Cardiac device for MUHC patient is first in Canada
CRT-D unit a major advance in treating patients with severe coronary disease
Montreal-area resident and heart patient Maurice Des Alliers says he’s thrilled to feel like a young man again.
Less than three weeks ago, Des Alliers, 67, became the first Canadian patient to get a medical implant just under his collarbone that regulates his heart. Called the cardiac resynchronization therapy defibrillator (CRT-D), the device is the first of its kind to be compatible with a full-body magnetic resonance imaging (MRI) scan.
For someone like Des Alliers, whose heart is severely scarred, the new device represents security, he said.
“I feel safer with it.”
The CRT-D is a major advance in treating patients with severe coronary disease, said surgeon Vidal Essebag, director of cardiac electrophysiology at the McGill University Health Centre.
Medical imaging is necessary to investigate scars and damaged areas of the heart that could be causing arrhythmia, or an irregular heartbeat, said Essebag, who performed the surgery at the Montreal General Hospital using the new implantable device.
An estimated 3,400 Canadians last year received a CRT-D implant. But such devices usually have a downside. These patients are then unable to undergo MRI scans because the powerful magnetic fields generated by the scan can heat the metal tip in the heart, reprogram the device making it malfunction or cause fatal arrhythmia, Essebag said.
Health Canada approved the new MRI-compatible device in May this year. Patients with severe heart problems will be prioritized for the device.
Much research in the past few years has focused on how to treat patients with implanted devices when they cannot have an MRI, Essebag said.
“What do you do if someone really needs an MRI? What are the safety precautions? What can be done? Obviously, with (MRIcompatible) devices designed to mitigate that risk, it makes it a lot easier,” Essebag said.
The device fulfils three important therapeutic roles, Essebag explained: it’s a defibrillator, a pacemaker and a synchronizer of heartbeats.
The pacemaker makes sure the pulse is never too slow, Essebag said.
“The defibrillator can deliver a shock to a patient who has a cardiac arrest, and restart the heart to save his life,” he added. “So it’s a pacemaker with an additional feature for patients with higher risk of cardiac arrest.”
Then there’s a third feature — a wire that sends electrical impulses to both lower chambers of the heart to help them beat in a more synchronized pattern, pumping blood throughout the body more efficiently, Essebag said.
Many patients with heart failure have weakened heart muscle whose ventricles do not beat together — it’s one side first, then the other, Essebag said.
For an already weakened heart, beating out of sync is not very efficient, he added.
In February, Des Alliers went to his local hospital emergency room because he was feeling very tired and couldn’t seem to get enough air. It turned out his heart was beating too slowly, at 36 beats a minute.
He had already suffered one attack in 1989, a portion of his heart wasn’t working at all, and he had two stents to treat weak and narrow arteries.
Des Alliers was transferred to the specialty heart centre at the Montreal General.
Des Alliers became the recipient of the new implant in a two-andhalf-hour operation on June 29, and he went home the following day.
“Now my heart beats at 75 beats a minute,” he said. “I feel like a young man.”
“Heart failure is the most rapidly increasing cardiovascular disease in Canada, affecting about half-a-million people,” Dr. Nadia Giannetti, chief of cardiology and medical director of the heart failure and heart transplant centre at the MUHC, said in a statement.
“In only the past year, around 3,400 Canadians benefited from a CRT-D, so it’s encouraging to know that an MRI-compatible device is now available in Canada.”