First Subcutaneous Implantable Defibrillator Used at UPMC Altoona

ALTOONA — UPMC Altoona is the first hospital between Pittsburgh and Hershey to implant a subcutaneous implantable defibrillator (S-ICD) for the treatment of patients at risk for sudden cardiac arrest (SCA).

The S-ICD system is designed to provide the same protection from SCA as transvenous implantable cardioverter defibrillators (ICDs); however, the S-ICD System sits entirely just below the skin without the need for thin, insulated wires — known as electrodes or ‘leads’ — to be placed into the heart itself.  This leaves the heart and blood vessels untouched, offering physicians and patients an alternative treatment to transvenous ICDs.

Haitham M. Hreibe, M.D., of Blair Medical Associates-Cardiology, Altoona, first performed the procedure July 31. The new procedure has the potential to replace 40 percent of all ICDs, but patients are carefully evaluated to see if they are good candidates.

“The device is totally under the skin, reducing the immediate complications such as pneumothorax (collapsed lung due to air collecting between the chest wall and lung), vascular complications, cardiac perforation, lead dislodgment,” Hreibe says, “and reducing the long-term complications, such as systemic infections requiring extractions (a high-risk procedure) and vascular occlusions.”

Sudden cardiac arrest is an abrupt loss of heart function.  Most episodes are caused by the rapid and/or chaotic activity of the heart known as ventricular tachycardia or ventricular fibrillation.  Recent estimates show that approximately 850,000 people in the United States are at risk of SCA and indicated for an ICD device, but remain unprotected.

The S-ICD system has two main components: (1) the pulse generator, which powers the system, monitors heart activity, and delivers a shock if needed, and (2) the electrode, which enables the device to sense the cardiac rhythm and deliver shocks when necessary.  Both components are implanted just under the skin — the generator at the side of the chest, and the electrode beside the breastbone. Implantation with the S-ICD System is straightforward, using anatomical landmarks without the need for fluoroscopy (an x-ray procedure that makes it possible to see internal organs in motion).  Fluoroscopy is required for implanting the leads attached to transvenous ICD systems.

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