February is Heart Health Awareness Month. Not only can the romantic heart be mended but the heart suffering from cardiovascular disease as well.

In this column, White Plains cardiologist Dr. Martin Cohen answers our questions about Implanted Cardiac Devices

 

Although the American Heart Association (AHA) recently announced that overall deaths from cardiovascular disease are dropping, heart disease remains the number one killer of Americans. Despite the prevalence of the disease, many patients are living longer because of advancements in technology. Throughout the past 20 years, an increasing number of patients have received life-saving pacemaker and defibrillator devices.

Today, more than two million Americans rely on a pacemaker or defibrillator to regulate their heart beat. Implanted cardiac devices are highly reliable and effective in managing heart rhythm problems, such as an irregular heartbeat--when a heart beats too fast or too slow.

As the patient population continues to increase, many questions have surfaced from patients and loved ones about implanted cardiac devices. In honor of February being Heart Health Awareness Month, Dr. Martin Cohen, MD, FACC of Cardiology Consultants of Westchester answers our questions.

 

When would a patient receive a pacemaker/defibrillator?

Physicians implant a cardiac device to help ensure the heart is contracting and pumping blood adequately. This ensures the body receives enough blood, oxygen and food. According to the AHA, reasons for implanting a pacing device include:

 

·       A heart that beats too slow or too fast

·       A heart that does not beat regularly

·       A blockage in the heart’s electrical pathways

 

Patients may receive a defibrillator for several reasons:

 

·       After resuscitation from a cardiac arrest

·       Rhythm problems known to carry risk of cardiac arrest

·       An inherited disorder that carries a risk of cardiac arrest

·       A weakened heart that places the patient at risk for cardiac arrest

 

For most patients, pacemakers and defibrillators are lifelong treatment options. Other patients only need a pacemaker or defibrillator for a short time, like after a heart attack. Such needs may be addressed with a temporary pacemaker or an external, wearable defibrillator.

Patients who are experiencing heart problems should immediately consult their physician.

 

How do Pacemakers and Defibrillators work?

A pacemaker senses when a heart beat is too slow and delivers a small electrical impulse to the heart, triggering it to beat. Defibrillators, which are larger in size, deliver an electrical shock to the heart when the heart rate becomes dangerously fast. In addition, defibrillators have pacemaker functions built into them.

Pacemakers and defibrillators are small units that each contain a pulse generator, which houses a battery and a computer chip. The generator is placed in a pocket, usually under the collarbone. The device is hooked up to the heart via thin flexible wires known as leads, which are advanced into the heart through veins.

 

Can a patient feel the device activate?

For a pacemaker this process should occur without any patient recognition. If the pacemaker action is felt by the patient, he or she should consult their physician; there may be a malfunction with the pacemaker or the wires that connect the device to the heart.

For defibrillators, the pacing functions also should occur without being felt by the patient. If the patient has a dangerously fast heart rhythm, the device will deliver a larger electrical shock to the heart to restore normal rhythm. If the patient is conscious when this occurs, he or she will feel the shock.

 

How does a pacemaker/defibrillator impact a patient’s life?

Many patients with implanted devices are able to live normal lives. Depending on your condition, your doctor may ask you to monitor your heart beat while exercising or doing physical activities. Other patients may only be able to do limited physical activity.

It is important for patients who are implanted with cardiac devices to see their doctors regularly and report any changes in their condition. Most implanted devices should be checked by a physician every three to six months to ensure proper functioning. Additionally, device batteries will need to be replaced every five to eight years. A physician should also check the leads in the implanted device to make sure they are functioning properly.

 

What are cardiac leads?

Cardiac leads are thin, insulated wires that connect and provide power from the implanted device to the heart. Over time, leads may malfunction or become infected—either of which can cause serious complications for patients. When malfunction or infection occurs, physicians and patients must consider a variety of lead management options and potential removal of the lead.

 

When should leads be removed?

Most patients who are implanted with pacemakers and defibrillators will live normal lives and never have a problem with their devices. However, some patients may encounter a problem such as malfunction and infection and should speak to their physician about lead management options, including removal.  

