Exciting option for cardiac arrest patients: subcutaneous implantable-cardioverter defibrillator
Each year, more than half a million
individuals in the United States
experience a cardiac arrest, which is
often fatal. Implantable cardioverter-
defibrillator systems are a well-
established treatment with a high
number of successful conversions for patients with heart rhythm
disorders that place them at risk for life-threatening arrhythmia.
Traditionally these systems have transvenous leads that are placed
through the bloodstream into the heart chambers.
Beaumont’s Heart Rhythm Center is offering an exciting new option
for patients at risk for sudden cardiac arrest. S-ICD, a totally
subcutaneous implantable defibrillator system, has leads that are
tunneled under the skin without entering the blood stream or
touching the heart. The recent “Effortless Study” showed a high
number of successful conversions of ventricular tachycardia (VT) and
ventricular fibrillation (VF) (98.5 percent acute termination of
induced VT or VF; 100 percent conversion of spontaneous VT/VF
events) with a low complication rate of 7 percent at one year.
Eligible patients have an indication for an implantable defibrillator,
but do not require transvenous pacing for bradycardia or
pace-termination of VT.
Update on novel oral anticoagulants for atrial fibrillation
The introduction of novel oral
anticoagulants (direct thrombin and
factor X(a) inhibitors), has ushered an
effective and more convenient options
for stroke prevention when compared to
the vitamin K antagonist, warfarin.
However, these agents have also resulted in new challenges. Now,
more than ever, it is critical to individualize such treatments, weighing
the risk of bleeding against the risk of stroke, and carefully looking
for potential drug interactions, especially with the concomitant usage
of potent antiplatelet agents in cardiac patients. This requires a
collaborative effort between cardiologists, primary care providers
and pharmacists. It also requires prescribing physicians to have a
clear understanding of the pharmacology of these agents. It is
anticipated that with proper usage, increasing numbers of vulnerable
patients with atrial fibrillation will be protected from embolic strokes,
and the devastating morbidity and mortality associated with
such strokes.
Atrial Fibrillation
RESEARCH
Beaumont’s Heart and Vascular Research department is
one of the largest in the country with many ongoing leading
edge clinical research trials.
Selected Current Trials
Victory-AF trial
Persistent atrial fibrillation (AF) is an arrhythmia that can
cause significant symptoms in patients and is associated
with an increased risk of stroke. Catheter ablation of
persistent AF has had moderate success, but has been
limited by the lack of specialized ablation catheters
designed specifically for this purpose. The Victory-AF trial
is testing ablation of persistent AF with phased
radiofrequency (RF) ablation, which is a new, promising
mode of ablation energy that is delivered via a trio of
unique catheter designs. Beaumont anticipates that the
investigational ablation system will be effective, efficient
and safe.
Principal Investigator: DAVID HAINES, M.D.
Coordinator: SCOTT ELDREDGE, RN, 248-898-6602 or
Transcatheter aortic valve replacement (TAVR): Is my patient eligible?
Currently, transcatheter aortic valve replacement (TAVR) is
approved and commercially available for inoperable and
high-risk patients with severe symptomatic aortic stenosis.
Beaumont uses the Edwards Sapien balloon expandable
transcatheter heart valve utilizing the transfemoral,
transaortic and transapical approaches, depending on
patient anatomy. Additionally, Beaumont is participating in
two TAVR trials. The first is utilizing the Sapien 3 device to
treat intermediate risk patients (STS score of 4 to 8
percent). All patients deemed eligible are treated with the
Sapien 3 valve and are not randomized to surgery. The
Sapien 3 device is inserted through a 14 F expandable
sheath and has a fabric cuff to reduce the risk of
paravalvular aortic regurgitation. The second TAVR trial is
enrolling extremely high risk patients (estimated surgical
morbidity and mortality of greater than 50 percent) with
degenerated bioprosthetic valves (stenosis or
regurgitation).
To refer a patient, call Beaumont’s Heart Valve Clinic at
248-898-0230.
