When I learned that our Yankees manager Aaron Boone would be undergoing a pacemaker implant I immediately thought of Ex-Yankees Batboy Shawn DeRosa who spent several years as an implantable pacemaker defibrillator specialist in south Florida. I wanted to hear directly from Shawn on how Aaron would do with the procedure, what to expect and what to be aware of in regard to how Aaron would recover and be able to get back to the Yankees dugout as our leader ASAP. The following detailed letter below was sent back to me from Shawn DeRosa on what the patients have to deal with under going pacemaker implantation.
After being hired directly by Mr. Steinbrenner as a Yankees batboy I had a successful time in the implantable pacemaker, defibrillator, heart valve, surgical cardiac ablation industry. My plans were to go with the Yankees 100 percent as I left college 1 month early achieving all my college credits early and I was going right to Tampa to get to work. I had even met with Mr. Steinbrenner in NY and he still was open to giving me new opportunities and had me meet with Jack Lawn. The only reason I ever left the Yankees after graduating from Hanover College, Hanover, Indiana was the excitement of working closely with cardiologists, cardiovascular surgeons, electrophysiologists and patients receiving care in the implantable pacemaker defibrillator industry and being a colleague helping surgically implant, test & program these highly engineered devices and interrogating and extracting data from the devices and sharing clinical recommendations and findings directly with the doctors to help improve patient quality of life and improve patient outcomes. If it wasn’t for the pacemaker industry I’d probably still be in Yankee pinstripes. I miss my time with the Yankees every day and I am grateful for the warmth and hospitality Ms. Jennifer Swindal has given to me welcoming me back to the Yankees over the last several years and supporting the Lauren’s Kids child abuse charity in Florida and the Bronx.
Getting back to pacemakers. Luck would have it that I had the opportunity to work very closely every day with Dr. Manuel Sivina at Mt. Sinai hospital in Miami Beach who was the surgeon who installed both of Joe DiMaggio’s pacemakers at Mt. Sinai hospital in Miami Beach. Dr. Sivina and I probably completed over 300-400 hundred surgical implantable pacemaker defibrillator cases together at Mt. Sinai.
Aaron Boone is going to do great with his new pacemaker. He is going to have a normal wound bandage over his surgical pocket site which is like a little skin pocket on the top of his chest. He will have a little soreness, nothing abnormal. They will probably tell him not to get the surgical incision site wet for a few days and then when it gets wet to let the bandage naturally fall off. The only issues early on are to not dislodge the leads (pacemaker wires that have been placed down thru his cephallic and or subclavian veins leading into the superior vena cava along the right side of his heart into his right atrium and right ventricle. The doctors suture down the leads to his tissue and muscles with suture sleeves however you want to be extra careful not to overstretch your arms or lift heavy objects or throw with force as you could dislodge those leads and have to have a surgery to put the wires back in place. Since Aaron doesn’t need to throw batting practice or hit fungo grounders he should be fine returning back to the field and dugout immediately to coach the team. Most likely the physicians gave him a choice as to what side he wanted the pacemaker implanted and I recall Aaron throwing with his right hand so most likely I think Aaron probably chose to have the pacemaker implanted from the left side so that it would not be in his way when he is throwing a baseball. Aaron most likely can go right back to work and just not do anything strenuous with moving his upper body and lifting or throwing because as I said you do not want to dislodge the electrodes wires (known as pacing leads) inside the heart. We commonly suggested 2-3 months before any strenuous activity with your upper body to give the leads enough time to develop fibrotic scar tissue at the tips and around the leads to secure the in the heart. Another activity he should be careful with is showering; Aaron shouldn’t reach to much when taking a shower so the clubhouse staff Rob and Lou Cucuzza should have some nice long back, leg, feet shower brushes placed in Aaron’s stadium home clubhouse shower and on the road in Aaron’s hotel showers, at his home residence and at all the visitors clubhouse manager office showers for Aaron so he does not have to to reach far with his arms when showering including washing his back and feet etc…
He is most likely going to feel significantly better since it sounds he was feeling sluggish and easily winded. On the technical side of things, these electronic devices hermetically sealed in titanium cans have advanced microprocessors with algorithms and diagnostics that measure every heart beat and provide analytics to the electrophysiologists and cardiologists as to how Aaron’s heart is performing, responding and utilizing the pacemaker every heartbeat including intracardiac electrograms that at stored automatically to give the doctors immediate notification if Aaron is having any atrial and or ventricular arrhythmias.
