The cardiac electrophysiology team at the Department of Internal Medicine at the American University of Beirut Medical Center (AUBMC) performed on Friday, January 22, 2016 the first subcutaneous defibrillator implantation in Lebanon and the region, a procedure useful in preventing sudden death in patients with or at risk for cardiac arrest. The novel therapy addresses patients with risk for sudden cardiac arrest, particularly young individuals in whom the lifetime risk of device-related complications may be deemed to be unacceptably high, by implanting a device completely under skin without invading the vessels or the heart. Demonstrating exceptionally high safety and efficacy, the state-of-the-art technology has been increasingly used in the US and Europe and has been newly introduced in Lebanon and very few other countries in the region.
The procedure was performed by Dr. Bernard Abi-Saleh and Dr Bernard Harbieh at AUBMC on a 19 -year -old young man with several attacks of ventricular tachycardia reaching 240 beats per minute and near cardiac arrest episodes found to have a genetic condition called arrhythmogenic right ventricular dysplasia (ARVD), a rare form of cardiomyopathy in which the heart muscle of the right ventricle is infiltrated by fatty tissue.
The subcutaneous defibrillator, a small battery-powered device that constantly monitors a person’s heart rhythm, delivers a therapeutic dose of electricity to restore the rhythm when it senses the heart is beating dangerously fast (tachycardia) or chaotically (sudden cardiac arrest). The subcutaneous implantable cardioverter-defibrillator (S-ICD) represents a paradigm shift in ICD technology with several advantages over the conventional transvenous ICD.
With subcutaneous ICD the heart is untouched; not only does it involve placing the lead under the skin, rather than directly into the heart hence preventing perforation of the heart, which by itself is another complication associated with traditional ICDs, but it also does not carry the risk of bleeding or puncturing the lung. The subcutaneous ICD is also the best option in the case of heart infections as its extraction does not involve the heart since its lead does not invade the heart.
Cosmetically, the subcutaneous defibrillator is a more appropriate option than the traditional defibrillator since it is implanted under the arm pit and is very hard to be noticed in comparison to traditional ICDs usually implanted over the left upper corner of the chest and easily detected on a bare chest.
“The S-ICD is a great innovation providing an alternative to treat patients with life-threatening heart arrhythmias for whom the routine ICD placement procedure is not ideal,” said Dr. Maurice Khoury, Director of cardiac electrophysiology at AUBMC. “Defibrillators detect rapid and dangerous heart rhythms and shock the heart back into normal rhythm when the patient’s heart beats abnormally fast (ventricular tachyarrhythmias). The S-ICD is best used for young patients, as well as patients with occlusions of their subclavian veins especially dialysis patients,” added Dr Abi-Saleh.
The cardiology division at the American University of Beirut Medical Center (AUBMC) led by Dr Samir Alam is the first in Lebanon to implant the S-ICD System and this procedure is yet another proof of AUBMC achieving its 2020 vision by being a leading medical center in Lebanon and the region.