Implantable Cardioverter Defibrillator – a New Cardiology Procedure took place at University Hospital Limerick. Pictured above are Dr Stephen Tuohy, Consultant Cardiologist and Joseph O’Neill from Moyasta, County Clare.
New Cardiology Procedure at University Hospital Limerick
THE Cardiology Department at University Hospital Limerick (UHL) continues to improve patient services with the successful implantation of a subcutaneous ICD (implantable cardioverter defibrillator).
In what is believed to be the first procedure of its type carried out in a public hospital in Munster, 74-year-old patient Joseph O’Neill from Moyasta, County Clare, was treated in October by Dr Stephen Tuohy and team in the cath lab in UHL.
Himself a native of County Clare, Dr Tuohy has recently taken up a post as consultant cardiologist at UL Hospitals Group. “This implant is still a relatively new technology and has particular advantages over transvenous devices in certain patients” explained Dr Tuohy.
“Essentially an implantable cardioverter defibrillator (ICD) is a small implantable battery-powered device that can deliver a shock to the heart to somebody who has a life-threatening heart rhythm such as ventricular fibrillation or ventricular tachycardia. In this way, we can restore a normal heart rhythm as and when required and the device continuously monitors the patient to look out for those potentially dangerous heart rhythms.”
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Transvenous ICDs have been used for many years. This intervention involves electrical leads being placed through a vein and into the heart. The more recently developed subcutaneous ICD technology allows for a regular heart rhythm to be restored without the need for the leads to touch the heart itself. This can reduce potential complications in the long term. It also means a simpler and less invasive procedure for patients if the device system ever needs to be removed.
“In certain cases we may recommend an ICD for a patient who is at risk of going into a rapid, life threatening heart rhythm. Most commonly we would be recommending such a device for older patients but also for younger patients with certain cardiac conditions,” said Dr Tuohy.
“Most commonly, ICDs have been transvenous but now with advent of this new technology we have the option of placing an ICD without any device actually touching the heart. This procedure is entirely subcutaneous, which means under the skin. While this option is not suitable for all patients who need an ICD, it is a preferable option in certain situations.”
“We are delighted that this procedure is now available here in UHL for patients in the Midwest and we look forward to advancing more technologies and interventions for cardiology patients in the region,” Dr Tuohy said.
Originally from Lahinch in County Clare, Dr Tuohy was appointed as consultant cardiologist in University Hospital Limerick in September 2020. He practised as a cardiologist and associate professor in Portland, Maine in the USA for two years prior to the current appointment.
Dr Tuohy completed a cardiac electrophysiology fellowship through the Cleveland Clinic Foundation in Ohio, USA, after a period of cardiac electrophysiology research at the Mater Hospital in Dublin and undergoing specialist training in medicine and cardiology with the Royal College of Physicians of Ireland.
Dr Tuohy has a medical degree, bachelor of science and master of science from NUI Galway. He also holds a doctorate in medicine from UCD and was awarded the Cormac Trust Research Fellowship Grant for his research on sudden cardiac death in Ireland.
Special interests include the management of heart rhythm disorders, the implantation and management of cardiac devices such as pacemakers and defibrillators, the management of individuals at high risk for arrhythmias, and the implantation of devices to prevent stroke in certain atrial fibrillation patients.
Implantable Cardioverter Defibrillator
Joseph O’Neill’s Story:
Joseph O’Neill, 74, from Moyasta, County Clare first got a heart attack in 2010. “It wasn’t a serious one if you can say that about a heart attack but serious enough for Shannondoc to send me by ambulance first to Ennis and then into Limerick. It was Dr Terry Hennessy who was looking after me then and it was he who recommended I get my first ICD device, the kind where the wires travel along the veins and up to the heart,” recalled Mr O’Neill.
With the transvenous ICD safely implanted, it was a new lease of life for Mr O’Neill. However his health began to suffer after a subsequent car accident.
“After the accident, I developed medical problems and I knew I had serious problems at that stage. I was able to do a bit of research myself and I spoke to my own doctor about it and I was referred in to UHL.”
Mr O’Neill recalled that he began to feel better after being put on an antibiotic but specialists in the cardiology department, including Dr Stephen Tuohy, also shared his concern about the existing device and that he should consider a subcutaneous ICD.
“That meant having to go back to the Mater Hospital in Dublin for surgery to have the older device taken out and to come back down to UHL again to have a new subcutaneous device put in. I was listening to people on the radio or in the papers talking about how they were anxious about going into hospital because of the Covid-19. The more I thought about it, the more I said to myself that people should not be afraid to get help. I want to say to the men and women out there who are thinking that way that they absolutely need to go in for their operations. Without the help I got from UHL and the Mater, I would not be alive today.”
“They way I was looked after, I would say to people to have no fear in the world of Covid. I was tested five or six times for Covid between Limerick and Dublin. People know what they are doing and they are taking all the precautions. The staff I met know people are anxious about it and they do everything they can to make you relaxed and comfortable. We could even have a joke about it. While I was in hospital I met nurses from Ireland, from India, from the Philippines, from all over the world and they were all brilliant. The medical teams, the cleaners, the caterers; I could not fault any one of them. I remember before one of my operations I asked one of the doctors ‘Will I be able to play the piano when I wake up?’.
He said: ‘Of course you will Joe.’. ‘Says I that’s great doctor because I was never able to play it before!’. That will tell you how relaxed I was in the care of these people.”
“I know that I am extremely fortunate to be alive today and I will make the best of it. It has been a long road and I am grateful to all the doctors in cardiology who have helped me along the way Dr Hennessy, Prof Kiernan and Dr Tuohy. It’s thanks to them and all the teams that I am here today.”
Cardiology at UHL:
The cardiology department at UHL is a modern facility that provides 24-hour cardiac care to patients from Limerick, Clare, North Tipperary, North Kerry and North Cork.
This includes care for patients including non-invasive and interventional procedures such as: ECG, Echocardiogram, Coronary angiography, Coronary Angioplasty, stenting, cardiac device implantation and advanced structural interventions.
It includes a 16-bed acute cardiac care unit, a step down cardiac facility and a day cardiology unit. UHL is a nationally designated 24/7 Primary Percutaneous Coronary Intervention (PPCI) centre for STEMIs.
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