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[August 20, 2008]

SUNY Downstate is First in City to Implant New Cardiac Device:
New Defibrillator is Smallest, Thinnest

The cardiac team at SUNY Downstate Medical Center recently performed the first implantation in New York City of the world’s smallest, thinnest defibrillator device. This new device, called the Cognis™ Cardiac resynchronization therapy defibrillator (CRT-D), received approval by the US Food and Drug Administration (FDA) in May and was released for use on August 4. 
Created by Boston Scientific, the device is 9.9 mm thin – less than ¾’s of an inch wide – and  offers improved safety design, enhanced diagnostics, flexible programming options, and increased battery life for patients experiencing heart failure or have conditions caused by irregular heart beats, including cardiac arrhythmias, ventricular fibrillation or ventricular tachycardia. Because of its small size, the device also potentially offers improved therapies for pediatric patients with these conditions.  
Ventricular fibrillation may be felt as an occasional heart flutter.  “In some patients, a flutter will go away by itself, in others, the condition left untreated can lead to sudden death,” said Dr. Adam Budzikowski, a cardiologist who specializes in the electrical currents within the body that control the heart.
Patients with heart failure have problems keeping the left and right sides of their heart beating in synch. Implantable defibrillators detect irregular heart rhythms and deliver small, therapeutic electric shocks to restore normal rhythm. The Cognis CRT-D device paces both sides of the heart to restore synchrony and help the heart pump more efficiently.  It also gives physicians better options for stimulating the left side of the heart to restore a normal beat after the device is implanted.
“Because of its smaller size, the Cognis CRT-D is a better cosmetic option for patients,” said Dr. Budzikowski. “It also gives physicians more options, by allowing physicians to access up to six pacing vectors for the left ventricular lead, compared to other devices on the market that offer only three or four. This makes this a better option for patients who need cardiac resynchronization.”  
The Cognis CRT-D’s small size and six pacing vectors also mean that patients who might otherwise have to have an open heart procedure to have a life-saving defibrillator implanted can now have the device inserted through a small incision in the chest, with less scarring and faster recovery time.
“The COGNIS CRT-D offers us a new platform to treat heart failure and sudden cardiac death,” adds Dr. John Kassotis, director of Clinical Cardiac Electrophysiology at SUNY Downstate.  “We expect it will help us tailor individualized pacing therapies for patients, especially heart failure patients who have frequent atrial arrhythmias
That was the case for the patient, a 54-year-old woman with severe heart and lung disease, whose illness was so severe that she had to sleep sitting up at night. Her cardiac disease created such shortness of breath that she wasn’t able to lie flat.
Dr. Budzikowski led the implantation surgery.  The patient was ready to be released from the hospital by mid-day on Wednesday. 
“This was the best – and possibly only option for this patient,” said Dr. Budzikowski.  “Her quality of life will definitely improve.”
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SUNY Downstate Medical Center is the only academic medical center and college of medicine in Brooklyn, Queens, and Staten Island, providing comprehensive patient care, health education, research, and community outreach services.  Its University Hospital of Brooklyn offers 24-hour emergency interventional cardiology backed by cardiothoracic surgery, a state-of-the-art electrophysiology laboratory, and one of the best performing high-volume cardiac cath labs in the state. Other specialty services include the only transplant program in the three boroughs and robotic surgery for prostate cancer.