Amit Guttigoli, MD, really likes gadgets. One in particular caught his interest and passion. He’s become such a fan that he now trains doctors on two continents how to use it.
The nifty device is called the S-ICD or subcutaneous implantable cardioverter defibrillator. It’s similar to a pacemaker, but larger and lasts longer. Pacemakers are permanent devices that are implanted under the skin, usually close to the shoulder or collarbone, that send electric signals to start or regulate a slow heartbeat. An ICD has a generator and electrode leads going into the heart that deliver two levels of electric energy based on the heart’s rhythm and what it may need. Patients with underlying congenital or structural heart abnormalities, or those with limited access in the chest, aren’t good candidates for an ICD. Enter the S-ICD. It operates similarly to its older brother, the ICD, and can deliver a shock without wires ever touching the heart. S-ICDs are implanted under the skin next to the rib cage above the breast bone.
Dr. Guttigoli already conducts a course on S-ICDs at Methodist Dallas Medical Center, but he’s recently taken his expertise overseas. In June, Dr. Guttigoli joined a handful of proctors to be sent as international faculty to make sure the device implants were done safely in Japan. Dr. Guttigoli visited hospitals in Osaka, Nagoya, Ise, Himeji, and Sapporo where he supervised the first few cases of S-ICD implantation. He said he saw more congenital heart issues among the Japanese, particularly in the younger age groups.
“It is an honor and privilege to be asked to come and proctor the Japanese who are very well accomplished themselves in the medical field,” says Dr. Guttigoli. “It feels very good to know that we do some cutting-edge and advanced work at Methodist that is being recognized in other parts of the world.”
He believes S-ICDs are an important advancement in the management of sudden cardiac death since they can be implanted safely without having to touch the heart or blood vessels. He says this significantly decreases both the short and long-term risks involved with implantation of a traditional trans-venous ICD like perforation of the heart and lung, lead dislodgment, and infections that could result in endocarditis. As of early August, Dr. Guttigoli had implanted 40 S-ICDs, more than any other physician in Dallas.
“I believe any patient who qualifies for an ICD should get an S-ICD if they don't have a specific reason not to.”