Systolic Medical - CRT Training anh Humanitarian project

Northwest and Systolic Medical Products (in Vietnamese, Systolic is Tâm Thu) have organized the fourth CRT training and humanitarian project in cooperation with Hue Medical University Hospital and the Good Samaritan Medical and Dental Ministry.

The Vietnamese television network in Hue has reported on this project on their web site. GSMDM has a blog report (do a search for "Atiga" to jump to the relevant part of the blog). Since these are written by "laymen", there are technical details that are not accurate.

For us here at Northwest and Systolic, the project started in May 2011 when Dr Tran Thong and Mrs Phuong Dung Nguyen (Managing Director of Systolic Medical) were contacted during the Scientific Sessions of the Heart Rhythm Society by Biotronik USA about Dr Walter Atiga (Fairfax, VA) desire to help train cardiologists in Vietnam. As the distributor of Biotronik cardiac rhythm products in Vietnam we have feet on the ground and understand the needs of the cardiology community in Vietnam. We were pleasantly surprised that this was aimed at the Hue Medical University Hospital, with which we have a very good relationship and where we had held part of the 2nd CRT Training and Humanitarian project back in early 2010. We recommended that the bulk of the training and humanitarian project be focused on cardiac resynchronization therapy, a technique to help heart failure patients which is relatively new and expensive in Vietnam. This is also a procedure that Dr. Atiga has extensive experience with. While CRT procedures are performed in Hanoi and Hochiminh City (Saigon), it is relatively rare in Hue due to the poorer financial conditions of patients in central Vietnam. Thus, patients have to suffer. Wealthy patients, who can afford the procedure, have been going to Hochiminh city for treatment, depriving cardiologists in Hue from gaining the necessary experience. This is the reason we had the 2nd project in Hue 2010.

In June 2011, Biotronik USA agreed to donate 7 CRT-P systems (Stratos LV generators and leads) in support of Dr Atiga's effort. Shortly thereafter, Medtronic USA agreed to donate 5 dual chamber pacemaker systems (Sensia SEDR01). The final donation from Biotronik also included a Cylos DR-T pacemaker, which turned out to be an extremely good fit (more later). By the 2nd week of July all the devices and accessories arrived in Hue.

A good cardiologist need a good "tech" to support him. For this, Dr. Tran Thong (Northwest) has volunteered to assist on the first day, Monday July 18. Since the arrangements for this project were not finalized until June, he unfortunately had to get back to the US the next day. Systolic Medical Products has agreed to provide one of its field engineers to support Dr. Atiga for the remaining procedures. In addition to supporting Dr. Atiga during the implant, he also helped the local cardiologists program the devices.

Dr Atiga was also supported by a number of student volunteers from GSMDM, who are mostly (?) of Vietnamese descent. They provided translation services with the patients and help chase down surgical supplies.

Professor Huynh Van Minh, the chair of internal medicine at the Hue Medical University, for his part, has to find the patients. With his extensive network of former students throughout central Vietnam, he came up with a total of 14 patients, 7 of whom needed CRT, the rest are various patients who needed pacemakers and one patient who needs a replacement defibrillator (ICD) for the one that we donated last year.

To the list were added a patient from Saigon that was referred by Dr Vien Doan (read about her in the GSMDM blog) and another referred by Systolic Medical as an indigent patient who has a persistent swelling problem and needed to have her pacemaker replaced.

So, to the list of 13 devices, Northwest offered three (3) 2nd hand devices: 2 dual chamber pacemakers and 1 ICD. Northwest has been collecting used cardiac rhythm devices (pacemakers and defibrillators) from US funeral homes since 1997. From 1997 till about 2001, the majority of the pacemakers implanted in Vietnam were these recycled pacemakers that were given free of charge to indigent patients. In total over 500 devices were given free of charge to poor cardiac patients in Vietnam since the inception of the program in 1997.

