In Practice: Implanting Oregon’s first subcutaneous defibrillator

brancatoinpractice

Scott C. Brancato, M.D.

Clinical cardiac electrophysiologist, Providence St. Vincent Heart Clinic, Heart Rhythm Consultants

Past lives
Medical degree, Georgetown University School of Medicine; internal medicine internship, residency and cardiology fellowship, Alpert Medical School of Brown University; electrophysiology fellowship, Brigham and Women’s Hospital, Harvard Medical School. Cardiology consultant at a teaching hospital in Kenya; chemical engineer before medical school

Distinctions
Lectured on atrial fibrillation ablation at Heart Rhythm’s 34th Annual Scientific Sessions, 2013; presented abstracts on arrhythmias at regional and national conferences, published articles and book chapters in cardiology

You were the part of the first team in Oregon to implant the S-ICD (subcutaneous implantable cardioverter defibrillator). What’s novel about this device?
This is the first implantable defibrillator that does not require leads to be placed in the venous system and heart. The device, which is about the size of a deck of playing cards, is placed under the skin just below the armpit. The lead travels under the skin across the chest and up toward the neck.

This is a huge advantage for several reasons. Traditional ICDs require puncturing the vein leading to the heart and screwing the wires into the heart muscle itself. If leads in the venous system and heart get infected, they may need to be removed. This can be risky since they can adhere to the walls of the vein or the heart itself. The S-ICD system avoids these potential complications.

How effective is this compared to traditional implants?
A recent prospective study of more than 300 patients found the S-ICD was 100 percent successful for resuscitating patients in whom life-threatening arrhythmias were induced at the time of implant. There has been no direct comparison to traditional devices yet.

Which patients are most likely to benefit from the S-ICD?
The indications for the S-ICD are the same as for traditional ICDs – that is, patients who are at risk for sudden cardiac death from a cardiomyopathy or genetic condition, for example, or those who have experienced cardiac arrest from ventricular tachycardia or ventricular fibrillation. However the S-ICD may be particularly beneficial for young patients, patients who are at a high risk for infection or patients who may have vascular access issues.

On whom should it not be used?
The S-ICD cannot pace the heart, so it shouldn't be used in patients who need pacing for bradyarrhythmias or to interrupt tachyarrhythmias.

Where did you grow up?
I grew up in the Maryland suburbs outside of Washington, D.C. My parents worked for the government – my mother was an attorney at Walter Reed National Military Medical Center and my father was a civil servant for the federal departments of energy and transportation. My younger sister is a clinical psychologist in Washington, D.C.

What drew you to Portland and to Providence two years ago?
My wife was born and raised in Portland. I’ve loved it here since I first visited, so when we were both finishing medical training we started looking at jobs in the area. The electrophysiology program at Providence St. Vincent Medical Center had an excellent reputation, and I contacted the director, Dr. Dan Oseran (now medical director for Providence Heart and Vascular Institute and my boss), about a possible position. As luck would have it one opened up just as I was finishing training. I was invited for an interview and found I really connected with the people here, especially my partners, who have been great mentors.

You run marathons and once cycled from Portland to Seattle. What’s your guilty pleasure?
I’ve been hooked on some treat TV series recently. The latest were “True Detective” and “House of Cards.”