LifeVest proves its worth for a Bucks County man
STUART LEE FRIEDMAN
The voice was the first thing Thomas Richey heard when he regained consciousness on his bathroom floor.
“Treatment has been given. Call your doctor.”
That voice was an electronic message broadcast from a small white vest made by Zoll Medical Corporation. The vest was a cardioversion device.
Richey’s story began one week earlier when he checked himself into St. Mary Medical Center. He had been struggling with climbing stairs for a few days and was not feeling well. His doctor focused on his gall bladder, and the 65-year-old Richey felt it could wait until after a trip to Ocean City, Md., to play golf.
But while he was there, he was unable to play. He drove himself to St. Mary that Monday, Nov. 2, and was immediately triaged to Dr. Alexander J. Koppel, a cardiologist. Koppel diagnosed a heart attack, and within two hours of his admission to the hospital, Richey had a stent installed.
Within 48 hours of that procedure, however, Richey’s heart twice deteriorated into a life-threatening arrhythmia called ventricular tachycardia, or v-tach. Normal heart rhythm is guided by a pacemaker in the wall of the right atrium called the sinus node.
The electrical signal normally travels down to the lower chambers of the heart – the ventricles. In v-tach, however, that pace-making signal fails to orchestrate the highly sophisticated choreography of the heart chambers, and a pacemaking signal then emanates from the ventricles upward, resulting in a fast, ineffectual beat.
Richey was lucky, however. Those v-tach episodes occurred in the hospital where cardioversion paddles were available to deliver a shock that effectively rebooted his heart into a normal sinus rhythm.
After almost a week in the hospital with no further episodes, Richey was finally cleared to go home but was ordered to wear the Zoll LifeVest. Just three days later he went into a third episode of v-tach, passed out, and the next thing he remembered was hearing the LifeVest.
Koppel explained that the vest is a wearable defibrillator that is an alternative to a surgically implantable cardioverter defibrillator (ICD). Heart muscle weakened by a heart attack can sometimes strengthen, precluding the need for such a permanent device as an ICD. The vest is designed to cover that interim period of cardiac muscle convalescence.
The vest can – and should – be worn at all times except when showering or bathing, during which time the patient is encourage to have a caretaker or loved one monitor that period of vulnerability. Koppel described it as essentially a numbers game, saying that most who wear the vest never see it activate.
“Those that do need it, hopefully it is not in that 15- to 20-minute period they were taking a shower. That would be really, really bad luck.”
Both the wearable and implantable cardioverter devices are programmed to recognize life-threatening rhythms.
And although extremely rare, they can fire incorrectly, misidentifying a more benign abnormal rhythm or being confused by extraneous interfering electrical activity. The vest has a safety feature for that, however. It emits a noise to warn the patient of an impending shock, which the patient can – at the push of a button – prevent.
The treatment sequence begins with a 5-second vibration alert followed by a series of two tone sirens and a recorded voice warning of an impending shock treatment. A blue gel is released at the electrodes within the vest, and the shock is delivered with a voice instructing bystanders to not touch the patient or interfere with the treatment.
In general, Koppel said that if a patient is alert enough to preclude the shock, he should. The vest is a well-established therapy according to Koppel, but he feels it is underutilized. “There are studies under way that I believe will prove the efficacy of this, but it is really at this time not 100 percent established therapy.”
The Zoll LifeVest was developed by Dr. M. Stephen Heilman (who also created the ICD) and has a proven track record of success. The LifeVest was FDA-approved in 2001. Koppel says that most cardiologists use it as an established standard of care, and that a majority of cardiologists he knows in Bucks County share his approach.
Richey’s case is a good example of a situation in which the LifeVest is applicable, according to Koppel. “These life-threatening rhythms can happen a day after the heart attack, a week after the heart attack or years after the heart attack. But his was pretty quick,” Koppel said.
Koppel urges those who have had cardiac muscle damage to ask their cardiologists about the LifeVest as a temporary measure before a decision can be made about an ICD.
After Richey’s device activated, his wife rushed him back to the hospital. Richey went into another episode of v-tach the following morning. That formed the basis of Koppel’s decision to implant a permanent ICD.
“I would have been dead if this technology had not been there,” Richey said. He added that only 3 percent of the LifeVests being worn actually are activated.
“I happened to be in the lucky three percent,” he said.