Since a couple of the CRT patients had atrial fibrillation and did not need any atrial lead, the available leads were sufficient to support all 16 patients and they were all used up.

The team before the first implant.

team

The team at a later implant

Over the course of the week of July 18-22, 2011, Dr Atiga helped trained the cardiologists in Hue. He did some of the first implants, and then stepped back and just supervised the local cardiologists. Professor Minh concluding remarks about the training session was that it was a dream come true.

The patients came from various provinces and towns (see map)

2 from Quang Binh
2 from Quang Tri
7 from Thua Thien- Hue
1 from Daklak
1 from Binh Duong
1 from Saigon.

It was fortunate that among the devices that Biotronik USA donated was a Cylos DR-T pacemaker. This pacemaker was ideal for the patient with obstructive hypertrophic cardiomyopathy that was referred by Dr Vien Doan, the GSMDM group leader, since it offers negative AV hysteresis.
The patient with the swelling was diagnosed with a severe venous block around the lead entry point. Since the leads were implanted 10 years ago, attempts to unblock were unsuccessful. Her pacemaker was replaced and she was put on permanent diuretics.

On Thursday July 21, 2011, Professor Minh organized a small workshop to allow Dr. Atiga an opportunity to lecture on heart failure, patient evaluation with ECG, CRT indications, implantation techniques. There was additional lecturers from the University. About 20 cardiologists from various provinces attended the workshop.

Some of the workshop participants

Overall we believe this has been a very rewarding experience for Dr Atiga, and the cardiology team in Hue.
We believe the GSMDM student volunteers who helped Dr. Atiga, also got an appreciation of the difficulties of practicing medicine in an underdeveloped country and hope that they will come back and help further in the future.

We would like to take this opportunity to express our thanks to Biotronik USA and Medtronic USA for their generous equipment contributions.

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Aug 3, 2011 update. Đức, the Systolic Field Engineer, reported that in one case on Wednesday, Dr Atiga had bad luck with implanting the left ventricular lead in a patient. After 3 unsuccessful hours, he decided to give the lead cardiologist a turn. He was successful in fixating the LV lead. One has to recognize that this is a difficult case and luck has a lot to do with success. The threshold was not ideal, but given the difficulties, acceptable. The Vietnamese team was very proud of this case. And kudos should be given to Dr Atiga, the teacher!

Since almost all our webpages at this site are in Vietnamese, we would like to summarize below the 3 previous training and humanitarian projects

From Dec 1 through 3, 2008, Dr Bui (California) led the cardiologists at Nhan Dan 115 and Cho Ray hospitals, both in Saigon, through 7 implants of CRT-D and CRT-P devices. All the devices used were 2nd hand devices collected by Northwest from funeral homes in the US. Patients paid for the leads according to their financial capability, the rest being paid for by Systolic Medical.

From March 8 through the 19, 2010, Dr. Bui led cardiologists at Hue University hospital, Hue, and Heart Institute of HCM City, Nhan Dan 115 and Cho Ray hospitals in Saigon through the implant of 12 CRT devices. 9 of the devices were donated by Medtronic and St Jude Medical, 3 of the devices were 2nd hand devices collected by Northwest. In addition to these CRT devices, Northwest provided 3 recycled ICDs to the University hospital in Hue, and Thong Nhat and Tam Duc hospitals in Saigon. In addition to the leads provided as part of the donated systems by Medtronic and St Jude, the patients paid for additional leads according to their financial capability and Systolic Medical paid for the rest.

From October 4 through 7, 2010, Dr. Leitch (Australia) led cardiologists from the Heart Institute of HCM City, Saigon, and the National Heart Institute at Bach Mai hospital, Hanoi, through 4 CRT implants. The devices were provided by Biotronik and Systolic Medical. The patients paid for the leads, with Systolic Medical helping patients in difficult financial conditions. Dr Leitch also led a training on atrial fibrillation ablation at the National Heart Institute.

CRT Training and Humanitarian project IV

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