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

scott.eldredge@beaumont.edu

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

heartandvascularconferences@beaumont.edu.

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.