| This summer Harrison Medical Center expanded its already excellent cardiac care with a new $1 million, state-of-the art electrophysiology lab, giving the medical center the capability to conduct electrophysiology (EP) studies and perform automatic implantable cardiac defibrillator (AICD) implant procedures, and eliminating the need for patients requiring these procedures to travel outside of Kitsap County.
Electrophysiology is considered “interventional” cardiac care, meaning it mitigates the need for cardiac patients to undergo invasive surgical procedures. Considered experimental for nearly two decades, electrophysiology has become increasingly common in major medical facilities. Still, specialists in electrophysiology are rare, with only around 100 graduates in the specialty each year.
The electrophysiology lab will be run by one of those specialists, cardiac electrophysiologist Dr Jignesh S. Shah, who joined Harrison’s medical staff in July after a two-year electrophysiology fellowship at New England Deaconess Hospital, the teaching hospital of Harvard University.
“I specialize in the study and treatment of the heart’s electrical system,” said Dr Shah.
Dr Shah will spend about half his time at Harrison conducting EP studies, and the other half on AICD implant procedures. Both the EP studies and the implants are designed to help correct and regulate abnormal heart rhythms, which are caused by irregularities in the way the heart’s electrical systems are working.
EP studies are diagnostic and treatment-focused. Threading a feed wire into the heart through a small hole in the patient’s leg, Dr. Shah and his team can analyze the heart’s electrical system to locate the source of abnormal electrical conduction.
“Electrophysiology is difficult,” said Mike Gray, Harrison’s assistant director of medical imaging. “They are reading very subtle abnormalities.”
Once those abnormalities are located, Dr. Shah can perform an ablation, safely cauterizing that small bit of heart tissue that is causing the heart’s electrical system to beat out of synch.
“It’s a curative procedure,” said Dr. Shah.
AICD implant procedures are similar to those performed with pacemakers. Feed wires from the AICD are inserted into the ventricle of the heart and lead into the “generator” portion of the device, which is inserted into a “pocket” between the subdermal and muscle tissue just below the patient’s collarbone.
But unlike pacemakers, which assist the heart in maintaining a constant, regular beat, AICDs function more as external defibrillators do, emitting a shock to the heart when an irregular beat is detected, bringing the heart back to a regular rhythm. AICD devices are also much larger than pacemakers, measuring about two inches long and an inch and a half wide.
“It’s a good sized device,” said Dr Shah. “But it used to be bigger.”
AICD implants do not offer a cure for patients who experience irregular heartbeats, and do not take the place of any cardiac medication the patient might be on.
“Defibrillation doesn’t stop [the irregular heartbeat,]” said Dr Shah, “It corrects it [when it happens].”
AICDs are often used when curative procedures, such as ablation, would be overly invasive, such as when the abnormality is found in the lower chambers of the heart.
Before Dr. Shah joined Harrison’s staff, around 200 patients a year were sent to Tacoma or Seattle when they required an AICD implant. Now those patients can receive the treatment they need close to home.
“We can do everything here now except for transplants and neurosurgery,” said Gray. “We’re stepping up to a whole other level of service.”. | 
