When Tom Lynch arrived at work the morning of Dec. 9, 2004, he anticipated a routine, busy schedule as Director of Administration and Finance for UAB’s Division of Cardiovascular Disease. Feeling healthy only a week before his 41st birthday, he had no reason to suspect it would be the day he would come dangerously close to death while sitting behind his desk.

After a 9:30 a.m. meeting, Tom was in his office discussing a project with Administrative Supervisor Debra Reid when suddenly—and completely without warning—he collapsed in his chair. A rare and potentially fatal arrhythmia had caused Tom to experience sudden cardiac arrest, a condition in which the heart stops and death can occur within minutes due to lack of blood flow to the brain and other vital organs.

Reid acted quickly, interrupting a phone call of Division Director and cardiologist Robert C. Bourge, M.D., whose office is adjacent to Tom’s, to tell him he was needed in Tom’s office immediately—it was an emergency. “On Thursdays, I’m typically in clinic. But, a conference call kept me in the office that day,” Dr. Bourge recalls. Arriving seconds later, Dr. Bourge, who is also Tom’s boss, directed his staff to call 9-1-1, began performing CPR on Tom, and asked someone to retrieve the automated external defibrillator (AED) located just down the hall. Using the AED, Dr. Bourge administered a lifesaving shock to Tom’s heart, restoring a normal heart rhythm in less than two minutes. When the paramedics arrived a few minutes later, Tom had a strong pulse and was moving and responsive.

Dr. Bourge says use of the AED saved Tom’s life that day. “The arrhythmia Tom experienced is rare and fatal. If he had been almost anywhere else—in his car, or even in his office with the door closed—his chances of survival would have been very low. I call him lucky.” Tom agrees several factors were working in his favor. “I’m very fortunate I work with Dr. Bourge and with a group of great people who were very responsive and acted quickly. I hate to think what would have happened if I had been in my office alone,” Tom says. “But also, if an AED hadn’t been available, the outcome would not have been good for me. The AED intervention was the key.”

Tom received advanced care and treatment for his condition at UAB Hospital. Ranked among the top cardiovascular hospitals in the nation, UAB provides a full spectrum of cardiovascular services and the most advanced procedures available for a broad range of conditions. Today, after successful treatment for his arrhythmia, Tom enjoys traveling with his wife, Tiffany, swimming, golfing and playing with their miniature pinscher, Topaz. “The reality then was that I almost died that day. The reality today is that Tiffany and I celebrated our 12th anniversary, and I’m alive,” Tom reflects. In this ehealth magazine interview, Tom and Dr. Bourge discuss Tom’s rare arrhythmia and treatment and also explain the need for increased public access to AEDs like the one that played a critical role in saving Tom’s life.

Tom: “I’m often asked whether I had any symptoms or warning before my cardiac arrest that day, and the answer is none whatsoever. I felt fine that morning, and I had no pre-existing health problems I was aware of.”

Dr. Bourge: “Tom had a rare, frequently fatal arrhythmia called ventricular fibrillation caused by a condition known as Purkinje cell automaticity. Specific fibers in a certain part of his heart—the Purkinje fibers—began firing on their own, out of sequence, and this caused his heart to shut down. There are fewer than 50 cases of this type of arrhythmia ever reported worldwide—likely because most people with this condition die and you never know why.”

Tom: “I certainly never thought anything like this would happen to me. It’s ironic—and fortunate—that it happened here, on a day when Dr. Bourge was in the office. My experience underscores the need for access to AEDs in public places.”

Dr. Bourge: “Yes, AEDs can be a critical factor in saving the lives of people who have suffered cardiac arrest caused by various conditions, including blocked arteries and more common arrhythmias. I’ve always been a strong advocate of AEDs, and UAB has been involved in defibrillation research for many years. It’s gratifying to know that UAB’s cardiac rhythm lab played a key role in developing the type of shock—a biphasic current—used to convert Tom’s heart to its normal rhythm. Fortunately in his case, the arrhythmia was completely curable.”

