Doctors at Intermountain Medical Center on Tuesday successfully implanted Utah’s first subcutaneous defibrillator — which is placed farther away from the heart, with no wires touching it — in a 20-year-old man from South Jordan.
The device works like any other defibrillator, by shocking Brandon England’s irregularly beating heart into normal rhythm. "It’s kind of like having his own paramedic squad in his chest," said England’s surgeon, IMC cardiologist Jeff Osborn at a Thursday press conference.
But it’s less invasive because it’s able to detect life-threatening arrhythmias and deliver shocks without wires touching the heart, Osborn said.
England was discharged from the hospital on Wednesday and is still sore but said he feels a weight has been lifted.
He looks forward to hunting and fishing again, activities he hasn’t been able to enjoy since he was diagnosed last April.
"I didn’t really have much to live for," he said. "I couldn’t do much of anything."
The diesel mechanic was diagnosed with dilated cardiomyopathy, a condition in which the heart becomes weakened and enlarged and can’t effectively pump blood. Months of drug treatment failed to sufficiently strengthen his heart, putting him at risk for a sudden heart attack and death, said Osborn. "These arrhythmias are totally unpredictable."
England’s parents, Lisa and Don England, were uneasy about the new procedure. But once the benefits were explained, "any fear was replaced by excitement," Lisa England said.
The subcutaneous implantable cardiac defibrillator (S-ICD) is inserted under the skin beneath the armpit. It replaces the "leads," or wires, of traditional defibrillators — which must be threaded through a vein and placed into the chambers of the heart — with an electrode sensor and shocking coil that rests on the sternum.
The device won approval from the U.S. Food and Drug Administration in 2012. Private insurers and Medicare started covering it after studies found it worked as well as older models and reduced the risk of infection and repeat surgeries to replace defective, damaged or dislodged leads.
"Having wires placed directly into the heart has its risks," said Osborn. "The leads can crack ... and have a finite life."
The added distance from the heart means a more powerful shock is delivered, about 2.5 times stronger than conventional defibrillators, said Osborn.
The device isn’t recommended for all heart arrhythmias and won’t replace standard defibrillators. It’s FDA-approved only for patients whose abnormally rapid heartbeats originate from the lower chambers of the heart and it doesn’t work for those who need a pacemaker.
And it costs in the $24,000 range, a few thousand dollars more than traditional models.
But its durability and five-year battery life is attractive to younger patients, Osborn said. "If it prevents future surgeries, that’s a real benefit."
University of Utah Health Sciences also has the device and may do their first procedure later this month, said a hospital spokeswoman. St. Mark’s Hospital also plans to offer it within the next six to seven months.
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