Saving lives with a steady beat

New Brunswick Heart Centre leverages innovative technology to help patients with irregular heart rhythms

It should have been a typical morning for Emma Gallant, or at least as typical as it can be with an eight-week-old baby in the house. Her alarm clock went off and while other members of the household were scrambling to meet the day, Emma did not move.

When her husband checked on her, he discovered she was not breathing and immediately swung into action, performing CPR and telling their oldest daughter Hillary to call 911.

Emma Gallant, 32, an experienced nurse and a brand new mom to baby Ava, was in cardiac arrest. “I hadn’t had any problems with my heart my whole life. It was a big shock. No one expects that’s going to happen to them, especially when they have a new baby in the house.”

When paramedics arrived at the Gallant home, they defibrillated her twice then rushed her to the Saint John Regional Hospital. She spent a few days in intensive care before being admitted to the New Brunswick Heart Centre at the Regional for treatment of the electrical problem that had caused the dangerous arrhythmia in her heart.

“We weren’t sure why my heart went into a bad rhythm but the possibility of it happening again was there. So I ended up getting an ICD, which is kind of like a pacemaker that will shock my heart if it goes into a bad rhythm again.”

ICD is an implantable cardioverter-defibrillator, a small unit with a computer that monitors the heart rhythm and, when necessary, generates an electrical shock to restore a normal heart rate and rhythm. Ms. Gallant had hers for five years when one of the leads into her heart broke.

In the face of that, she became only one of a few hundred Canadians to be fitted at the New Brunswick Heart Centre with an advanced technology – a subcutaneous ICD or S-ICD.

Implanted under the skin, an S-ICD is different from a traditional ICD in that the leads that run from the device to the heart are implanted under the skin instead of through the veins. This allows the leads to be more easily removed and replaced.

Dr. Rob Stevenson, a cardiologist at the New Brunswick Heart Centre, says Ms. Gallant’s initial attack in 2015 was a shock, not only because she was so young but also because she was a colleague who had worked in cardiac care.

“Her case is very interesting for a number of reasons,” Dr. Stevenson says. “Number one, she is very young and has never had any heart problem. Two, she is a new mother and you’re scared to death that this is a young mother who is very sick and you’re responsible for her recovery because there’s so much at stake. And three, she is a colleague. I thought to myself, ‘God, this is Emma. What’s going on here?’ It was not immediately clear what was causing the problem.”

Dr. Stevenson says the ICD has the ability to treat hearts that beat too quickly, an arrhythmia that has a very fast, dangerous and unstable heart rhythm. The ICD, he says, can identify that and shock the heart.

“In essence, what it’s doing is interrupting sudden cardiac death,” he says. “If that fast, unstable heart rhythm were to continue, it’s possible the patient could have a complete cardiac arrest depending on whether there is someone around or how long it takes for the first responders to get there. The time between the patient going down with the cardiac arrhythmia and the time when they receive the first shock can significantly affect their outcome.”

Dr. Stevenson says there’s no way to predict an episode. He says it can happen, for example, when someone is sleeping, driving a car or out for a jog.

“We do everything we can to reduce the likelihood of these events occurring, but we can’t predict them. What the ICD does is monitor every beat. It’s with you all the time. So when this does happen, an ICD can identify this dangerous and unstable rhythm and treat you within seconds.”

While doctors and nurses worked on solutions for Ms. Gallant’s heart problem, she herself says she felt relaxed and confident at the Heart Centre, surrounded by professionals she knew and respected. “The care was amazing,” she says.

Dr. Stevenson says Ms. Gallant’s story is one of success. Baby Ava is now six years old and Emma works as a nurse in Cardiac Rehabilitation, helping other patients chart their own course to heart health.

“All we want is for people to get back to the life they knew before and be able to do the things they want to do,” says Dr. Stevenson. “That is always the goal.”

As it turns out, Emma is working in the cardiac rehabilitation program here and helping in the Heart Function Clinic. She is a cardiac nurse specialist and she has the skill set that can help patients transition back to the life they knew before. In her case, she is intimately aware of it because she has been through the process herself.

“That is what is so cool about this story: we have a nurse returning to provide cardiac care when she has actually been a patient herself," Dr. Stevenson says.

The New Brunswick Heart Centre is the province’s only tertiary cardiac care centre and provides close to a million Atlantic Canadians with the leading- edge treatments and care they need.

The centre’s specialists in clinical cardiology, interventional cardiology, cardiac surgery, electrophysiology, anesthesiology and research are constantly striving for better ways to diagnose, treat and educate patients.

Dr. Stevenson, who has been with the Heart Centre since 2008, says the centre is a testament to the power of collaboration.

“It’s a continuum of care from the moment someone is picked up at their home by emergency services, through the Emergency Department and working with those experts, then calling in cardiac services – the cardiologists, the interventional cardiologists, the electrophysiologists, and sometimes the cardiac surgeons, to do what it is we need to do.

“In Emma’s case, she was resuscitated and came to the coronary intensive care unit.” She then required complex electrophysiological (EP) diagnosis so we knew what we were dealing with. She went to the electrophysiological suite and, I must say, the Saint John Regional Hospital Foundation has been instrumental in ensuring we have state-of-the-art EP instrumentation in the suite we have here.”

The Heart Centre’s electrical specialists, Dr. Satish Toal and Dr. Samuel Wang, performed the testing and implanted the ICD devices into Ms. Gallant, first the traditional device and later the S-ICD.

Dr. Stevenson said the continuum of care also carries on in the community through family physicians, nurse practitioners as well as the cardiac rehabilitation program and the Heart Function Clinic.

“Patients have this touch point back to the hospital, back to experts, who will help them transition to life as normal,” he says. "For Ms. Gallant, being able to work once again in cardiac care is the perfect job."