Later that day, at UAB Hospital, initial cardiac tests determined that a blockage was not the cause of Tom’s cardiac arrest, leading his physicians to suspect an arrhythmia. The next day, an ICD (implantable cardioverter defibrillator) was inserted as a precaution. This device continuously monitors heart rhythm and, if an abnormal rhythm is detected, delivers a small electrical shock to the heart to convert the rhythm back to normal. The ICD is surgically implanted under a patient’s collarbone, similar to a standard pacemaker.

Tom: “My physicians obtained the rhythm printout from the AED Dr. Bourge used on me; it helped them find the source of the electrical problem in my heart. Then, two days after my cardiac arrest, I was treated with radiofrequency ablation by Neal Kay, M.D., head of cardiac electrophysiology at UAB.”

In this procedure, catheters are used to localize and selectively destroy—using radiofrequency energy—the areas of tissue causing abnormal impulses. The procedure is painless, and patients are often able to return home the same day.

Tom: “I have the ICD in place as a safeguard, but I’ve had no problems since that day. I follow up with my cardiologist Dr. Kay every six months and have made no changes to my lifestyle or activity level. I think the important message in my story is that we need to increase public accessibility to AEDs because they save lives.”

For every minute that a person remains in cardiac arrest and defibrillation is not provided, the chance of resuscitation drops by almost 10 percent. After 10 minutes with no defibrillation, the chances of resuscitating a victim of cardiac arrest are very low. Though cardiopulmonary resuscitation—also known as CPR—delivers a limited amount of blood and oxygen to the brain, defibrillation is the only effective way to resuscitate a victim of ventricular fibrillation.

Dr. Bourge: “The reason we had an AED in our office the day of Tom’s cardiac arrest is because of a similar event that occurred in 2000 when a young nurse suffered a cardiac arrest in one of the Department of Medicine academic buildings. I performed CPR, but an AED was not available. It took almost nine minutes for the paramedics and our emergency department staff to arrive, which is actually considered a quick emergency response time.”

After this incident, Dr. Bourge had an AED placed in the Division of Cardiovascular Disease office. The device was donated by the Lord Wedgewood Charity and StopHeartAttack, two organizations that work in concert to provide AEDs to schools and other public places. At the time of Tom’s cardiac arrest, his was the only UAB academic office with an AED. Since then, six more AEDs have been dispersed to Department of Medicine and other University academic offices.

Dr. Bourge: “Most anyone can follow the instructions for using an AED and assist in saving a life, though training is preferable. Formal CPR training from the American Red Cross and the American Heart Association provides instruction in using an AED. I encourage everyone to become certified in CPR.”

Regardless of which brand of AED is used, the only knowledge required to operate the device is to press the “ON” button. Once the AED is turned on, it speaks to the operator in a computer-generated voice that guides one through the rest of the procedure. The AED automatically analyzes the patient’s heart rhythmto determine if a shock is required. If a shock is needed, it will automatically charge itself and tell the operator when to press the button that will deliver the shock. Once the shock is delivered, or if no shock is indicated, the operator is prompted to check the patient for signs of a return to normal breathing or circulation.

Dr. Bourge: “We are entering an era of true public access to defibrillation. At the Atlanta airport, for example, nine lives have been saved in the past 18 months. Because of their lifesaving potential, I’d like to see AEDs installed in a greater number of public places, such as banks and shopping malls. Because there are banks on nearly every corner, the public could easily recognize that an AED is available there.”

Tom: “Although I was fortunate to have skilled people around me during my cardiac arrest, it doesn’t require a chief of cardiology at a major medical center to use an AED successfully. My experience shows the value of public accessibility to AEDs and the lifesaving impact an AED can have. I never thought I would need one, but you never know.”

For more information about cardiovascular services available at UAB, log on to www.uabhealth.org/cardiovascular. Or, to schedule an appointment with a UAB cardiologist, please call UAB HealthFinder at (205) 934-9999 or 1-800-UAB-8816.