HUS Meilahti hospital area sign in Helsinki. LEHTIKUVA

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In a significant medical advancement, the HUS Heart and Lung Center in Finland has commenced the implantation of the country's first extravascular implantable cardioverter-defibrillators (EV-ICDs). This groundbreaking next-generation device represents a major step forward in the treatment of life-threatening ventricular cardiac arrhythmias.

The EV-ICD, distinct from traditional transvenous and subcutaneous ICDs, is implanted entirely outside the heart and blood vessels.

Its lead is positioned under the breastbone, close to the heart, which mitigates many late complications associated with older ICD models, such as vein blockages and blood-borne infections. When compared to subcutaneous ICDs, the EV-ICD boasts greater versatility, a smaller size, and a longer lifespan, with an expected operational duration of over ten years. It is also subject to regular monitoring through the Pacemaker Outpatient Clinic and automated remote systems.

This innovative device autonomously treats life-threatening arrhythmias by either overdrive pacing or delivering an electric shock during ventricular fibrillation. Additionally, it provides back-up pacing to maintain a sufficient heart rate during sudden heart rate pauses.

Currently, HUS is the sole Finnish hospital implanting these next-generation ICDs and accepts patients from all over Finland. To date, only a few hundred EV-ICD devices have been implanted worldwide, marking Finland's entry into this elite group as a significant milestone.

The patient selection process for EV-ICD implantation at HUS is meticulous. Annually, around 100 patients receive an ICD at the center. However, the new EV-ICDs are implanted on an as-needed basis, as they are not suitable for every patient. "Patients who need frequent pacing will receive a traditional device, and those with left ventricle contraction irregularities will get a cardiac resynchronization therapy pacemaker," explains Dr. Jarkko Karvonen, deputy chief physician in cardiology at HUS Heart and Lung Center. He further adds, "If a patient is likely to require open-heart surgery later, we will choose a device with a transvenous lead."

Dr. Karvonen expresses enthusiasm about the variety of ICD options now available. "It's wonderful that our patients are among the first to benefit from such advanced technology," he says, underscoring HUS's commitment to providing cutting-edge medical solutions.

The introduction of EV-ICDs at HUS represents a major leap in cardiac care, offering Finnish patients the latest in medical technology and reaffirming the country's position at the forefront of innovative heart treatments.

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