Further, with pacemakers and just a slow heart rate with no AV atrial ventricular node dysfunction and or heart block and just Sinus Node dysfunction and or Sick Sick Syndrome; Aaron would want to allow his pacemaker to allow full intrinsic AV node conduction down to his ventricles without the pacemaker having to fire and pace his right ventricle unless completely necessary as a result of any type of AV node heart block. The more he can benefit from his normal ventricular contractions versus the right ventricular electrode pacing and contracting his heart the better his long term health as right ventricular pacing is asynchronous and provides an artificial LBBB left bundle branch block since physiologically the left ventricle always contracts before the right ventricle. Sometimes they even place 2 electrodes in both the Right ventricle and Coronary Sinus to pace both of the ventricles almost simultaneous because it is more synchronous and physiologic. Besides programming a long PR interval (AV pacing intervals); these pacemaker devices have algorithms to minimize unnecessary right ventricular pacing and allow the pacemaker to function like a single lead right atrial pacing device with automatic backup ventricle pacing only if completely necessary for intermittent AV node heart block of any kind. Also I read Aaron has felt sluggish and exhausted which lead me to believe he may be possibly chronotropically incompetent and his heart rate is not rising appropriately for his given level of exercise and effort. These pacemakers come with sensors, some with minute ventilations sensors and others with accelerometers and some with dual sensors. I believe they are using accelerometer sensors in some of the baseball data gathering with swinging a bat. So you want to make sure he has a proper rate response activity sensor programmed with the rapid response Aaron prefers to elevate his heart rate with an upper maximum heart rate limit that can be programmed that he and his doctors feel is appropriate and the device will pace his atrium at higher beats per minute (bpm) and if his has good intrinsic atrial ventricular node conduction the pacing of the atrium will always conduct naturally down thru the AV node to the ventricles. These pacemaker devices have several diagnostic features to store intracardiac electrograms for arrhythmias and other diagnostic heart rate histograms and arrhythmia data. The pacemaker devices now also allow the patient to download data over the internet to the doctors offices for review if the patient does not feel great. I’m sure Aaron will keep a remote monitoring device at his home and Steve Donohue the Yankees Sports Medicine director will want to keep those remote assistant portals in the clubhouse and take an additional remote assistant portal on the road. With regard to Aaron’s pacemaker programming; the main thing is you do not want to pace his right ventricle unnecessarily if he has good intrinsic AV node conduction as the data clearly shares long term chronic asynchronous right ventricle pacing may lead to LV dysfunction, atrial arrhythmias and or heart failure since. Right ventricle pacing is asynchronous to the way the heart normally contracts. Remember the heart contracts from the left ventricle to right ventricle in a matter of milliseconds and squeezes like taking a towel and twisting it. So when it comes to follow ups and diagnostics Aaron and his doctors will want to see how much he is pacing in the atrium and ventricles; hopefully it’s only pacing in the atrium with normal AV node intrinsic conduction however the diagnostic tools will let you know if Aaron has any intermittent AV node heart block. You will also want to use the diagnostics to catch any potential arrhythmias. I used to program my diagnostics very sensitive so we didn’t miss anything. I would want to catch potential arrhythmias at 120 or 140 bpm as a result of slow ventricular tachycardia and or Supra ventricular tachycardia SVT atrial fibrillation 300-400 bpm or 150-250 bpm atrial flutter with a rapid ventricular response at 3 to 1 conduction and or 2 to 1 conduction. Some of the devices have a sleep mode that can be programmed by a set time and or comes on naturally with the sensor response via activity and or minute ventilation (which is his breathing activity, how much, how often, how deep; it measures his transthoracic impedance which is measured by sending a light voltage impulse from the tip of the pacing lead electrode to the pacemaker can in his chest implant under his skin and the device algorithm will recognize when the patient is a rest. I thought this may be helpful and I’m always here to answer any questions you may have. Lastly the majority of pacemaker devices come with some type of MRI compatibility and cellular testing compatibility. So Aaron should be ok there with any further diagnostic imaging he may receive in the future. Just as a sign of precaution his doctors may suggest to use the opposite ear for cell phone calls and not to place his cell phone directly over his pacemaker with a shirt front pocket. This would be strictly as a suggestive precaution as the vast majority of implantable pacemakers have been cellular tested and MRI tested for safety and approval.