A new generation of implantable defibrillator at Geisinger

Geisinger patients with dangerous cardiac arrhythmias may be eligible for a new type of implantable defibrillator that is highly effective.

Geisinger Heart and Vascular Institute in 2024 introduced the Medtronic Aurora extravascular implantable cardioverter-defibrillator (ICD). Unlike traditional devices, the new technology is implanted completely outside the heart and vascular system, which reduces potential complications down the road.

The technology has been under limited release. Geisinger is the only hospital system in the region using the Aurora EV-ICD in clinical practice.

Defibrillators are traditionally implanted through a vein under the collar bone with leads attached to the heart. While they are highly effective at stopping life-threatening arrhythmias, they carry potential complications, including infections and lead failures. 

“When a lead gets infected or breaks, we are often faced with removing these wires from the blood vessel and the heart. Although we offer this and are a referral center with excellent metrics for this, it can be a challenging and higher risk procedure,” says Geisinger electrophysiologist Dominik Beer, DO. 

The incidence of infection with this traditional type of system increases when patients have comorbidities such as kidney disease and diabetes, Dr. Beer says. Also, younger patients with a long horizon have a significant chance of dealing with a lead breakdown in their lifetime. 

The Aurora EV-ICD avoids these potential problems by keeping the entire system outside of the heart and blood vessels, Dr. Beer says. The system is implanted under the breast bone.

A pivotal clinical trial involving more than 300 patients showed excellent primary outcomes for safety and efficacy.  The success rate was 98.7 percent for terminating ventricular fibrillation, and 92.6 percent of patients had no major system or procedure-related complications at six months after implantation.

Another key outcome was that the Aurora EV-ICD had a 70 percent success rate of terminating arrhythmias with anti-tachycardia pacing. Anti-tachycardia pacing is a feature that sets the Aurora EV-ICD apart from the only other extravascular defibrillator on the market, produced by Boston Scientific. The Boston Scientific ICD, implanted over the breast bone, is unable to provide anti-tachycardia pacing.

Anti-tachycardia pacing is a pain-free method of terminating some ventricular arrhythmias that reduces the likelihood of a shock. For patients with a very fast arrhythmia, anti-tachycardia pacing can pace them out of the arrhythmia before a shock is needed, says Dr. Beer.

Another advantage of the Aurora EV-ICD is a more favorable cosmetic result, as the scar is hidden just under and to the side of the left breast.

“Cosmetic effect is much better. It’s superior to any other device. Some patients, particularly younger patients, like that,” Dr. Beer says.

Dr. Beer notes that shortcomings of this new technology include that it cannot provide pacemaker functionality like a traditional trans-venous ICD system. Patients who require pacemaker functionality are not candidates for the Aurora EV-ICD.  Secondly, the EV-ICD cannot be implanted in patients who have had open heart surgery.