Implantable Defibrillators New to Colorado Springs
Sept. 06--The first time Rosie Knox went into cardiac arrest, she felt dizzy and fell to the floor as her heart beat too fast to effectively pump blood.
A month later, she got dizzy again. Then she felt a jolt inside her chest.
"It felt like somebody hit me in the chest really, really hard," Knox said.
That "hit" came from a device relatively new to Colorado -- a skin-deep defibrillator capable of shocking a heart back to its normal state. While implantable defibrillators have existed for decades, Knox's device appears less invasive than past versions, which required doctors to bore wires into patients' hearts.
In June, Knox, of Widefield, became the first person in Colorado to get a life-saving shock from that device, said Dr. Brad Mikaelian, who implanted it at Memorial Hospital.
Called a subcutaneous implantable defibrillator, the device features a flat, peach-sized generator that doctors place beneath the left armpit. A skin-deep wire strings out across the chest and up near the sternum.
When the device senses the heart kicking into cardiac arrest, it delivers a jolt measuring 65 to 80 joules -- roughly five times weaker than traditional paddles used by doctors to shock flat-lining patients back to life.
As medical technology advances, doctors have increasingly sought to simplify procedures while reducing risk and cutting down on rehabilitation times. Cardiac procedures are no different -- but costs vary.
Though the device is covered by Medicare, some insurance companies have been slow to cover it -- creating a barrier for some patients, said Dr. Derrick Fansler, cardiac electrophysiologist at Penrose- St. Francis Health Services. He arrived at the hospital in late July but was among the first doctors to implant it while he worked in Missouri.
It works best in certain patients. For example, unlike long-standing implantable defibrillators, it can't also serve as a pacemaker. It takes a slightly larger incision to implant, and some people may find it more uncomfortable because it rests close to the skin rather than deeper in the chest, Fansler said.
Then again, wires used by past implantable defibrillators leading into the heart can wear down or fracture, and replacing them can be troublesome -- a problem this newer device is meant to address.
Nine patients at Memorial Hospital have received it. None have been used at Penrose-St. Francis Health Services, though some are scheduled to get the device.
"You have to customize it to the person," Fansler said. "You have to guess about what their future is going to hold, in terms of infection risk, in terms of future device needs."
In May, when Knox first went into cardiac arrest, doctors revived her with defibrillator paddles -- a harrowing experience that may have left her dead, if not for her son first administering CPR.
Mikaelian implanted the device during Knox's three-week hospital stay.
"The life-insurance analogy, I don't really like it, but it kind of fits," Mikaelian said.
While at work in June, Knox felt dizzy again. Then she felt a jolt inside her chest -- but she never collapsed, and her heart beat normally afterward.
She received a second shock in July when her heart once again went into overdrive. That is when doctors located and addressed the underlying problem: an arrhythmia that required surgery.
She has yet to need another jolt from the device since that operation.
She hopes never to feel it again.
"It's my life -- this is part of my life now," Knox said.
Copyright 2014 - The Gazette (Colorado Springs, Colo.)
