MRI-friendly implantable defibrillator a life-changer

An Ontario woman who is the first in North America to receive a unique implantable defibrillator says she now feels fantastic and relieved that doctors can monitor both her heart and brain as closely as needed.

Justine Bovenkerk of Ontario is the 1st person in North America to get device

An Ontario woman who is the first in North America to receive a unique implantable defibrillator says she now feels fantastic and relieved that doctors can monitor both her heart and brain as closely as needed.

Justine Bovenkerk, a 35-year-old mother and dental assistant in Newmarket, Ont., needed a defibrillator to treat a condition that can cause her heart to both race and slow. Doctors say she also requires regular MRIs to monitor lesions in her brain.

Dr. Atul Verma was excited to find an implantable defibrillator that worked not only for his patient's heart but also her brain monitoring needs. (Courtesy Southlake)

"It puts us into a quandary," said Dr. Atul Verma, a cardiologist and cardiac electrophysiologist at Newmarket’s Southlake Regional Health Centre in Ontario who treats Bovenkerk. CTs are not as effective for monitoring and current pacemakers that are safe for MRIs only speed up the heart.

Bovenkerk needed an implantable cardioverter defibrillator, but the current metallic devices aren't compatible with the magnetic fields of an MRI. That's when Bovenkerk's medical team turned to a model that is approved for use in Europe.  Within five days, Health Canada approved the application to try it in her case as the device meets Canadian, U.S. and European regulations for reliability.

"We're excited we're able to give Justine exactly what she needed," Verma said Wednesday.

"The big difference which makes it compatible with MRI are there are some subtle engineering changes in the design of both the defibrillator and the wires that attach to the defibrillator to make them less likely to interact with the magnets."

Bovenkerk was diagnosed with myotonic dystrophy at age 24 when she experienced problems getting her hand muscles to relax. After her younger brother suffered sudden cardiac death, genetic tests showed she and her mother and siblings all had the heritable condition. She is the most affected.

In December, paramedics took Bovenkerk to Southlake after she awoke to find she was blind in her right eye and her arm was numb. The brain lesions were diagnosed during the hospitalization. 

"One minute it just feels just like pins and needles or something and then all of sudden I just have no feeling. I was like 'OK, this is not normal.'"

The minimally invasive implant procedure was performed on Dec. 24 — just in time to allow Bovenkerk to spend Christmas Day at home with her husband and six-year-old son as he wished in a letter to Santa. 

Bovenkerk recalled the night Verma told her the implant was approved. "I started to cry. I'm under the hands of the best care. It was a relief to know that when I go home, if something happens, I feel safe. I don't have to worry so much. It was an amazing feeling.

"If it had happened about two years ago, this wouldn't even be option," Verma said.

Before the implant, Bovenkerk said she was often tired from her heart rate slowing and stressed over the possibility of being rushed to hospital. Now she said she feels excellent, has returned to work and is starting to resume workouts at the gym.

Although Bovenkerk is still wearing zip-up shirts to avoid lifting her arm too high, she was able to enjoy building a snowman recently. Initially nervous to be a guinea pig, Bovenkerk is now happy to share her story with other Canadians who may need an implantable cardioverter defibrillator.

While Bovenkerk's situation is rare, Verma said older individuals often need a defibrillator and some could benefit from MRIs, such as for stokes or other neurological conditions.

He pointed to studies that suggest between 10 per cent to 25 per cent of patients who get an implantable defibrillator may need an MRI at some point in the next two decades. The hope is that MRI will pick up changes early enough when medical treatment can make a difference to the course of the illness.

The Southlake hospital has a provincial mandate to deliver advanced diagnostic and treatment services within six regional programs, including cardiac and cancer.

Verma said the Berlin-based manufacturer of Bovenkerk's implantable defibrillator confirmed it was the first import of the device to North America.