Sonoma cardiologist carves new path

Before this year, if a heart patient needed to be implanted with a heart-monitoring device, the procedure needed to take place in a hospital.

Last month, a Sonoma cardiologist injected the potentially life-saving device into three patients in a single day right in his office – and it may be first time the procedure had ever been done on an out-patient basis anywhere in California, he says.

After longtime Sonoma cardiologist Jim Price retired in mid-2018, Dr. Thomas Dunlap began seeing patients in Sonoma full time – at Northern California Medical Associates Cardiology, 558 Third St. W. Dunlap specializes in cardiovascular disease, peripheral vascular and endovascular medicine, interventional cardiology and pacemaker implants.

Dunlap, who lives near Kenwood, believes he is the first California doctor authorized to implant the small loop recorders for monitoring heart rhythms in an office setting. Previously, Dunlap had implanted the devices at Santa Rosa Memorial Heart and Vascular Institute; he is also affiliated with Sonoma Valley Hospital.

The injectable loop recorder has a three-year battery life and can detect life-threatening atrial fibrillation, pauses and ventricular arrhythmias, said Dunlap, adding that the device can be a crucial tool in helping to prevent complications of heart arrhythmia, such as lack of consciousness and stroke.

The device previously was the size of a gum pack, but it is now half that size and small and simple enough to be inserted in an office.

'The device is perfect for the Sonoma population,' said Dunlap. 'This is new and a huge benefit to patients. It is considered the standard of care for the diagnosis of difficult recurrent heart rhythms.'

The procedure itself takes about five minutes and the total visit around 20 minutes.

More important than the speed is the cost. Dunlap noted that it is about a third of the cost to do the procedure on an outpatient basis versus in the hospital. It is also a Medicare-recognized procedure and covered by most insurance plans.

Cleared by the U.S. Food and Drug Administration in 2017, the Insertable Cardiac Monitor (ICM) is a third the size of an AAA battery and allows physicians to continuously and wirelessly monitor a patient's heartbeat for up to three years. The device weighs about 1.5 ounces and is placed just beneath the skin through a small incision of less than a centimeter in the upper left side of the chest, using a minimally-invasive procedure. Its presence is often nearly undetectable to the naked eye once the incision has healed.

The device also features a self-learning algorithm, which learns and adapts to a patient's unique heart rhythm over time.

The device can be used to monitor patients suffering from intermittent chest palpitations for potential episodes of cardiac arrhythmias.

Dunlap said that he is pleased to have broken new ground with the device, right here in Sonoma, where he was born and raised. He attended St. Francis Solano School from kindergarten through eighth grade before boarding at Bellarmine College Preparatory and attending Santa Clara University. He received his medical degree from the University of Southern California School of Medicine and did his residency in internal medicine and his fellowship in cardiology at the University of Michigan Medical Center.

As for the three patients who helped Dunlap break new ground last month – all were local Sonoma residents. Two were women and one was a man. All three were over 65 and needed the device to monitor heart rhythm abnormalities.

Dunlap said that all three procedures went 'perfectly' and the three patients are doing well.

He expects to continue to do a handful of the procedures every month.

Watch a video of the implant procedure below:

Email Lorna at lorna.sheridan@sonomanews.com.