Wireless ICD – a first for sub-Saharan Africa

Posted on 5 December 2016

Patients with certain types of arrhythmia live in constant fear of sudden cardiac arrest (SCA). However, with an implantable cardioverter defibrillator (ICD), 19 out of 20 people will survive SCA. Mediclinic Panorama, together with cardiac electrophysiologist Dr Razeen Gopal, is the first hospital in sub-Saharan Africa to introduce the only non-invasive and wireless ICD – the subcutaneous implantable cardioverter defibrillator (S-ICD).

The first patient in sub-Saharan Africa to receive the S-ICD was a 55-year-old man from Bellville. Dr Gopal, of the Cape Town Atrial Fibrillation Centre based at Mediclinic Panorama, inserted the device under his skin on 21 November 2016, and then performed two more S-ICD insertion procedures.

‘Mediclinic is always investigating how the needs of our patients can be answered through innovation, and we believe that Dr Gopal’s introduction of this technology in our hospital is one of these remarkable situations,’ says Mediclinic Panorama hospital general manager Riaan Vorster.

Reducing risks and costs

During sudden cardiac arrest, the heart’s electrical system malfunctions, resulting in interrupted blood flow to the body. A lack of blood to the brain will quickly cause unconsciousness, and if the heart is not shocked back into its normal rhythm within three minutes, brain damage and/or sudden cardiac death will occur.

ICDs sense dangerous arrhythmias and administer a shock to the heart to restore normal (sinus) rhythm. Patients at risk for SCA include patients with ventricular tachycardia, Long QT syndrome, Wolf-Parkinson-White syndrome, and other congenital ventricular arrhythmias where an ablation was not successful in preventing sudden fast heart rates.

The S-ICD is placed under the skin, and no leads are placed inside or touching the heart. ‘This eliminates potential complications associated with cardiac wires, such as systemic infection,’ Dr Gopal explains. The S-ICD can also be pulled out and removed easily, whereas the traditional transvenous system is only removable during delicate surgery because the wires may become submerged and entwined in scar tissue.

‘Research has shown that the S-ICD has a very low complication rate,’ adds Vorster. ‘We’re offering this new technology to patients at a similar price to the traditional technology because we want to provide solutions that will positively impact lives.’

The procedure

The 10 steps that electrophysiologists follow to insert the S-ICD device are as follows:

Step 1: Prepare the patient for general anaesthesia and the procedure.
Step 2: Make the incision on the patient’s lower left breast line.
Step 3: Place the S-ICD device in a space between the latissimus dorsi muscle and the serratus anterior muscle.
Step 4: Create a tunnel underneath the skin adjacent to the sternum.
Step 5: Position the shock lead to run firstly from the device underneath the skin to the bottom of the sternum, and then from the left side of the thorax to the centre of the thorax.
Step 6: Pull the lead upwards through the tunnel under the skin. The second half of the lead makes a 90-degree turn and runs straight upwards adjacent to the sternum, but below the skin.
Step 7: Check that there is no air trapped in the tunnel. The surgical team checks that the lead is positioned as close as possible to the bone.
Step 8: Stimulate the heart to induce ventricular tachycardia or fibrillation in the patient to check if the device will recognise and diagnose a potentially fatal heart rhythm and deliver an immediate shock to the heart.
Step 9: Close the incisions and wake the patient.
Step 10: Discharge the patient, ideally the next day.

EMBLEM S-ICD is the first and only FDA-approved ICD product with both the device and the leads inserted beneath the skin and with no leads inserted through the veins or touching the heart. It is more compact and durable than previous iterations, while offering additional benefits such as remote monitoring.