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Today we were the first in the Czech Republic to implant a patient with the latest type of defibrillator

The Cardiac Centre of the Na Homolce Hospital has today achieved another first in the innovative treatment of cardiological diseases.Today, in the hybrid operating room, cardiologist Prof. Petr Neužil and cardiac surgeon MUDr. Ivo Skalský successfully implanted the latest extravascular cardioverter-defibrillator (EV-ICD) as the first in the Czech Republic.

Unlike traditional implantable cardioverter-defibrillators, with this new system the doctors place the electrode under the sternum very close to the heart and do not route it through the bloodstream. This prevents potential complications such as heart perforation, blockage of blood vessels or infection. An implantable cardioverter-defibrillator is a device similar to a pacemaker that is used to treat cardiac arrhythmias and to prevent sudden cardiac death. The standard of care is a defibrillator, where wires and electrodes for stimulation are inserted under the collarbone directly into the vascular system, primarily into the right ventricle or right atrium. This is associated with a number of potential complications and also infections. 

The new extravascular implantable cardioverter-defibrillator (EV-ICD) system represents a completely new solution whereby, using a minimally invasive approach, the defibrillator is implanted under the left arm and the electrode for defibrillation (high-energy discharges to stop ventricular fibrillation) is placed under the sternum very close to the heart.

The defibrillator has a conventional size and weighs less, which is positively reflected in a doubling of its lifetime. This is estimated at 11.7 years.The placement of the electrode away from the heart and blood vessels is designed to help prevent long-term complications such as cardiac perforation, blockage of blood vessels or infection.

"The new extravascular cardioverter-defibrillator system is designed for patients who are at risk of life-threatening cardiac arrhythmias, and who have not had a previous sternotomy (chest surgery) and do not need continuous bradycardia (abnormally slow heart rate) pacing," says Prof Petr Neuzil, head of the cardiology department.

The extravascular ICD system (EV-ICD) represents a completely new concept in the field of implantable ICD systems, where the electrodes for defibrillation (high-energy discharges to stop ventricular fibrillation) are located outside the vascular system, i.e. outside the heart cavity, but at the same time the same lead contains electrodes for stimulation in addition to the defibrillation electrodes.

The latter is made possible precisely because it is inserted not under the skin but by a special introducer under the sternum so that it presses directly on the surface of the heart. The stability of this complex combined electrode is made possible by the double axis curvature.

Cardiologists at Na Homolce Hospital have been involved in the development of the latest type of defibrillator, testing the basic stimulation parameters and studying the nature of the defibrillation discharge. This system was tested on a total of 14 patients at Homolka. As of October 2023, the first implantations of the EV-ICD system are taking place in a limited number of European cardiac centres so that it can be routinely used in clinical practice. 

The first implantation of the EV-ICD took place in the Czech Republic at the Nemocnice Na Homolce Cardiac Centre on 3 November 2023 with the aim of expanding its use to other cardiac centres in the Czech Republic.