No matter where or how, VA doctors work together to get best results for patients

When Bryce De Witt got out of the Air Force in 2022, he was the picture of health. At 35-years-old and a father of four, he was physically fit, enjoyed CrossFit and hiking, and working his first post-military job as a firefighter and paramedic. Out of nowhere, he began experiencing low energy and a low heart rate.  

“All of the sudden, I felt terrible,” De Witt said. “No energy and I passed out multiple times, so I was unable to work. With no history of heart issues in my family, I just knew there was something very wrong.”

For more than a year, De Witt sought help at community health care systems near his home in Foresthill, California. Exasperated, he turned to the Sacramento VA Medical Center. The staff there referred him to the San Francisco VA Health Care System and Electrophysiologist Liong-Bing Liem, D.O., FACC. Talking over Zoom, De Witt was immediately impressed with Liem and his team of experts.  

“Within 24 hours of meeting Dr. Liem, I was scheduled for pacemaker insertion surgery,” De Witt said. “He took my concerns seriously and was in it with me every step of the way. He was determined to give me back my quality of life.”

After surgery, De Witt felt better but still did not feel like his old self. His specialty care team at the San Francisco VA suggested he consider a new technology, only available at one VA in the country, the Michael E. DeBakey VA Medical Center in Houston, Texas. 

Late last year, the Houston VA became the first VA in the nation to offer Veterans with abnormally slow heart rates the new Aveir DR Leadless Pacemaker technology. This leadless system consists of two tiny pacemakers, each smaller than an AAA battery, that are inserted via a catheter in a large vein in the thigh. Without any incisions, the two devices are secured within the upper and lower chambers of the heart and work together to normalize the heart’s rhythm.

“Adding the second pacemaker makes all the difference,” said Electrophysiologist Hamid Afshar, M.D., who, working with Cardiologist Irakli Giorgberidze, M.D., performed the procedure at the Houston VA. “After reviewing Mr. De Witt’s history, we had a strong inclination that by upgrading the existing ventricular device to a dual chamber device we could help return his health to his normal baseline. This advanced, leadless technology is changing the pacing as we know it and can be an immediate game-changer for our Veterans.”

According to Liem, plans were underway for the San Francisco VA to obtain the dual pacemaker technology, but he did not want De Witt to wait.  

“The day Mr. De Witt was scheduled for the procedure in Houston was actually the same day that San Francisco VA received approval as the second VA to perform this type of surgery,” Liem said. “If Mr. De Witt were my son, I would want him to be able to resume an active life as soon as possible and taking advantage of this new technology immediately offered him that opportunity.”

Doctors at the Houston VA jumped at the chance to care for De Witt and collaborate with Liem and the San Francisco VA team.

“There may be more than 170 VA medical centers in the country, but we truly are one VA,” said Afshar, who is also a professor of Medicine-Cardiology at Baylor College of Medicine and board certified in internal medicine, cardiovascular disease, and clinical cardiac electrophysiology. “We are committed to working together to get the best results for our Veterans.”

In Houston, De Witt underwent the short 30-minute procedure. Straightaway, his two pacemaker devices began communicating through electrical pulses to ensure every heartbeat stayed in sync. De Witt was discharged from the Houston VA the next day.  

“I walked out of the Houston VA and went straight to the airport to come home,” De Witt said. “Right away, I felt so good that I found myself walking around and around the airport. The VA doctors literally gave me my life back.”

According to Giorgberidze, who is also director of Houston VA’s Electrophysiology Lab and an associate professor at Baylor College of Medicine, the dual pacemaker technology was a perfect fit for De Witt.  

"With this new, advanced technology, there are no wires implanted in veins, no metal device under the skin, and no surgical incision,” said Giorgberidze, who is board certified in cardiovascular diseases, clinical cardiac electrophysiology, and internal medicine. “This means the potential for less risk, greater comfort, and fewer post-procedure restrictions for Veterans. Our goal is to improve our Veterans’ quality of life and leadless pacemakers in both chambers of the heart are incredibly successful.”

Following his procedure in Houston, De Witt has fully resumed his physical activities and is now working as an emergency department technician and enrolled in nursing school.  

“My plan is to ultimately work at the VA,” De Witt said. “The VA has been the best health care I’ve ever received, and I want to be a part of that.”