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Implantable Cardiac Defibrillator (ICD)
An ICD is a small device, about the size of a silver dollar, that is implanted inside your body to continuously monitors your heart rate and rhythm. The ICD can detect a potentially hazardous heart rhythm (arrhythmia) and respond by generating a small electrical shock. This shock is harmless but strong enough to send your heart back into normal rhythm.
While the ICD is not a cure for your heart rhythm problems, it can bring a dangerous heart rhythm under control and save your life. Some medications can help prevent arrhythmias, but the ICD is the only device that can actually stop an arrhythmia once it has started. The ICD allows you the freedom to participate in activities you enjoy.The ICD device has two main parts, a pulse generator and electrical leads to the heart.
The pulse generator is a lightweight metal case that houses a small computer and a battery. It continuously monitors your heart rhythm and is responsible for delivering the small shock through the leads if necessary. The pulse generator also stores information about heart rhythms in its memory, which physicians can later retrieve and examine.
The leads are insulated, flexible wires that are placed in your heart. They carry the electrical signal to your heart from the pulse generator when needed and also send information about your heart's rhythm back to the generator.
The ICD can be programmed by your physician to respond to different types of arrhythmia. The electrical treatment, or therapy, sent by the ICD can assist with rapid heart rates (antitachycardia pacing), fibrillations and slow heart rates (bradycardia pacing). Depending on what type of treatment is delivered by the ICD, patients report a feeling of "fluttering" in the chest to a stronger "thump" or "kick." These sensations pass quickly.
Implanting an ICD
An ICD is implanted during a minor surgical procedure that is performed under local anesthetic at the hospital. You will probably be admitted to the hospital on the day of the procedure. Before the process begins, several lab tests are performed and an EKG study is done. Your physician will visit with you and obtain a medical history and perform an examination. He or she will also explain the procedure, its benefits and risks and allow you to ask questions or express concerns.
Before the surgery, an IV is inserted into your arm to deliver medication. Sometime a sedative may be administered to help you relax.
Usually an ICD is implanted under the skin in your upper chest area. Occasionally it may be implanted in your abdomen. A small pocket is made for the pulse generator just under your skin. The leads are inserted into a vein in your chest and guided to your heart with the help of X-ray images. The leads are then tested and attached to the pulse generator.
The pulse generator is programmed to treat your specific rhythm problem. Once programmed it is placed in the pocket in your chest. The device is tested after implantation, and then the incision is closed and covered with a sterile dressing. The entire procedure usually takes one to two hours.
Recovery
You will remain in the hospital for one to two days. During this time nurses will check your blood pressure, pulse and incision. Your physician will also monitor the ICD to ensure it is working properly. You may experience some pain and stiffness around the incision for about a week.
Your physician will give specific instructions to follow at home while you recover. Generally these include:
- Avoid heavy lifting.
- Limit arm movements as directed by your doctor.
- Do not wear tight clothing over the pulse generator.
- Contact your doctor if any signs of infection at the incision site develop (redness, swelling, warmth).
- Contact your doctor if twitching, hiccups that won't stop or arm swelling on the side of the incision develops.
- Contact your doctor if a rapid heart rhythm, dizziness, chest pain or shortness of breath occur.
- Follow your doctor's recommendations for medications.
- Inform other physicians, dentists and emergency personnel of the ICD.
Follow-up Visits
Your physician will monitor the ICD during follow-up visits several times a year. You can be seen at your doctor's office, clinic or hospital, and a routine visit lasts 15 to 20 minutes. During these visits, your doctor or nurse may use a programmer, a device that can "talk" to the ICD device. If your medical condition changes, the programmer can also reprogram your ICD as necessary.
Since the ICD runs on batteries, the pulse generator will need to be replaced eventually. In general, batteries last five to eight years.
If a Patient Receives a Shock from the ICD
If an abnormal heart rhythm is detected by your ICD, it will usually deliver a shock within a few seconds. When that happens you should:
- Remain calm and rest, either sit or lie down.
- Have a plan for a friend or family member to call an ambulance if you loose consciousness for more than a minute.
- Contact your physician if you do not feel well afterward.
- If you feel fine following the shock and no more symptoms appear, it may not be necessary to call your doctor immediately, but he or she should be notified within 24 hours.
You should always call your doctor within 24 hours of being shocked. However, you need to call your doctor right away:
- If you receive two or more shocks in a row.
- If symptoms of a rapid heart rate last longer than two minutes.
- Before having any medical or dental procedure.
- If your have questions about medications, activities or the ICD.
- If you plan to travel or move.
If you have an ICD, it is recommended that you devise an emergency plan. This plan should include carrying a list of medications and dosages, keeping emergency phone numbers on hand and encouraging friends and family to take a course in CPR. You may also want to consider wearing a Medic-Alert bracelet or necklace and remember to always carry your ICD Identification Card.
Living with an ICD
Once you have recovered from the surgery, you can resume most normal activities. Always follow the advice given by your physician.
Driving can be resumed depending on your physician's recommendations and local laws.
Traveling is not a problem, however you should ask your physician for the name of a doctor or heart center in the area to which you are traveling. If a longer trip is planned (longer than three months) bring along a copy of your medical records and arrange with your doctor to see another specialist in the area.
It is safe to resume sexual relations; however, if a shock is experienced, you should contact your physician. The shock is not harmful to your partner, but he or she may experience a tingle or buzz.
With an ICD, certain things must be avoided. One in particular is a strong magnetic field. This can interrupt proper function of an ICD. Following are lists of safe items and things to avoid.
Things that Are Safe
- Kitchen appliances such as microwave ovens, toasters, blenders and electric can openers.
- Televisions, AM/FM radios, VCRs, CD and DVD players, remote controls and garage door openers.
- Handheld appliances such as hair dryers and shavers.
- Major appliances such as washers, dryers, electric stoves and refrigerators.
- Electric blankets and heating pads.
- Spark-ignited internal combustion engines such as lawn mowers and leaf blowers.
- Personal computers, printers, fax machines, electric typewriters and copy machines.
- Machine shop tools like drills and table saws. Keep tools 12 inches from implant site.
- Airport security archways are safe, but they may detect the metal in your ICD. If this happens, show the security officer your ICD card in your wallet. If a search is necessary, insist on a hand search. Security wands may interfere with ICD devices.
- Theft-detection systems at the entrances of stores, libraries and public places are safe.
- Cellular phones are generally safe but should not be held close to an ICD. It is recommended that you hold the phone to the ear farthest from the ICD. Do not carry the phone in a shirt or jacket pocket close to the device. As a rule, they should be kept six inches away from the ICD.
- Indoor cordless phones are safe.
Things to Avoid
- Large generators, electric motors and other large industrial equipment such as arc welders.
- Strong magnets.
- Radio transmitters, ham radios.
- Large stereo speakers.
- Battery-powered cordless power tools such as screwdrivers and drills.
- Maintaining or repairing any electrical or gas-powered appliance.
- Leaning over the open hood of a running car.
- Other Medical Procedures - With proper precautions, most medical procedures are unlikely to interfere with an ICD; however, certain procedures should be avoided. These include magnetic resonance imaging (MRI), electrosurgery, diathermy, lithotripsy and radiation therapy.
If you have any questions regarding the safety of something or are planning any medical procedure, you should contact your physician.
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