Participants: Dr. James Marcum (Host), David Wendt
Series Code: BRX
Program Code: BRX00014B
00:01 Welcome back to Bible Rx, I'm glad you have taken time
00:04 out of your busy schedule to learn something about your
00:07 bodies and the health world we live in.
00:09 We are so fortunate today to have Dr. David Wendt and
00:12 Electrophysiologist with the Chattanooga Heart Institute
00:15 with us and I know firsthand how valuable he has been to
00:18 my patients whether it be implanting a pacemaker or a
00:21 defibrillator, or just seeing them through
00:23 a tough situation.
00:24 The day before break we were talking about the economics
00:27 of whether we are going to be able to afford this.
00:29 I agree I don't think there is any good answer to some of
00:32 these things and I think it's going to be time and prudent
00:35 decision makers they're going to move us through this.
00:37 One thing we want everyone to do is to be educated about
00:40 what is out there and to understand what decisions they
00:43 have and we are answering peoples questions.
00:45 The next one is very fascinat- ing, this person is actually
00:49 not that old, 59 years old and has had a couple bypass
00:52 surgeries and he has recently been told by his cardiologist:
00:54 His ejection fraction or the strength of the heart is
00:57 about 28%, he doesn't feel good:
01:05 the cardiologist didn't talk to him very long and I don't
01:08 know if I should get one or not.
01:09 - right. - he's wanting a little extra guidance on this
01:12 issue of whether he should have a defibrillator.
01:14 He doesn't feel bad.
01:16 And you know these are patients that you see all the time
01:19 too, and before I get into the answer I just want to
01:23 respond, medicine is so complicated today and all of us
01:28 rely heavily on our colleagues.
01:30 While I might be an Electrophysiologist I rely on
01:34 the folks who do imaging, rely on everybody to take care of
01:39 these patients and I have a little sphere, but without
01:43 our collegiality or our interactions we can't take care
01:47 of everybody the way they need to be cared for.
01:48 Let me go back to the patient, so the ejection fraction
01:51 is a number that we use commonly.
01:53 It means that every time the heart squeezes it ejects out
01:57 a certain amount of blood and saves the rest to re-prime
02:00 the pump if you will and that normal number is 55%.
02:03 And a longtime ago, well years ago now people did a number
02:07 of studies and found that if that number was less than
02:10 30 or 35 there was a much higher risk of something called
02:14 sudden cardiac death.
02:15 The story of the development of this device is absolutely
02:19 fascinating, there was a Jewish physician, Dr. Merosky
02:23 who was in school in Israel, and his beloved professor
02:27 had a heart attack and they were sitting at the table one
02:30 day and he passed out at had this thing called ventricular
02:34 tachycardia and Merosky became very sad and said to his
02:38 wife this is awful and she didn't understand.
02:41 He said well he's going to have this again
02:43 and he will die.
02:44 There must be something we can do.
02:45 So he on his own, went basically to a small room in a lab,
02:50 and again just like Robocken developed this device and
02:54 he came to the United States and went to a number of
02:57 medical schools and finally Hopkins said will give
02:59 you a closet across the street in the basement,
03:01 leave us alone and we won't talk to you.
03:04 When he had the device completed he went to the
03:06 companies and they said we don't believe this so
03:09 we are not going to do it.
03:10 He went to the national meetings, put a device in
03:13 a dog that he had, the dog fibrillated and the device
03:16 delivered a shock and the dog got up and walked off
03:19 stage and everybody realized at that point
03:22 we had something that really can make a difference.
03:25 Today we see patients in this category, instead of being sad,
03:30 we can say okay these are the options and we have an
03:33 opportunity to prevent this episode of sudden death
03:36 and keep you safe for your family.
03:39 And 59 is not that old anymore, and the older I get the
03:42 younger it seems of course.
03:43 The devices have come through a number of generations.
03:47 This is a mid-level generation, it used to be about
03:51 this big and they got put in the bellies.
03:53 Now they are there signs today and actually like the
03:57 pacemaker they going to the skin up in this area and
04:00 are implanted very simply put a couple of leads.
04:04 So what I do when I talk to patients who have a need
04:08 for these devices, is I will say look, these are the
04:12 statistics, this is where your heart ejection fraction is
04:15 and the likelihood of you having an episode of sudden
04:18 death is much higher than the average individual.
