Penn’s cardiac arrhythmia program is a regional and national referral center for heart rhythm disorders. For patients at risk for recurrent, sustained ventricular tachycardia or fibrillation, an implantable cardioverter defibrillator (ICD) is often the treatment of choice and Penn is a pioneer in the development and use of ICDs.
In 1981, Penn Medicine physicians implanted one of the first ICD devices used to treat ventricular arrhythmias, abnormal life-threatening rhythm from the ventricles. Since that time, they have remained at the forefront of every new development and contribution in the field of implantable devices.
“Penn Medicine has been at every stage of this cutting-edge technology for the past 30 years,” said Francis E. Marchlinksi, MD, director of Penn’s electrophysiology program. “Members of our team helped determine the guidelines for implantation and we continue to investigate new advances in ICD technology.”
How ICDs Work
Implantable cardioverter defibrillators detect ventricular tachycardia or fibrillation and shock the heart to restore the normal rhythm. The device is connected to leads positioned inside the heart or on its surface that deliver electrical shocks. The leads are connected to a pulse generator about the size of a deck of cards that is implanted beneath the skin of the chest or abdomen. Electronics in the devices sense cardiac rhythms and sometimes pace the heart, as needed.
ICDs have been very useful in preventing sudden death in patients with known, sustained ventricular tachycardia or fibrillation. Newer ICDs are smaller and have simpler lead systems. The device leads placed in the heart can be installed through blood vessels, and do not need open chest surgery.
Penn is a full-service arrhythmia center, with programs located at the Hospital of the University of Pennsylvania, Penn Presbyterian Medical Center and Pennsylvania Hospital. The electrophysiologists, many of whom are recognized as “Top Doctors” and “Best Doctors,” cover all aspects of ICD management from implantation through extraction, with an emphasis on optimization. The optimization clinic evaluates patients to make sure their biventricular ICD or pacemaker is working appropriately for treating heart failure.
“ICDs shock the heart back into a normal rhythm and that can be very uncomfortable for patients” Dr. Marchlinski said. “An ICD is insurance for the heart: it can save the patient’s life during a life-threatening episode, but it should rarely be triggered.”
The Penn Difference
Penn Medicine’s arrhythmia team is led by board-certified electrophysiologists who collaborate with heart failure specialists, cardiovascular surgeons and other specialists in treating the full spectrum of heart rhythm disturbances. These extended teams of caregivers review all cases on a daily basis to further optimize treatment strategies.
Each year, physicians at the Hospital of the University of Pennsylvania place more than 400 ICDs, a number that has increased by 40 percent in just the past three years. In addition, more than 4,000 electrophysiology procedures and 1,100 catheter ablation procedures are performed annually.
The cardiac arrhythmia program at the Hospital of the University of Pennsylvania is one of the largest hospital-based electrophysiology programs in the country with the largest team in the region. Its five EP laboratories are equipped with state-of-the-art imaging and mapping systems and technologies designed to enhance and improve the accuracy, safety and effectiveness of cardiac device implantation.
The Next Generation of ICDs
In August, electrophysiologists from Penn Medicine implanted the region’s first subcutaneous implantable cardioverter defibrillator (ICD) for sudden cardiac arrest, a potentially fatal electrical malfunction of the heart.
The leads of ICDs are a common reason for device replacement, which increases the risk of complications. While Penn has one of the few programs in the country experienced in lead extraction, this research can lead to expanded indications for the use of ICDs as well as improved safety, according to Dr. Marchlinski.
Other technologies on the horizon include biological pacemakers and transmitters that can be placed in the heart to improve its ability to squeeze.
Symptoms of Tachycardia & Ventricular Fibrillation
Tachycardia, a rapid heart beat, can produce detectable symptoms including:
- Palpitations
- Heart pounding or racing
- Dizziness
- Lightheadedness
- Fainting or near fainting
- Rhythm may be fast and regular or fast and irregular.
Ventricular fibrillation (VF) is a severely abnormal heart rhythm that can be life threatening. A person experiencing a VF episode suddenly collapses or becomes unconscious because the brain and muscles have stopped receiving blood from the heart.
The following symptoms may occur within one hour before the collapse:
- Chest pain
- Dizziness
- Nausea
- Rapid heartbeat
- Shortness of breath
For more information about the arrhythmia program at Penn Medicine or to schedule an appointment please visit PennMedicine.org/heart or call 800-789-PENN (7366).
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