Record-Journal
Published Sunday, January 7, 2007
By Jeffery Kurz
Lawrence Field was in pretty good spirits the other morning at MidState Medical Center, considering he'd just undergone surgery. The 55 year-old, who retired a couple of years ago after 30 years with the Meriden Highway Division, said he'd known for a while “something was going on with my health.”
He'd had shortness of breath and had reached the point where he couldn't walk any distance without getting really tired and out of breath. Tests showed his heart wasn't pumping blood the way it ought to. So early last week a surgeon put a device inside him that's designed to help make sure that it does. Called an implantable cardioverter defibrillator, or ICD, the device is about the size of a beeper. From its perch inside the body, just under the collar bone, it monitors the heart's activity and is programmed to shock the heart back to normal rhythm if anything goes awry.
“They said I may never need it,” said Field. “It was up to me, but with the shape my heart was in, with this in there it would save my life.”
The implant procedure is a relatively new offering at MidState, and is a direct result of the hospital's affiliation with Hartford Hospital. That he could have it taken care of close to home made all the difference in the world to Field.
“If it wasn't done here, I wouldn't have had it done,” he said.
In the 20 years since receiving FDA approval, implanted pace-making devices have gone from high-risk specialties to low-risk operations, said Dr. Christopher A. Clyne, director of interventional electrophysiology at Hartford Hospital. Clyne performs up to 400 ICD procedures a year in Hartford. In the past year, he's done about 20 at MidState.
The service is part of MidState's goal of offering comprehensive heart-care treatment. The hospital has been shaping that strategy since identifying cardiovascular-related diagnosis as the number-one reason people check into MidState. Coming in second are lung-related problems.
The collaboration with Hartford Hospital helps expand the range of services to meet that heart-care goal, said Lynn M. Amarante, MidState's director of cardiology and critical care services.
“This is a wonderful example of the partnership between Hartford Hospital and MidState” and how that partnership brings services to the local community, said Jeff Flaks, MidState's vice president and chief operating officer. “For us, this is really wonderful,” he said.
“We are now able to bring in techniques that we didn't have access to before,” said Dr. Richard A. Bugliari, a MidState cardiologist. “These patients now can have things done at MidState - we now have access to the latest techniques.”
“The most common cause of death in North America is death related to coronary heart disease and heart failure,” said Clyne.
About 5 million Americans have cardiomyopathy, or weakened heart function, that, as in Field's case, puts them at higher risk for cardiac arrest. For such patients, the use of implants has been shown to prolong life significantly, said Clyne.
The heart's rhythmic beating is governed by an electrical system that can be thrown off for a variety of reasons, including cardiomyopathy. Ventricular fibrillation occurs when that short-circuited electrical activity causes the lower chambers of the heart to beat in a rapid, uncoordinated fashion. It results in little or no blood being pumped from the heart.
“And when that happens, you're dead within minutes,” said Bugliari.
So the implants are a way of protecting at-risk patients from sudden death. From the monitor run wires that go through a vein into the heart and allow it to keep watch for rhythm disorder. It records every heartbeat and the heart rate. If it detects an irregularity, the device within 10 seconds sends a defibrillation impulse to shock the heart back to normal rhythm. It works with 98 percent effectiveness, said Clyne.
Many people are familiar with the large, external defibrillation tools that are used, often with great dramatic effect (“CLEAR!”) in television and film dramas. An ICD is a miniature way of doing the same thing inside the body — without losing precious minutes on a trip to the emergency room.
Patients who are candidates for ICDs will also need other treatments for heart function, including medication. The devices are there to keep them from dying suddenly. They do feel the shock when the correction is administered.
Field said he understands the device could be there a long time without sending him such a shocking message. But if and when it does, he'll know it's saved his life.