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Royal Victoria Hospital surgeons fit patient with pioneering new heart implant

By Rebecca Black

A swathe of heart attack victims in Northern Ireland who were ineligible for a potentially lifesaving implant may now qualify after a ground-breaking new device was used for the first time at the Royal Victoria Hospital in Belfast.

Anne Martin was the first recipient of the pioneering wireless device yesterday.

Mrs Martin suffered a cardiac arrest while visiting Forestside shopping centre four months ago. Her son managed to save her with CPR. She has been in hospital since.

Dr Ernest Lau, consultant cardiologist, explained that because she received dialysis, she was not able to receive the type of cardiac defibrillator implant device that was available before.

It works by detecting abnormal heart rhythms and shocks the heart back into normal rhythm.

Mrs Martin was able to receive a new piece of technology called an S-ICD – or subcutaneous implantable cardiac defibrillator. It was implanted in an operation yesterday, and now Dr Lau expects she will be able to be discharged next week after months in intensive care.

During the operation the device– which is about the size of a deck of cards – was placed under the patient's skin just under the armpit area.

The wire then runs along the left side of the breast bone.

What makes this device different from those used previously is it has no part touching the heart.

It doesn't require wires or electrodes to be implanted through a vein and attached inside the heart.

It is produced by a Boston company, but manufactured in Tipperary.

The wires in traditional implantable defibrillators over time can become covered in scar tissue and present a much more risky procedure to replace if they break, compared to replacing wires on S-ICDs.

A key risk with such devices is infection; if medication can't clear it up, a surgeon needs to remove the defibrillator and wires – a complex, risky procedure.

Dr Lau told the Belfast Telegraph the team at the Royal were delighted at the operation.

"This particular patient was in hospital for about four months," he said. "Usually for a sudden cardiac arrest, therapy would be an implantable cardio defibrillator, but because of her dialysis there was a problem gaining access to her central bloodstream.

"So until this new technology became available, a patient like her would not have been able to have had protection against future sudden cardiac arrest.

"The system we implanted is a new concept.

"The entire ICD is implanted just underneath the skin with no wires placed inside the bloodstream at all.

"It is great to be part of the team in Belfast to successfully use the first manufactured in Ireland."

Cardiac arrest claims more than 350,000 lives per year in Europe and is the predominant mode of death for patients with heart failure.

Ventricular tachy-arrhythmias is the most important cause of heart attacks, but can be successfully treated by a timely electrical shock delivered to the heart, known as defibrillation.

BACKGROUND

The device is implanted under the skin, beneath the armpit.

A wire is run across the chest and upward toward the neck. Without touching the heart, it can sense the heart's rhythm, similarly to how an EKG machine can. The defibrillator interprets changes in that rhythm, determining whether they're dangerous. If needed it delivers a shock, coaxing the heart back to normal rhythm.

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