ll be so much easier for me,” Martin said.

Similar to most new technology these days, Le predicts that the device will continue to become smaller with better battery longevity as the next generations are created.

A recent study in the Journal of the American Heart Association found that the subcutaneous ICDs were effective in shocking patients’ heart back into rhythm and had lower rates of complications than traditional ICDs.

“This is truly a paradigm shift in less-invasive long-term treatment option for our patients,” said Le. “This technology has been in development over the past 10 years and has now become a reality.”

About Texas Health Presbyterian Hospital Dallas
Texas Health Presbyterian Hospital Dallas is an 898-bed acute care hospital and recognized clinical program leader, having provided compassionate care to the residents of Dallas and surrounding communities since 1966. U.S. News and World Report has ranked Texas Health Dallas among the nation’s best hospitals in digestive disorders, orthopedics, and neurology and neurosurgery. An affiliate of the faith-based, nonprofit Texas Health Resources system, Texas Health Dallas has approximately 4,000 employees and an active medical staff of more than 1,000 physicians. For more information, call 1-877-THR-WELL, or visit TexasHealth.org/Dallas.