Joe Rizzo (although this is a true story the patients name has been changed to protect his privacy) had never thought of himself as unhealthy.  At the age of 52, Joe's job as a financial consultant was going well.  Although Joe had suffered a heart attack 12 years earlier which left a moderate sized scar in his heart, he recently had a normal stress test and jogged two miles a day.  This all changed one day when Joe was with friends playing golf.  In the middle of the game, Joe collapsed.  No pulse could be found and CPR was started.  Fortunately, Joe's golf club had recently aquired a device called an automatic external cardiac defibrillator (of AED).  This was attached to Joe while CPR was continued and automatically analyzed Joe's heart rhythm.  It found Joe was in a rapid and, if left untreated, fatal heart rhythm called ventricular tachycardia.  The AED automatically then delivered a high voltage shock to Joe's chest (similar to what we see on TV when a code blue is called on a patient and the paddles are used to restore life).  This shock reset Joe's heart out of this fatal heart rhythm and restored a normal pulse.  Twenty minutes latter Joe was awake but still dazed.

Joe was taken to JFK medical center and referred to Dr. Fishel.  Dr. Fishel performed a test on Joe called an electrophysiology study or EP study.  This test revealed that the scar left in Joe's heart from the distant heart attack was the cause of the cardiac arrest.  Scars from previous heart attacks are a common cause of sudden death and cardiac arrests.  The scars can at times wake up, often years or even decades after the original heart attack.  The scars can then produce rapid heart rhythms during which time the heart is moving so rapidly that no blood is pumped.  Although this might sound like a rare problem, in fact it is the most common cause of sudden death in people who have had previously damaged hearts.  All to often, the patient first learns of their problem when they have a cardiac arrest.  Joe was lucky, in Florida about 90% of all cardiac arrest victims die as a result of the heart rhtyhm problem.

Although Joe made a complete initial recovery, he was at grave risk for having another cardiac arrest and with the next one he might not be as lucky.  Dr. Fishel therefore implanted an implantable cardiac defibrillator (or ICD) in Joe's chest.  This device, slightly larger then a modern pacemaker, is like having a paramedic with you at all times. The device constantly monitors the heart and if a potentially dangerous rhythm occurs, it can shock the heart back into it's normal condition.

A Modern ICD

The Surgery was done the next day and Joe was discharged home the following day. He made an uneventful recovery and can to our ICD clinic every three months for the next year.  He resumed regular exercise and returned to work.  he was feeling so good that he at times wondered if his cardiac arrest was an isolated event perhaps due to some other cause.  Then, while at work one day Joe suddenly became very dizzy while sitting at his desk.  He started to loose his breath and his vision started to fade.  He could feel himself about to pass out when he felt a sudden jolt in the center of his chest.  He latter described this sensation as equivalent to having a mailbox hit your chest at 60 miles an hour.  

Joe was again take to the hospital.  Here the ICD was interrogated.  An ICD will memorize the patients EKG before it delivers any therapy.  By holding a wand over the device, a doctor can letter pull up the EKG to see what rhythm the patient was in.  

An ICD Interrogator and Programmer

Joe's ICD interogation revealed he was in ventricular fibrillation.  This rhythm is universally fatal unless a shock can be delivered to the heart.  The first ICD shock restored normal rhythm.  Joe was sent home from the hospital this time the very same day a bit chastened but convinced an ICD had saved his life.  This occurred three years ago and since that time he Joe has received no further shocks.  Many patients with ICDs will receive shocks very rarely (if ever), while others will receive very frequent shocks.  How often the device is used depends largely on the patient and his or her heart condition.

Joe remains a patient of Florida Electrophysiology Associates and is doing very well.  He remains active and leads a full life.  Joe is a very active participant in our ICD support group which provides emotional support and answers questions which patients with ICDs might have.  He also now recommends the manufacturer of his ICD (Medtronic in Joes case) to his clients as an investment - after all the investment paid off for him