JUNE 2014, ISSUE IX | TRENDING NEWS IN HEART & VASCULAR DISEASE AND SERVICES
Visit: heart.beaumont.edu for other Beaumont Health System heart and vascular information.
$50 lung cancer screening available at Beaumont
More people die of lung cancer each year in the
United States than any other type of cancer, yet
when it’s caught early, there are more
treatment options and much higher survival
rates. To promote early detection and save
lives, Beaumont now offers a $50 Lung Cancer
Screening that uses low-dose CT imaging for earlier diagnosis of lung
cancers. Lung cancer death rates in CT screened patients fell by 20 percent
and overall survival improved. Patients should be from 55 to 80 years of
age, have a smoking history of one pack a day for 30 years, and have
smoked within the last 20 years. They should also have an anticipated
survival of greater than five years from co-morbid conditions. Beaumont
also has the Lung Nodule Clinic for patients with positive scans.
Patients require an order in EPIC or a prescription ordering “Lung Cancer
Screening CT.” Your patients can schedule an appointment by calling
800-328-8542.
Medicare expands coverage to include cardiac rehabilitation for CHF
Medicare has recently expanded its coverage of
Phase II exercise-based cardiac rehabilitation
services to include selected patients with
chronic congestive heart failure (CHF).
Structured exercise coupled with appropriate
cardioprotective medications, aggressive risk
factor modification and ongoing medical surveillance has been shown to
significantly improve prognosis in this escalating patient population (JAMA
2009; 301:1439). Your CHF patients may qualify for Medicare coverage of
Phase II cardiac rehabilitation if they meet the following criteria:
• left ventricular ejection fraction less than or equal to 35 percent
• New York Heart Association class II to IV symptoms despite “optimal
heart failure therapy for at least six weeks” (e.g., ACE/ARBs, beta
blockers, digoxin, statins, at dosages deemed appropriate by
contemporary guidelines)
• no major cardiovascular procedures or hospitalizations within the
previous six weeks from referral date
• no planned major cardiovascular procedures or hospitalizations over
the next six months from referral date
Beaumont offers three cardiac rehabilitation locations that you can call for
additional information: Beaumont, Grosse Pointe: 586-443-2960,
Beaumont, Royal Oak: 248-655-5750 or Beaumont, Troy: 248-964-8520.
D ID YOU KN OW ?
Beaumont’s Hyperbaric Medicine Center is one of the largest programs in
the country. Hyperbaric oxygen therapy is used to treat diabetic foot
wounds, chest wound secondary to radiation therapy as well as radiation
cystitis, osteoradionecrosis and chronic refractory osteomyelitis. For more
information, call Beaumont’s Hyperbaric Medicine Center at 248-655-3147.
3601 West 13 Mile Rd. | Royal Oak, MI 48073-6769heart.beaumont.edu
MARK YOU R CALEN DAR
U P CO M I N G CO N FE RE N CES/EVE NTS
Advances in Cardiovascular Imaging and InterventionsOct. 9 - 11, 2014TROY MARRIOTT, TROY, MI
Practical Update in Cardiology, 2014DETAILS PENDING
24th Annual Cardiovascular ConferenceFeb. 22 – 25, 2015PARK HYATT BEAVER CREEK, BEAVER CREEK, CO
For more information or to register for any of the above conferences, visit: http://meded.beaumont.edu/cardiology-conferences
For more information about Heart and Vascular Continuing
Medical Education, contact Shannon Herrington, CMP,
Heart and Vascular Education at 800-732-6368 or email
To receive the Beaumont Heart & Vascular Update for Physicians e-newsletter, opt-in at heart.beaumont.edu.
Visit: heart.beaumont.edu for other Beaumont Health System heart and vascular information.
TRENDING NEWS IN HEART & VASCULAR DISEASE AND SERVICES
BEAUMONT HEART & VASCULAR UPDATE FOR PHYSICIANS
EDITORS:
Steven Almany, M.D. &
Simon Dixon, MBChB, FACC
For more information visit: heart.beaumont.edu or to talk to a Beaumont heart and vascular specialist, call 888-877-8766.