In this feature interview, we speak with Russell Greenlees, a recent graduate of the Arrhythmia Technologies Institute who is now employed as an Associate Clinical Specialist at Medtronic. In his youth, Russell was diagnosed with hypertrophic cardiomyopathy (HOCM), and after an open-heart myectomy that resulted in complete heart block, he had a biventricular ICD implanted. Russell lives in Dunedin, Florida. Here he shares his personal story.
When were you first diagnosed? Were you having cardiac symptoms at the time?
I was diagnosed at about age 11. I was attending a small Catholic middle school at the time and needed to get a physical to play on the basketball team. This was my first visit to our family doctor since switching over from my pediatrician. The doctor heard a murmur and recommended I get an echo.
I was having no symptoms at the time except maybe for some fatigue, although that was kind of the norm for me. A week later, they found I had a large septum and it was easily diagnosed as HOCM. So what was supposed to be just a routine checkup changed my life. For whatever reason, my pediatrician had never heard the murmur before.
When did you receive an ICD?
The ICD was implanted shortly after my diagnosis, so just a couple of months afterward, at age 12. My septum was so enlarged, my doctors thought that I was a good primary prevention patient. We went to Minneapolis and Boston for some second opinions as well. After the ICD was put in, I had a couple of inappropriate shocks from T wave oversensing, so the device was fine-tuned and I was fine for a while. Then, during my freshman year of high school, as I was sitting in the auditorium, I spontaneously went into ventricular fibrillation (VF). The device shocked me five times. That was the first real event I had had with my ICD, and I felt very fortunate that I had decided to go ahead and have the device implanted at such an early age, out of precaution. However, since the ICD shocked me five times, my doctors changed out the device and put in a subcutaneous Array, which I don’t think is done very often these days. An SQ Array is an extra shock lead to help cover more of the myocardium.
What were your feelings about being diagnosed at such a young age?
I look back on it now and see that there were both pluses and minuses. I didn’t really realize at the time how big of a deal it was, so I was mostly able to brush it off. However, as I look back on it now, I think I blocked a lot out — I don’t remember much of the early diagnosis or the steps that were taken. I think going through this situation definitely made me grow up a little faster and learn to deal with it. There was really no other option but to move on.
What have been some of the main adjustments in having an ICD? When did you have the open-heart myectomy?
I’ve gone through quite a few devices and have had some issues with lead dislodgements and the Riata and Fidelis leads. I also had one more spontaneous VF episode on the golf course while I was still in college, so that was the only other significant cardiac event I experienced. Everything was going okay for a while.
However, it is important to note that ventricular pacing 100 percent of the time to bypass the obstruction used to be recommended for young HOCM patients in general. The DAVID study later demonstrated that chronic ventricular pacing, especially RV atrial pacing, could cause heart failure. My doctors and I knew the risks, but we continued RV pacing, and over the years, I began to develop heart failure. When my doctors turned off the RV pacing, I had more symptoms of nonsustained ventricular tachycardia (VT) and overall arrhythmia, although fortunately I was not getting shocked very often. It then became a “catch-22” of whether to RV pace and have these increased heart failure symptoms including fatigue, or not RV pace and have a greater chance of VF and VT. At that point, we decided to do the open-heart myectomy (in October 2013).
As a result of the myectomy, I am now pacemaker dependent and have third-degree complete heart block. If I get my heart rate up a certain rate, I start to block; so when I work out, I wear a heart monitor. Being pacemaker dependent is one of the main drawbacks from having the surgery. These devices are generally made for the older population, so it’s a little more difficult to set up the right parameters for younger and more active patients.
Do you think your personal medical background played a role in your pursuing a career in the cardiovascular medical device field?
Absolutely. My first device was from Medtronic, and I have had other company’s devices over the years as well. I met a lot of the reps and clinical specialists involved in my care over the years. These were all great people who were very supportive. I always wondered what it would be like to be on the other end, and this definitely swayed me to get into the industry. A couple people who have become close friends in the industry told me about how to go about it. I then attended the Arrhythmia Technologies Institute in South Carolina.
Tell us about your experience at the Arrhythmia Technologies Institute.
It was fantastic — I could not have expected more! The whole staff is amazing. You also know what their placement rate is. If you work hard and excel there, you’re guaranteed to get a spot in the industry. It was definitely worth it.
Has your medical background helped benefit you in your work at Medtronic?
Of course. I know what it’s like to be on the other side of things, and my experience is a little different because I was so young when everything first happened. Therefore, when working with a younger patient, I have had instances in which I’ve told them how I was in their position at one point and that I know how it feels. My medical background has definitely given me a unique perspective and helps me connect with patients quite a bit.
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