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Sri Lanka marks a aboriginal for the country and South Asia as a dual-chamber cardioverter defibrillator (ICD) that is MRI friendly, is built-in in a patient. Kumudini Hettiarachchi speaks to Consultant Cardiac Electrophysiologist Dr. Asunga Dunuwille
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It is a Sri Lankan accommodating in her mid-70s who holds the almanac not alone for actuality the aboriginal in this country but in the accomplished of South Asia to be adapted with a dual-chamber implantable cardioverter defibrillator (ICD) that is accordant with alluring resonance imaging (MRI).
Dr. Asunga Dunuwille
The accommodating was in bifold jeopardy, MediScene understands, afore the MRI-compatible dual-chamber ICD was adapted in this latest technology to be alien in the acreage of cardiac-electrophysiology or in apparent agreement the heart’s electrical impulses.A affection advance she had suffered some time ago had lessened the affection functions. She was a victim of arrhythmias (see box) while on and off she was additionally decumbent to affection blocks which fabricated her faint, said Consultant Cardiac Electrophysiologist, Dr. Asunga Dunuwille, who amid this accessory in an operation abiding beneath than two hours on December 3 at the Durdans Hospital in Colombo 3.
The ICD is a acceptable accessory for those whose hearts become alarmingly fast, says Dr. Dunuwille who is absorbed to the National Hospital’s Cardiology Institute, abacus that the specialised acreage of Cardiac Electrophysiology in Sri Lanka is on par with any developed country including America.
The accent of this latest accessory lies in the actuality that for this patient, like abounding others in the country who additionally needs a alternation of MRI scans for added illnesses the accustomed ICD, would aloof not do, it is understood.
Pacemakers and accustomed ICDs which are battery-operated shut bottomward back there is addition alluring field. This is a above disadvantage for those defective capital MRIs.This botheration has been affected by the world’s aboriginal MRI-compatible ICD, which like the accustomed ICD can be built-in in the high larboard chest beef about an inch beneath the skin.
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During anaplasty to admit this MRI-compatible dual-chamber ICD, a faster affection amount is induced to analysis the “shocking function” of the “shocking coil” of the device, says Dr. Dunuwille, answer that the accessory is again programmed to go into action back the accommodating suffers an arrhythmia.
This dual-chamber accessory has a bifold account as it comes in accessible either back the affection amount goes faster or slower, back an arrhythmia occurs, MediScene understands. The accessory will shock the affection for the baby that is fast to acknowledgment to normal, while demography on the role of a pacemaker back the baby is slow.
Tracing the history of affection device-implantation, Dr. Dunuwille is quick to point out that while in developed countries pacemakers accept been acclimated for over 50 years, in Sri Lanka they accept been about back the 1980s. ICDs accept been acclimated for about 25 years the apple over and in Sri Lanka these specialized arrhythmia casework accept been in actuality back 2003.MRI-compatible accessories accept been in the apple bazaar alone for about two years and now we accept them in Sri Lanka, says Dr. Dunuwille. Therefore, patients do not charge to seek analysis away not alone adverse a far greater amount but additionally ability the aggravation of travelling out of the country, he adds.
Specialised cardiac electrophysiological abutment is accessible at the NHSL in Colombo, the Kandy Teaching Hospital and called clandestine hospitals in Colombo.
Role of pacemakers and ICDs
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There is a “natural pacemaker” amid in the upper-right breadth of every affection which sends out an electrical accepted to accumulate the affection accent as it should be, MediScene understands.
When this pacemaker gets diseased, the accent gets disrupted and the affection beats slower or irregularly. It is to actual this that a pacemaker, a baby device, is implanted. An ICD which is a added circuitous pacemaker, is built-in in those with alarmingly fast affection rates, says Dr. Asunga Dunuwille.
Explaining the difference, he says that while a basal pacemaker sends electrical pulses throughout to allure the affection to exhausted normally, an ICD will accelerate a ‘shock’ alone back there is a call in assertive conditions.
Arrhythmia problem
A assignment on the affection follows from Dr. Asunga Dunuwille. When asked about prevalence, he says that 1 of 10 cardiac patients would accept an arrhythmia problem. Arrhythmias are due to heart-rhythm problems, back the electrical impulses that alike the heartbeats go awry, authoritative the affection to exhausted too fast, too apathetic or irregularly, MediScene learns. A “fluttering” or “racing” affection may announce an arrhythmia. Often harmless, sometimes admitting they may be aggravating or alike life-threatening.
Faster affection ante may action due to assorted affidavit and in best instances there is no crisis of abrupt cardiac death, says Dr. Dunuwille, citation above-mentioned ventricular tachycardia (SVT) as an example. This action which presents as a fast heartbeat, area the affection contest and again slows or stops abruptly, does not crave device-implantation, but can be convalescent by radiofrequency ablation.
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However, in assertive ventricular tachycardia altitude (a accelerated baby that starts in the ventricles) there is the crisis of abrupt cardiac death, according to Dr. Dunuwille and as such charge accessory implantation.
Ventricular tachycardia could be acquired by:
Structural affection ache either due to changes in the affection afterward a affection advance or some added cardiomyopathy (a abrasion of the affection beef adverse the pumping action). This includes hypertrophic cardiomyopathy area the affection beef becomes blubbery which affects the acquiescence of the heart-wall, abbreviation its stretchability and contractability. This action which could abide in allegedly advantageous sportspersons can advance to abrupt cardiac afterlife and needs a accessory implantation.
Electrical-cardiomyopathy which causes Long QT Syndrome (disorder of the heart’s electrical activity) and Brugada Syndrome additionally charge devices.
Pacemakers are additionally appropriate for patients with appropriate Bradycardia — a action area the baby slows so that the beating amount is beneath than 60 or lower per minute – including Sick Sinus Syndrome and affection blocks, it is learnt.
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