Airport security can be a nightmare for anyone, but patients with implantable cardioverter defibrillators carry an added burden. Their titanium implants may set off metal detectors, so every patient carries a card from the manufacturer explaining how the device works.
The hitch, Lauren Gerber discovered, is that not all airport security workers have command of English, and many don’t understand the concept of invisible devices that keep the heart beating smoothly.
“A few years ago we went to the Dominican Republic, and I explained that the wand cannot be used because the magnetic currents will interfere with my defibrillator, so a hand pat-down must suffice,” said the 34-year-old Deerfield resident. “They just stared at me, and said, `Step to the side and we must search for weapons with this wand.’ I pointed to my little scar near my shoulder where the defibrillator is under my skin. They said, `Oh, we understand now. Just take it out and it will be fine! We’ll give it back to you!’ “
It’s no small matter, with airport security as tight as ever, but these devices are lifesavers. Certainly Vice President Dick Cheney, by virtue of his position, doesn’t have to jump through hoops–or airport security lines–when he flies around the country on government aircraft.
But last June, Cheney had an implantable cardioverter defibrillator (ICD) put in his chest to keep his heart beating at a normal rhythm. Cheney, who has suffered four heart attacks since 1978, experienced erratic heartbeats last summer, and his cardiologists monitored his heart with a portable electrocardiogram. It showed he was at risk of developing ventricular fibrillation, which leads to sudden cardiac arrest. The only cure for these chaotic heartbeats is an internal or external electrical shock.
An ingenious combination of both a pacemaker and defibrillator, the pager-size titanium ICDs have two thin insulated wires, or leads, that are carefully threaded into the veins to the heart. If the heart rate slows down too much, the pacemaker speeds it up. If the heart rate is dangerously racing, the defibrillator slows it with a jolt back into a normal rhythm.
The National Institutes of Health reports that the risk of recurrence of sudden cardiac arrest for heart attack survivors is 18 percent in two years and 32 percent after five years. Seventy percent of these attacks happen away from a medical setting. Electrophysiologists, or cardiologists with extra training in rhythm disturbances of the heart, attempt to control the arrhythmias that cause the heart to stop beating.
“There are two main things that can go wrong with the heart. One is with the pumping function, when a heart attack occurs. The other happens when there is a malfunction with the electrical system,” said Dr. Scott Miller, an electrophysiologist at Advocate Lutheran General Hospital in Park Ridge. “If the heart muscle is not stimulated by electrical signals, it will just lie there like a piece of liver. If something disrupts the electrical system, the heart will beat too fast or too slow, totally out of sequence.”
Patients with Cheney’s symptoms, with damage from a previous heart attack and scarring of the heart tissue, make up the bulk of ICD wearers. They may be feeling fine, then suddenly experience palpitations, shortness of breath and fainting. Some have previously undetected cardiomyopathy, or genetic abnormalities in the structure of the heart. Still others have rhythm disturbances that show up later in life.
One patient of Miller’s, a 70-year-old retired physician, had two heart attacks, triple and quadruple bypass surgery and angioplasty before Miller “strongly suggested” he get an ICD.
“That was five years ago. He’s alive today and feels much more secure in his daily life,” Miller said, adding, “Now he has a life again.”
Indeed, ICDs lend a strong sense of security to patients who never knew if, or when, their hearts would simply stop beating.
“My implantable defibrillator is like having a little ER in my body!” Al Rushakoff said. The north suburban man never had a heart attack or cardiac arrest. But Rushakoff, 58, discovered eight years ago that his racing heartbeat and dizziness were traced to a hereditary condition called long QT syndrome, a disorder of electrical impulses that can cause sudden cardiac arrest. Knowing that his father and two uncles had died from heart attacks, the wary Rushakoff bought his own automated external defibrillator and carried it with him everywhere until he finally agreed to an ICD.
Now Rushakoff walks daily, swims and feels that “life has improved so much! It’s like an insurance policy. Some people get depressed because they have a foreign object in their body, but I feel so relieved!”
“People should not be afraid of this technology. If you can jumpstart a car battery, you should certainly rejoice in being able to start a heart again,” said Gerber, who was at work in 1998 when she experienced cardiac arrest. The psychologist had never suffered from dizziness or irregular heartbeats, but she was also diagnosed with long QT syndrome. After reviewing her family history of relatives who suffered fatal heart attacks, including a first cousin who died in his 20s, doctors implanted an ICD below her left collarbone under the skin.
Her defibrillator, or “D,” as she calls it, has been a lifesaver in the truest sense. Several times it has shocked her heart back to a normal rhythm with a jolt “that feels like I was hit by a middle linebacker,” Gerber said. “But if the choice is to live or not to live, there really is no choice, is there?”
The biggest restriction placed on ICD wearers is during the first six months, when they are restricted from driving.
“We want to make sure they don’t faint and lose control of the car,” Miller said. “Some patients do complain, but they forget that we put it in to prevent them from dying.”
ICD users are discouraged from playing contact sports but can go back to all other forms of exercise.
“One patient wanted to know if he could water ski again, and could he damage his ICD?” Miller said. “I told him, sure, he could damage it water skiing but only if he slammed into the dock and broke his collarbone!”
Strong magnetic fields can deactivate an ICD, and some wearers get mild shocks from magnetic fields, so MRI scans are not allowed. Doctors suggest that digital cell phones be used on the right ear rather than the left and carried in the right shirt pocket away from the device. Theft-deterrent sensors at shopping malls also can be an annoyance to ICD wearers, because they can temporarily interfere with functioning.
“I don’t lounge around near the security devices at the doors talking to my friends,” Rushakoff said.
For further information on implantable cardioverter defibrillators, visit the Web sites www.Zaplife.org, www.Medtronics.com and www.americanheart.org.