04:21 This is going to keep you safe, it is not going to change
04:24 your life in any way except if you go through the airport,
04:27 you will have to have the hand checked probably.
04:31 The batteries last five to seven years and then
04:34 we go through with the device does.
04:36 It's like having an EMT in your body always watching.
04:39 So the heart goes into a life- threatening rhythm it detects
04:43 it, delivers therapy, pacing or shock and you wake up
04:49 and you are fine usually.
04:51 There is a lot more to it than that, but that is
04:54 a small sketch of it.
04:55 Getting back to her question, would you recommend,
04:57 this is a person that hasn't felt bad since his bypass.
05:00 His ejection fraction is below that threshold.
05:03 This doctor says listen we should have it but he doesn't
05:06 feel bad, what would you say.
05:08 He probably needs it, this is an individual who
05:11 you recommend getting one of these devices.
05:14 So he's not really going to die from his heart attack or
05:17 his heart failure, he's going to die from this dangerous
05:19 heart rhythm? - potentially, now he may die from other
05:22 things too, but we know that his risk is serious and we
05:25 know that this is the thing that takes relatively young
05:28 people away from their families after they have had bypass
05:32 surgery or had had a heart attack and we can prevent that.
05:35 There's been some well done studies and it's proven
05:38 scientifically, so many of the things we see out there
05:41 on the medium and that is why we have this type media is because
05:45 want to give a balance and let them know the truth.
05:48 Some of these people make claims that it will cure this
05:51 or this herb and that but there is really no evidence,
05:54 but the defibrillators are very strong evidence-based
05:57 medicine isn't it? - yes it is.
05:58 It is not for everybody, I certainly have people who are
06:01 anxious about having these in.
06:03 They are anxious about getting shocks, they are in their
06:07 mid-80s, I've lived a good life, I feel fine if I go home
06:12 tomorrow and I die and I am with the Lord, I've made my
06:16 peace with that, I really don't want to go through this other
06:20 procedure, and that is fine.
06:21 I think our job is to present the data and to get a sense
06:25 of where that individual is in their life and what their
06:28 needs are, what their family's needs are.
06:30 I think that it's very important and I can't tell you how
06:33 many people I have talked to that said no, I am really happy
06:35 with my life, I've reached this point and I just don't really
06:38 want to have that happen anymore.
06:40 And that's perfect, but you offer them that and I think
06:42 that is part of good medicine.
06:44 Sometimes even ask well what would you do?
06:46 That is what it really becomes hard.
06:49 Right that's always a hard one.
06:50 I don't know what I would do but with these medical
06:53 problems, sometimes I think this could go either way.
06:56 An interesting story I had just last week, I had a gentleman
07:00 that had a defibrillator on and he was actually
07:02 dying from another malignancy sarcoma and we turned off
07:06 his defibrillator and his son was in the room.
07:09 He says listen this defibrillator has defibrillated
07:11 my dad 3 times over 8 years so I have had these great 8
07:15 years with him, can I have one?
07:17 You know he asked for one, I said I don't think we're
07:21 putting them in anybody that has completely healthy hearts
07:24 those hearts don't actually see a benefit.
07:26 You're exactly right and I get these stories too where
07:30 people it has gone off 2, 3 or four times and has given
07:33 them an extra eight to 10 years with their family.
07:35 They watched a grandchild graduate from high school.
07:39 That is worth the effort to go forward and say what
07:43 can we do to keep these folks going.
07:46 Well sometimes you know that extra time they have,
07:48 they can make decisions and do things with their life
07:51 that if you didn't have an opportunity they might not
07:54 be able to accomplish certain things.
07:56 Several people have got these devices and they really
07:59 have had a change of heart and realize that their time
08:02 might be short and made decisions and learn how to love
08:05 better and take care of their families better and then
08:08 you say that this on a eternal scale was very worth it.
08:11 Absolutely, I mean if a grandfather can repair a
08:15 relationship with his son or daughter, or be a part of
08:19 a grandchild's life, that benefit has innumerable
08:22 repercussions that we can't even fathom.
08:25 As a society we can't put a monetary value on that.
08:29 I know that those discussions will be coming up but
08:33 you just can't put a value on what that means to a family,
08:36 or to even make your life right and some people get
08:40 that extra chance to do that.
