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New defibrillator offers patients options

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Gary Couse was an avid outdoorsman who liked to hunt and backpack and was planning to hike the Appalachian Trail again this year. But after a heart attack three months ago left him at risk of sudden death, he was tied to an external defibrillator that meant he couldn’t make any overnight trips.

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Dr. Robert Sorrentino (from left), an electrophysiologist and director of the Georgia Regents Heart Rhythm Center, Cardiovascular Technician Brian Pruitt and Cardiology Fellow Dr. Rebecca Napier implant a new type of defibrillator in patient Gary Couse.  CHRIS THELEN/SPECIAL
CHRIS THELEN/SPECIAL
Dr. Robert Sorrentino (from left), an electrophysiologist and director of the Georgia Regents Heart Rhythm Center, Cardiovascular Technician Brian Pruitt and Cardiology Fellow Dr. Rebecca Napier implant a new type of defibrillator in patient Gary Couse.

“It’s really a pain,” he said. “In the middle of the night it start(s) beeping because it’s not making the right contact.”

But Wednesday he received a new type of defibrillator at Georgia Regents Medical Center that will give him more freedom and might prove more durable than previous models. Couse was implanted with the S-ICD System from Boston Scientific that sits just under the skin. Its electrode runs along the breastbone and doesn’t touch the heart. That makes it a better choice for those who need a defibrillator but who are also active, like Couse, said Dr. Robert Sorrentino, director of the Georgia Regents Heart Rhythm Center.

“I think that will allow him maximum mobility and give him the protection he needs when he is out on the Appalachian Trail by himself for six months,” he said.

Georgia Regents is the second hospital in Georgia to begin implanting the devices and Couse got the fourth one the hospital has done, said David Boss of Boston Scientific. A spokeswoman for University Hospital said one of its physicians was to be trained soon to begin implanting the devices.

Inside the electrophysiology lab at Georgia Regents, Sorrentino opens a pouch on Couch’s left side below the armpit and then carefully creates a tunnel underneath the skin over to and up the breastbone. With cardiology fellow Dr. Rebecca Napier, they carefully thread through the electrode and tie it down in place. That electrode will monitor the heart and deliver a shock if needed to bring it back into the correct rhythm, Sorrentino said. It is a higher energy shock than the normal defibrillator, Sorrentino tells the crew in the procedure room.

“You’re going through chest, you’re going through ribs, you’re going through everything and then the heart,” he said. But the electrode itself is solid, as opposed to the hollow ones inserted in the veins of the heart, so that has advantages such as potentially being more durable, Sorrentino said.

“It allows a lot of tensile strength since it doesn’t have to have a hollow core,” he said. “It’s a more robust lead than the intravenous leads.”

And not having to go into those veins means it could potentially be an option for some patients who were not good candidates for a defibrillator before, such as dialysis patients, who are more prone to infections that could necessitate removing the device, Sorrentino said.

“It also would be beneficial for people who don’t have good veins because over years and years and years the veins get consumed by having the wires there,” he said.

It is not a pacemaker so it is not appropriate for people who need that function or who have certain heart rhythm disorders, Sorrentino added.

Even though he is at higher risk now for another heart attack, Couse said he has remained active. He went skiing for two weeks in January and still rides his bike 40 or more miles at a time. That’s why he went for the new device.

“They said that this is the better way to go for an active person,” Couse said.

The plan had been to take on the Appalachian Trail this year but now that plan is on hold, he said.

“Possibly next year, I’ll just have to see,” Couse said.


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