by
Lauren Dubinsky, Senior Reporter | March 02, 2015
From the March 2015 issue of HealthCare Business News magazine
There have also been advancements made in the world of ICDs. Previously, patients with sudden cardiac arrest were treated with transvenous ICDs but Boston Scientific received FDA approval in 2012 for its subcutaneous ICD called the S-ICD System, which can treat those patients without touching the heart.
It utilizes a pulse generator like the transvenous ICDs, but it also uses a subcutaneous electrode and analyzes the heart rhythm instead of individual beats. Patients don’t have to undergo vascular surgery to have it implanted and it reduces the potential for systemic infection and complications associated with endovascular lead implantation or extraction. Subcutaneous ICDs are ideal for young patients with an inheritable form of heart disease that renders them vulnerable to sudden cardiac arrest, said Cantillon. Just like the pacemaker, the leads are the weakest link for a defibrillator system since they are susceptible to breaking and other complications.
“When you are dealing with somebody who is young, in their twenties for example, who is looking at a lifelong commitment to device therapy, there is a very significant advantage in taking that hardware out of the vascular space and putting it into the subcutaneous space,” says Cantillon.
Overcoming the challenges
“Structural heart disease in general, is a big growth area for all companies in medicine — we are able to do more and more things in the heart without opening the heart altogether,” says NYP/Weill Cornell’s Singh. “From a technical standpoint, the challenge is learning those skills.” NYP/Weill Cornell Medical Center has a lot of experience with transcatheter valves, but the leadless pacemakers and subcutaneous
ICDs were new to them. After going through a training course, the cardiologists have been making a lot of progress with developing those new skills. “Any surgeon will tell you that the more you do something, the easier it gets,” says Singh.
The cardiologists at Duke University Hospital also needed to go through the training course for the leadless pacemakers. “The leadless pacemaker system is unique — it’s unlike anything we’ve ever done,” says Atwater. “It’s a challenging procedure to get the pacemaker in but once you have the expertise, it can go reasonably fast.”
It’s also a challenge for the other staff members in the cath lab, noted Atwater. When a new procedure is introduced, they have to work on a new type of workflow to ensure that it gets done in a certain time frame that’s reasonable for both the hospital and the patient.
