UNMC cardiologist is first to use new device in Nebraska

UNMC’s John Schereshel, M.D., recently peformed the first installation of the SJ4 implantable cardioverter defibrillator in the state of Nebraska. (Photo contributed by St. Jude Medical)

A UNMC physician has performed Nebraska’s first implant of an implantable cardioverter defibrillator (ICD) that uses a new system that minimizes the number of connections between cardiac leads and the ICD.

The procedure was performed July 30 at the VA Nebraska-Western Iowa Health Care System’s Omaha Medical Center by John Scherschel, M.D., assistant professor in the UNMC Department of Internal Medicine, section of cardiology.

“It’s a significant breakthrough … the simpler the device, the lower the risk of complication or failure,” said Dr. Scherschel, a cardiac electrophysiologist, joined the UNMC faculty on July 1. “Patients are the real benefactors of this new technology.”

The patient, 75-year-old Eddie Fidler of Clarinda, Iowa, is out of the hospital and has returned to his normal activity level. He is pastor of the Church of God in Clarinda.

What is an ICD? An implantable cardioverter defibrillator (ICD) is a device implanted in the chest to monitor for and, if necessary, correct episodes of rapid heartbeat. If the heartbeat gets too fast, the ICD will stimulate the heart to restore a normal rhythm. In cases where the heartbeat is so rapid that the person may die, the ICD will give an electric shock (defibrillation) to reset the heartbeat. An ICD is similar to a pacemaker, which is another type of device that corrects an abnormal heart rhythm. Pacemakers are usually chosen to correct a heart rhythm that is too slow, while ICDs are used to correct a heart rhythm that is too fast. The ICD is implanted into the patient’s chest during a minor surgical procedure. A short stay in the hospital is usually required. Some patients may need to take antiarrhythmic medications that help the heart maintain a normal rhythm. Once the ICD is in place, it runs on batteries for about four to seven years, depending on how often an electric shock is discharged. ICD batteries will not run out unexpectedly, as physicians can detect when the battery is running low during a routine office visit. People with ICDs need to be careful in certain situations. More information on living with an ICD is available online. It is estimated that about 400 people per million have ICDs in the United States.

The new connector system, called SJ4, is manufactured by St. Jude Medical in St. Paul, Minn. It was approved by the Food and Drug Administration in April and first implanted in a patient in early June. It has only been available for use at a limited number of medical centers around the country.

The new system reduces the volume of device in the chest wall and that should help add to the patient’s comfort level, said Dr. Scherschel, who completed a fellowship in clinical cardiac electrophysiology at the Krannert Institute of Cardiology at Indiana University School of Medicine before he came to UNMC.

The SJ4 features a single connection between the device and the defibrillation lead, and a single set screw. Previous defibrillator lead designs required three separate connections and four set screws.

With fewer connections to make, the SJ4 reduces the time it takes to implant the ICD and thus reduces the risk of infections and incorrect connections, Dr. Scherschel said.

Another major benefit to patients, Dr. Scherschel said, is that the lead and ICD are part of a system that allows patients to be monitored remotely.

St. Jude Medical has a long history of working with the VA Nebraska-Western Iowa Health Care System, Dr. Scherschel said, so that’s why it was selected to be the first site in Nebraska and the first VA medical center in the country to use this exclusive technology.

If patients express a preference for the SJ4 device or if there is a medical need for it, Dr. Scherschel said he would be able to use the device for future procedures performed at The Nebraska Medical Center, UNMC’s hospital partner.