Fortis Escorts Heart Institute (FEHI), Delhi, implanted India’s first Subcutaneous Implantable Defibrillator (S-ICD) in a 48 year old heart patient from Bihar. The S-ICD System is approved for patients who are at a risk of sudden cardiac death due to life threatening ventricular arrhythmias and those who do not require a pacemaker.
The patient was treated by Dr Ashok Seth, chairman - FEHI and Dr Anil Saxena, director of Cardiac Pacing and Electrophysiology, who implanted the device.
The patient Arvind Sahay had suffered damage to his heart from a large heart attack in October 2014, and his heart was pumping at a low efficiency of only 25-30 per cent. He had undergone angiography and angioplasty with three stents after the heart attack and was breathless on occasions. In view of his poor heart function and the risk of sudden death, the decision to implant the subcutaneous ICD was taken.
Dr. Seth says, “Fortis Escorts has been constantly endeavouring to make path breaking advancements in cardiac care. This first case of S-ICD in India will be a strong hope for several potential ICD patients who could be at risk of sudden death, including those with poor veins and those at high risk for major infection associated with a transvenous lead. It is only a matter of time and as this technology becomes more pervasive and affordable to offer patients yet another choice for an enhanced recovery.”
Dr Seth further added that the sudden cardiac death is a major public health problem in India and accounts for about 10 per cent of all deaths in India. Nearly 80 per cent of these deaths are due to ventricular arrhythmias, a large number of which can be prevented by timely resuscitation. Implantable defibrillators (ICDs) have changed the outlook for such patients, by significantly reducing risk of sudden cardiac death and totally external subcutaneous ICD is a landmark advancement in this direction.
The subcutaneous ICD is an innovative device which does not require any leads to go into the chamber of the heart for its functioning unlike the other previous devices. It is totally external and under the skin only. The technique offers benefits such as lower risk of infection, no puncturing of the veins in the heart, and lesser chances of complications, over time. However, despite its advantages as the device cannot pace the heart, some patients who need the ICD are not suitable for this Subcutaneous ICD.
Dr. Saxena, says, “S-ICD lead is implanted along the rib cage and breast bone. It is found to have success rates comparable to conventional ICDs, with lower complication rates. In particular, the rates of infections reaching blood stream, and lead failure have been less. S-ICD offers special advantage for younger patients who need ICD therapy for longer periods, and therefore placement of leads inside the heart poses more long term risks. As one does not need to puncture any veins to go to inside of the heart, this device is safe and easier to implant and the procedure takes approx. 1-hour under local anaesthesia and sedation only. With more developments in the future, the device is expected to get cheaper also.”
“Another major breakthrough with this device is that it can be implanted in paediatric patients, as young as two years of age, offering better application in this segment. As it is implanted subcutaneously, it can also be a huge relief for diabetics who have to opt for this as it has a smaller and faster window to recovery.” adds Dr. Saxena,
Dr. Somesh Mittal, facility director, FEHI, says, “We are pioneers in the field of cardiology and are at the forefront of several ground breaking developments in cardiac procedures for adult and paediatric patients. This is yet another giant step in line with the efforts of Dr. Seth to take the institute further in the ‘Firsts’, reiterating his passion and commitment to cardiac care.”
For the family this has been a cause for a huge relief. They say, “We would like to thank the team of doctors who have given a new lease of life to our loved one and congratulate them for taking this giant step in cardiac care. Earlier this technique was available only in abroad. With this treatment now offered by one of the best cardiac hospitals, it not only saves considerable amount of time for the patient’s family but also a significant amount of cost.”