Another First in the BVI Medical History, at Bougainvillea Clinic:

Intra-Cardiac Defibrillator and Cardiac Resynchronization Therapy devices implanted in patientsí hearts at Bougainvillea Clinic

In what turned out to be a marathon session a team of doctors, nurses and technicians, led by Dr. Heskith Vanterpool , made medical history yet again for BVI when a total of six (6) patients had Pacemakers(PM), Intra-Cardiac Defibrillators (ICD) and Cardiac Resynchronization Therapy Devices implanted in their hearts at Bougainvillea Clinic on the 1st and 2nd October 2011. In addition to local cardiologist Dr. Vanterpool, members of the team included Dr. Kendall Griffith, interventional cardiologist of St. Croix; Cynthia Hassett , Medtronic Corporationís regional Manager for the Caribbean; Dr. Deonne Ranglin, Anesthesiologist, and several nurses and other professionals.

The first pacemaker (PM) to be implanted in BVI was done at this clinic in December 2010. A PM is inserted when the electrical impulse the causes the heart to beat is blocked (heart block) from going through from the atrium (smaller chamber) to the ventricles (bigger chambers) which pump the blood through to the body. The pacemaker helps the heart to beat in a near normal pattern, thereby relieving symptoms of weakness, dizziness, fatigue and shortness of breath. A pacemaker consists of a very small battery operated computer that is implanted in the wall of the upper chest, just below the collar bone (clavicle). This computer then controls the heart beat through wires (leads) that are passed via a large vein into the right side of the heart. The leads are anchored (fixed) into the right atrium and ventricle of the heart. The pacemaker monitors the electrical activity of the heart, resting when it senses a normal electrical impulse and stimulating the ventricle the normal impulse fails. Eventually after some years (3-9 years, based on how dependent the heart is on the pacemaker) the pacemaker computer/battery will need to be replaced. Sometimes it may be necessary to replace a lead for various problems such as fracture or displacement of the wire.

Another Pacemaker-like device, called an Intra-Cardiac Defibrillator (ICD), may also save lives in those persons prone to ventricular fibrillation, a form of cardiac arrest, that causes sudden death. The treatment of ventricular fibrillation is to deliver an electrical shock to the heart, either externally with shock paddles (external defibrillator) or internally with a device that is implanted in to the heart itself (intra-cardiac defibrillator). On October 1st, medical history was made when two patients had ICDs successfully implanted into their hearts. The devices were tested to ensure that they would work properly in the event that ventricular fibrillation (VF) occurred naturally. To do so we had to artificially induce VF during the procedure and allow the implanted ICD to administer the shock while the patient was still on the operating table.

X-Ray of chest/heart after CRT-D implantation

On the following day, October 2nd, an even more complicated and sophisticated procedure called Cardiac Resynchronization Therapy, (CRT), for treatment of a patient with heart failure was successfully performed. The CRT device was combined with an ICD, all-in-one (CRT-D). For normal function all sides of the left ventricle contract at the same time (synchrony) to pump the blood around the body. In one particular form of heart failure, because of an electrical abnormality one part of the wall of the left ventricle contracts while the other part is still relaxed, thus reducing the amount of blood ejected with each beat. Blood, therefore has a tendency to backup into and flood the lungs, thus blocking the exchange of oxygen and causing shortness of breath. This form of heart failure is helped by pacing the left ventricle from opposite sides (left and right) thus causing it to re-synchronize (CRT). Patients with this type of heart failure are also prone to ventricular fibrillation. Therefore, the CRT device was combined with an ICD, all-in-one. The benefit was almost immediate, our patient noting improvement in her symptoms within a couple of days after the implantation.

Patients were discharged 24 hrs after the implantation procedure. Both patients and family members expressed their gratitude to the medical team that was able to assist them right here at home in the BVI. Dr. Vanterpool and the staff of both Bougainvillea Clinic and Eureka Medical Clinic would especially like to thank Dr. Kendall Griffith, eminent interventional cardiologist form St. Croix, USVI and Mrs. Cynthia Hassett, the Caribbean Regional Manager for the Medtronic Corporation (maker of pacemakers and the other implanted devices) for giving of their expertise and time to help develop this important cardiac service here in the British Virgin Islands.

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