Dr. T. S. Kler
Studies have shown that 60 % of all cardiac deaths are due to Sudden Cardiac Arrest occurring due to tachyarrhythmias and this is one of the leading causes of death globally. It is estimated that more than 3 million people die yearly from SCA, with a survival rate of less than 1%.
Sudden cardiac arrest occurs most frequently in adults in their mid-40s to mid-50s, and affects men twice as often as it does women. The most common cause of sudden cardiac death is coronary artery disease.
When SCA strikes, and often without any warning or symptoms, it requires immediate action for survival. Survival can be as high as 90 percent if treatment is initiated within the first five minutes after sudden cardiac arrest. The rate decreases by about 10 percent each minute longer. While CPR can keep some blood flowing to your heart and brain for a short time, the most effective way to treat sudden cardiac arrest and restore heart’s normal rhythm is by defibrillation. The American Heart Association recommends defibrillation within 3 to 5 minutes of arrest, or sooner, for sudden cardiac arrests occurring outside the hospital.
Newer technologies in past few years have emerged as device therapy for arrhythmias- ICDs and device therapy for heart failure -Cardiac Resynchronisation Therapy – CRT).
Implantable Cardioverter Defibrillators (ICD) – an emergency room in the chest
An implantable cardioverter-defibrillator (ICD) is a specialized device designed to directly treatcardiac tachyarrhythmias. ICDs have revolutionized the treatment of patients at risk for sudden cardiac death due to ventricular tachyarrhythmia.
(Doctors quote)Patients at high risk for sudden cardiac arrest:- Post heart-attack patients with low pumping function (EF <35%)- Additional risk factors such as NSVTs (non-sustained ventricular tachycardia), PVCs (premature ventricular contraction) and syncope / presyncope increase the risk of SCA in post MI patients and can be assessed through echo and ECG testsAn (ICD) is designed to monitoryour heart rhythm 24 hours a day. If your heart isbeating too fast or irregularly, the device will first sendsmall painless electrical signals to correct your heartrate. If the fast heart rate continues, the defibrillator willdeliver a shock to restore your heart to a normal rate.The ICD is like an emergency room in the chest preventing sudden cardiac death due to fast rates.Novel programming algorithms that reduce administration of unnecessary shocks and allows for remote monitoring, so that the patient is managed from his home reducing his hospital visits, has brought a new ray of hope amongst heart patients.
Recently cardiac devices industry has yielded an interesting innovation with regard to pacemakers and ICDs which has increased its use in clinical practice phenomenally. These devices are embedded with new technology that allows for full-body MRI scans among patients with these devices. It is estimated that as many as 63 % of patients will need an MRI within 10 years of receiving a device. Furthermore, 85 percent of all pacemaker patients have one or more comorbidities, making comprehensive multi-specialty care, including access to MRI, important in today’s environment. Until the availability of MR-Conditional pacemaker and ICD systems, patients with devices have been contraindicated from receiving MRI scans because of potential interactions between the MRI and device function, which in turn affects the diagnosis and treatment.
The SureScan® technology is anapproved technology resulting in a growing number of implantable cardiac devices that are approved for use in an MRI (magnetic resonance imaging) environment.
Cardiac Resynchronization Therapy – resynchronize the heart and improve quality of life
Heart failure in India has been conservatively estimated to affect up to 4.6 million people, with up to 1.8 million new diagnoses made each year. Heart failure is a progressive disease associated with symptoms such as breathlessness, frequent urination, systemic and pulmonary edema requiring frequent hospitalisations to decompensate, all severely affecting the quality of life. Also repeated heart failure hospitalisations are associated with increased mortality.
Cardiac resynchronisation therapy (CRT) is a way of treating heart failure; this device uses tiny electrical pulses to both ventricles (lower chambers) of the heart to make them beat together again in a more synchronised pattern.
Latest addition in cardiac devices for heart failure patients is a cardiac resynchronisation device which coordinates the left and right ventricular contractions and improves the heart’s pumping efficiency. Infactthe latest AdaptivCRT® algorithm, is the only algorithm demonstrated to improve heart failure patients’ response to the therapy and reduce the risk of atrial fibrillation (as compared to conventional biventricular therapy). This device automatically adapts to patient’s needs, continuously optimizes therapy, improves response rate and reduces heart failure hospitalizations.
While technology innovation is generating newer and better devices &improving clinical outcomes in cardiac patients, it is quintessential to create awareness amongst the masses about the disease progression and risks and enable them to make informed decisions about choosing the right treatment at the right time to enjoy a healthy&quality rich lifestyle.
(The author is executive Director Cardiac Sciences Fortis Escorts heart Okhla New Delhi)
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