HKU successfully performs the first implant of a subcutaneous implantable cardioverter defibrillator in Asia
16 Apr 2014
Li Ka Shing Faculty of Medicine, The University of Hong Kong (HKU) has successfully performed the first implant of a newly developed defibrillator in Asia for two patients. The new defibrillator is completely implanted in the subcutaneous tissues of the chest wall of the patient without the need to put electrodes in the heart through blood vessels. It is relatively safe and can significantly reduce the risk of developing complications.
Professor Tse Hung-fat, William M W Mong Professor in Cardiology and Chair Professor of Department of Medicine, Li Ka Shing Faculty of Medicine, HKU says, “The greatest advantage of the new defibrillator is that the implantation can be conducted without putting any electrodes into the heart through blood vessels, leaving the heart untouched. Hence, the risk of heart perforation, and/or infection of the heart after the surgery will drop to zero percent.” He also mentions that a simple surgery can be carried out to replace worn-out electrodes in the future for the patients and their risk of having major cardiac surgery can be reduced.
About implantation of new defibrillators
The medical team of Li Ka Shing Faculty of Medicine, HKU successfully performed the implantation of a newly developed defibrillator for a patient with inherited cardiac diseases on March 31, 2014. The surgery was completed within an hour. The patient was in good condition and was discharged after the surgery. Up to now, the team has performed the same type of surgery on two patients who are both making satisfactory progress of rehabilitation.
The surgery requires three incisions over the patient’s left chest and the implantation of the new defibrillator under the skin over the ribs and sternum, leaving the blood vessels and the heart untouched, thus reducing the risk of developing severe complications. In addition, the defibrillator can be placed solely by anatomical landmarks without using X-ray, hence reducing patients’ radiation exposure.
Compared with traditional defibrillators
The new defibrillator can perform the same function as traditional defibrillator even though it is completely outside the heart. The size of the new defibrillator is slightly larger than that of the traditional defibrillator. However, as the implantation does not require any electrodes entering the blood vessels and the heart, the surgery is relatively safe. Compared with the traditional implantation which takes 1 to 2 hours for the surgery operation, the time for the new defibrillator implantation is relatively shorter as it can be completed in around an hour, so that the patient will not be anaesthetised for a long time. In addition, when replacing the worn-out electrodes of a traditional defibrillator, a laser/diathermy sheath must be used which may cause heart injuries. In contrast, the electrodes of the new defibrillator are hidden under the skin, so only a simple surgery will be needed to replace the electrodes.
The operation of defibrillators
Defibrillators monitor patients’ heartbeats. When a life-threatening heart rhythm is detected, the defibrillator will deliver electric shocks to restore normal heartbeats. Defibrillators can provide immediate help to patients at critical moments to avoid sudden cardiac arrest because of the inability of blood outflow to the heart. The daily life of patients will not be affected after the installation.
People who installed defibrillators
In general, high-risk patients suffering from certain cardiovascular diseases, heart failures, or hereditary heart diseases may be suitable to receive defibrillator installation after doctors’ assessments. In Hong Kong, around 200 patients install defibrillators every year.
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Professor Tse Hung-fat (Left), William M W Mong Professor in Cardiology, Chair Professor of Department of Medicine and Dr David Siu Chung-wah (Middle), Clinical Associate Professor of Department of Medicine, Li Ka Shing Faculty of Medicine, HKU successfully performs a surgery for Mr Yeung (Right) to install a subcutaneous implantable cardioverter defibrillator to prevent sudden cardiac arrest.
Professor Tse Hung-fat, William M W Mong Professor in Cardiology and Chair Professor of Department of Medicine, Li Ka Shing Faculty of Medicine, HKU mentions that although the size of the new defibrillator (Left) is slightly larger than the traditional one (Right). However, the implantation process is safer as no electrodes will go into the heart through blood vessels. Thus, the risk of heart perforation or infection of the heart after the surgery will drop to zero percent.
Dr David Siu Chung-wah, Clinical Associate Professor, Department of Medicine, Li Ka Shing Faculty of Medicine, HKU says that the surgery requires three incisions over the patient’s left chest and the implantation of the new defibrillator under the skin over the ribs and sternum. The surgery is simple and only takes around 1 hour.