According to the Heart Rhythm Society physicians should consider lead removal if:

 

• An infection of the pacing system or pocket where the device is placed occurs
• A cardiac lead breaks or malfunctions, which can cause a life-threatening arrhythmia
• A retained lead that poses immediate or imminent physical threat to the patient
• Abandoned leads have caused occlusion of all usable veins with the need to implant a new transvenous pacing system
• A lead interferes with the operation of another implanted device

 

How are the leads removed?

Because scar tissue can bind the lead in place, lead extraction demands expertise, as well as a plethora of specialized tools. The main extraction tools include laser and radiofrequency ablation, mechanical rotational sheaths and manual traction.



Cardiology Consultants of Westchester is using an Excimer Laser procedure, which produces pulsed burst of ultraviolet (UV) light energy to break down the scar tissue surrounding leads and frees the wires for easy removal. A recent, four-year retrospective LExICon (Lead Extraction in Contemporary Settings) study demonstrated the use of excimer laser assisted lead removals to be 97.7 percent successful in the removal of pacemaker and defibrillator leads.

 

Where can patients learn more?

Patients interested in learning more about pacemakers and defibrillators can call 593-7800 or visit: ccwpc.com.

What do NewYork-Presbyterian/Weill Cornell Medical Center renowned physician, professor and best-selling author Isadore Rosenfeld, M.D.; nutrition expert Joy Bauer, MS, RD, CDN; and award-winning broadcast journalist Max Gomez, Ph.D. have in common? They are taking part in Wellness Through Prevention Month—one of the most ambitious wellness programs undertaken in Westchester—sponsored by White Plains Hospital Center (WPHC). Throughout May a wide array of seminars, health screenings and fitness demonstrations will take place. Nearly all are free.

WPHC has long recognized the importance prevention plays in lowering risk for chronic diseases such as diabetes, heart disease, and cancer. WPHC has also been committed to making available the best resources and information about health and wellness to as many people as possible. Wellness Week was launched, in May of last year, as a comprehensive community-wide education program to underscore the importance of a healthy lifestyle in promoting health and wellness. This year the commitment has been significantly expanded.

Chronic illness is a national healthcare crisis with staggering consequences for individuals, families, and the economy. Nearly half of Americans suffer from one or more chronic diseases. About 75 percent of the estimated $2.2 trillion the U.S. spends on our strained healthcare system goes toward treating the chronically ill. A Milken Institute study found that the annual impact on the U.S. economy of the most common chronic diseases could balloon to nearly $6 trillion by the mid-century. Poor health also has serious long-range implications for businesses to compete successfully, further weakening the economy. Chronic illness takes a heavy toll on those who are afflicted and on their families. According to the National Business Group on Health, about 47 percent of U.S. deaths in 2000 were caused by health behavior that could be changed. Smoking, poor diet, and inactivity are cited as the largest culprits.

The goal of Wellness Through Prevention Month is to highlight how behavioral changes—such as eating right and keeping fit—can improve health and reduce healthcare costs.

The scope of the program includes events not only in White Plains but also in neighboring communities of Scarsdale, Mamaroneck, Port Chester, Rye, and Rye Brook. There will be programs targeted to seniors as well as the Spanish-speaking and African-American communities.

Among the highlights are lectures by Dr. Isadore Rosenfeld whose topic will be “Modern Prevention: How to Collaborate with Your Doctor,” and nutrition expert—and contributor to the “Today” show—Joy Bauer, MS, RD, CDN, who will appear at lecture sponsored by the Auxiliary of White Plains Hospital Center. Noted health and medical reporter Dr. Max Gomez will moderate a panel on obesity and weight loss, comprising physicians from the Hospital.

Leading Hospital medical experts will provide free lectures on  health issues including: Prostate Health, Diagnosis and Care, Breast Cancer Detection, Striking Back at Stroke, Arthritis and Joint Replacement, and Sports Injury Prevention.

I hope everyone will take advantage of this exciting month-long program and join the Hospital in making prevention a top priority for each of us and for our nation.

Jon Schandler is President and CEO of White Plains Hospital Center. For a complete schedule of events, visit wphospital.org .