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Almost 12 years ago, Sandra Lowry experienced what she thought were bouts of indigestion. But when the discomfort persisted, she went to her primary care physician, who determined she was in an abnormal heart rhythm in the upper chambers of the heart, known as atrial fibrillation (AF). Following up with a cardiologist, Lowry later learned that she had hypertrophic cardiomyopathy, an inherited condition that can result in sudden cardiac death as well as other less dangerous rhythm disturbances such as AF.
While AF, which affects over 2 million Americans annually, is itself not dangerous, it can cause a variety of symptoms that interfere with an individual’s quality of life. Of greater concern, it may lead to a stroke or heart attack. AF is treated with medications or with cardioversion –a procedure that delivers an electrical shock through the chest wall, allowing a normal heartbeat to be restored. Typically, the procedure requires anesthesia and blood thinning medication for weeks beforehand to reduce the risk of stroke.
Lowry’s search for specialized cardiac care led her to BWH Cardiac Electrophysiologist, Michael O. Sweeney, MD. Under his care, Lowry has become one of the first BWH patients to self-activate an implantable cardioverter defibrillator (ICD) for treating atrial fibrillation.
Sandra’s ICD system allows her to identify the presence/absence of atrial fibrillation by way of a “remote activator”. She then has the option of delivering a “self cardioversion” through her ICD. “I prefer to have some control over this,” said Lowry, who had the pager-sized cardioverter defibrillator implanted in 2001. The device performs the dual role of restoring a normal heart rhythm to both the upper and lower heart chambers. “Dr. Sweeney described the device as a form of life insurance,” explained Lowry. “If I feel my heart speeding up, the hand-held device allows me to check what is going on. If it confirms atrial fibrillation, I simply press a button to get my heart back on track.”
For three years, the 57-year-old reading specialist carried the remote activator with her unused. Then, in January, she sensed an arrhythmia episode coming on. The hand-held device indicated that her hunch was correct - she was in atrial fibrillation. Knowing she could deliver the cardioversion, but a bit intimidated, she called BWH arrhythmia nurse practitioner, Julie Shea, for support.
“Julie gave me the option of coming into the hospital,” said Lowry. “But she also reminded me that with the implanted defibrillator, I could do the cardioversion myself. With her coaching, I sat on a chair, held a pillow to my chest and activated the device.” Forty-five seconds later, Lowry felt her heart restored to normal rhythm.
Dr. Sweeney observed that the self-administered treatment might not be for all patients – “It takes someone with strong psychological wherewithal to take command of this type of situation," he said. But with the support of the BWH cardiovascular staff, such devices have given arrhythmia patients like Lowry an important new treatment option. Immediate self-treatment enables them to minimize unpleasant symptoms such as lightheadedness, sweating, fatigue and chest discomfort. Quick action may also help avoid the need for medication such as blood thinners. “Those who can self-administer a cardioversion streamline their care tremendously,” said Shea. “It’s terrific.” Sandra Lowry couldn’t agree more. “Now I know I can do it, and I know what to expect. It feels good to have this kind of power over my own well being,” she said.