08:42 That is a miracle even though it is science,
08:44 it is a miracle.
08:45 Well let's move on to our next question, this is
08:47 actually from a 24-year-old.
08:49 He said I am 24 years old and I have a condition called
08:54 SVT, I tried one medication and it makes me tired all the
08:59 time, my doctor asked me to see an Electrophysiologist
09:04 and consider a procedure called ablation.
09:07 I'm not really familiar with that could you fill me in?
09:10 So she's asking about an ablation, I guess she wants
09:14 a recommendation whether this is something
09:16 she should even consider.
09:17 Oblations are a whole arena of electrophysiology that
09:23 started out probably 20 years ago or so.
09:25 There was a condition called WPW as you know with Parkinson White
09:28 Dr. White was a cardiologist for President Eisenhower,
09:32 they found there was a little extra circuit in the heart.
09:35 Instead of the impulse going down to the bottom of the heart
09:39 normally it will click on to that circuit and start
09:42 racing away with itself.
09:43 For many years there was nothing we could do.
09:46 In the 1970s and 80s at Duke we would actually do open-
09:49 heart surgery where we would put a probe on our finger,
09:52 open the heart up like an ohm meter track where the
09:56 circuits were and cut it with a knife.
09:59 That's success rate was only about 80%.
10:01 So as time went on we were able, not we the people were
10:06 able to develop catheter like a microwave burn
10:09 just specifically to that area.
10:11 A fellow named Sonny Jackman in Oklahoma was the first
10:15 to really show that this could have a curative benefit.
10:18 Now you can go in through a groin, a vein in the leg
10:22 with a small catheter up to the heart, localize that
10:25 circuit and turn on that energy and it's gone.
10:28 It has been a revolution for people like this young lady.
10:32 Many times we see this in younger folks and boy,
10:37 I don't know, your kids are that old but young
10:41 adults, be they 15 to 28 are not
10:44 the most compliant with medicine.
10:47 They have things going on in their lives that are grabbing
10:50 your attention every moment of the day and they are trying
10:53 to live and do not want to be tied down taking medicine.
10:57 So the ablation offers a way to cure this problem and get
11:01 them off medicine basically, and there are a number of
11:04 these iterations out there.
11:06 Is this a safe procedure, would be safer?
11:08 Yeah in our hands it has been very safe, certainly early
11:12 one in any technology there is a learning curve and there
11:16 are complications but tens of thousands if not hundreds
11:19 of thousands of these have been done worldwide.
11:21 The risk is certainly less than a fraction of a percent.
11:26 It sounds like the risk of rhythm its self, passing out
11:29 and hurting yourself or in a car would be even greater
11:33 than the risk of the procedure.
11:34 Not only the physical risk, but the psychological risk.
11:36 Here is a young woman who's going out with her friends
11:39 to a football game and suddenly her heart starts and she
11:42 has to run home and there are a number of issues there
11:46 potentially need to be addressed
11:48 You won't have to take that lifelong medication with it's
11:51 side effects, and sometimes these medicines don't even
11:54 work. - that's right and they are always two edged
11:57 sword's as you know.
11:59 That is very interesting, so I guess the answer to that
12:02 one is we would probably say it is something I would
12:06 definitely consider to get an ablation and right now we
12:09 are ablating all different types of rhythms.
12:11 That was a great explanation and I got a good feel for
12:14 it, I didn't know they used an ohm meter and used a scalpel.
12:18 Basically yes, we are basically electrician so.
12:19 We are about out of time here today on Bible Rx so we want
12:24 to thank you for joining us.
12:25 Again we want to give you a chance to be a part of this
12:28 ministry, you can be a part of his ministry by sending us
12:31 your questions, your comments and we can be reached at
12:35 Heart Wise ministries P.O. Box 8 Ooltewah, TN 37363
12:39 or on our website: heartwiseministries. org
12:42 As we close I want everyone to think of our motto this year
12:46 At the heart of health is love, so no matter what you might
12:49 be going through, search for that balance and remember
12:51 that love is of course a healing treatment we could
12:54 almost prescribe everyday.
12:56 So if you don't have love in your life we want to invite
12:59 you to try find that somewhere.
13:00 Thank you for joining.