Why did my doctor order an implantable cardioverter defibrillator?
What is an implantable cardioverter defibrillator?
What does an ICD do?
What preparations will I need to make?
How is the implantation performed?
How long will the procedure last?
What will the recovery be like?
What happens after the implantation?
How will my ICD react in the outside world?
What should I do when I have an event?
Will my insurance cover this?
Who should I contact with questions about this test?
1. Why did my doctor order an implantable cardioverter defibrillator?
Your heart has an electrical system that helps it beat at a regular speed or pace. If your heart beats too fast, you may have felt dizzy, lightheaded or faint; weak, warm, or flushed; or heart palpitations or flutterings. Problems with heart rhythm are called arrhythmias and could lead to cardiac arrest.
To determine the causes of your heart rhythm problems, your physician may have ordered certain tests: electrocardiogram (EKG); treadmill test; echocardiogram; Holter monitoring; cardiac catheterization; and/or electrophysiology study (EPS). After studying the results, your physician may want to implant a cardioverter defibrillator (ICD) to control your fast heart rhythm.
There are two types of fast arrhythmias:
- Ventricular Tachycardia (VT): With VT, a ventricle contains a group of abnormal electrical cells called a circuit. The circuit sometimes sends out signals that make the lower chambers beat very fast. This keeps the chambers from being filled with the amount of blood the body needs to keep you from experiencing the symptoms listed above.
- Ventricular Fibrillation (VF): VF is the more serious arrhythmia. With VF, abnormal circuits in the ventricle sometimes send signals that are so fast and irregular that the heart muscle quivers rather than pumps. A quivering heart is called cardiac arrest. Emergency treatment must be given to get the heart pumping again, or death may result.
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2. What is an implantable cardioverter defibrillator?
An ICD is a small lightweight electronic device that is placed inside your body to keep track of your heart rhythm. When you have an arrhythmia, the ICD returns your heart to its normal rhythm.
An ICD has two parts. A generator houses a tiny computer and battery in a smooth, lightweight case that keeps track of your heart rhythm; makes electrical signals when they're needed; and records your heart rhythm, pulse and shocks the ICD sends out. (You won't feel the electricity coming out of the generator.) The lead is one or two thin wires covered by soft, flexible plastic that help the generator record your heart rhythm and carry pulses and shocks from the generator to your heart.
3. What does an ICD do?
An ICD can do one or more of the following:
- Antitachycardia pacing (ATP): The ICD can send out a series of pulses to override a fast rhythm. This may feel like fluttering in your chest or may not be felt at all.
- Cardioversion: The ICD can give your heart one or more small shocks to slow a fast rhythm. They may feel like thumps in your chest.
- Defibrillation: The ICD can send a strong shock to the heart if it senses a very fast, irregular rhythm. This may feel like a strong kick to your chest.
- Bradycardia pacing: In addition to slowing a fast heart rhythm, most ICDs can send out pulses to get a slow heartbeat back to the right speed. This may happen after an ICD shock or if a second heart rhythm condition exists.
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4. What preparations will I need to make?
You will be admitted to the hospital on the day of the procedure. You will be asked not to eat or drink anything after midnight the night before. Before you are taken to the operating room, the skin where the ICD is implanted will be washed and may be shaved. You'll be given medication so you won't feel the pain and to help you sleep through all or part of the procedure.
5. How is the implantation performed?
An implantation can be made in either your chest or your abdomen. An incision will be made in your skin below your collarbone. For an abdominal implant, a second incision is also made below your rib cage. The generator will be stored in a pocket that will be made either near the chest incision or below the rib cage under your skin or muscle. (ICDs can be inserted on either the right or left side. You may want to discuss your preference with your physician.) The lead is threaded through the incision into a vein in your upper chest. Using x-ray monitors, the lead is then guided into your heart's chambers. For an abdominal implant, the other end of the lead is threaded under the skin from the chest to the abdomen. The generator is adjusted to the proper settings and attached to the lead. After the generator is placed under your skin or muscle, the incision is closed and covered with a sterile dressing.
On occasion, a patch electrode is needed to help the ICD do its job. If that is the case, the doctor will make another incision and place the patch under the skin or muscle near the heart. A lead will connect the patch to the generator.
In rare cases, the ICD may be implanted during open-chest surgery. This may be done in conjunction with another heart problem, or if conditions prevent the leads from being placed in the veins. If that occurs, the leads are attached to the outside of the heart and the generator is placed in an abdominal pocket.
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6. How long will the procedure last?
The implantation may take two to three hours.
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7. What will the recovery be like?
You will stay in the hospital a day or two to make sure the ICD is working properly. Your pulse, blood pressure and incision sites will be checked regularly by a nurse. Prior to discharge, a chest x-ray may be taken and the ICD's settings may be adjusted from outside your body. You will be asked not to lift your arm above your shoulder on the ICD side so that the leads will have a chance to secure themselves inside the vein and your heart. You may experience some stiffness and pain in the incision area, for which you will receive medication.
When you return home, you can continue most of your daily activities. Remember to take it easy for about a month to keep from pulling the leads out of place. Avoid heavy lifting, running and playing contact sports until your doctor says it's safe to resume those activities. Take your temperature every day for a week (it should be normal) and check your incision for signs of infection such as redness, swelling, drainage, pain and if the area is warm to the touch. Notify your doctor if any of these signs appear. You may need to schedule a doctor's visit to have your sutures or staples removed if you have them. For a few weeks, you may feel numbness in the area surrounding the ICD. This is normal. Your incision should heal completely within a month. There is a chance you will feel and see a small bump under your skin at the ICD incision site. It won't be noticeable under your clothes.
After you heal, avoid rubbing or playing with your ICD. Continue taking your medication as directed by your doctor. Talk to your doctor about driving. In some instances, driving may be restricted due to your heart rhythm problem, not the ICD.
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8. What happens after the implantation?
You will need to schedule regular office visits with your doctor to make sure your ICD is working properly. When you have a fast heart rhythm, or event, the ICD keeps track of what your heart rhythm was during the event and what the ICD did to treat it. During these visits, the ICD's records are checked and its settings are adjusted if necessary. This can be done from outside the body.
ICD batteries, which are located in the generator, need to be replaced every 3 to 7 years. (Don't worry, the batteries won't run down unexpectedly.) This requires opening the incision to replace the generator. This procedure is shorter than the initial one. The same situation will occur when the leads need to be replaced.
9. How will my ICD react in the outside world?
When you first get your ICD, you will be given an ID card to carry. This card contains important information about your ICD. Show it to any doctor, dentist or other medical professional you visit. Since ICDs also tend to set off security devices at airports, stores and libraries, you will need to show your card to security personnel. You may even consider getting an identification bracelet or necklace saying you have a heart rhythm problem and an ICD.
Microwave ovens in good working order will not interfere with your ICD. Things like computers, hair dryers, power tools, radios, televisions, VCRs, electric blankets, and fax machines are all okay to use.
There are a few things that might interfere with your ICD. These include very strong magnets (like those used for MRI tests), hand-held security wands, heavy-duty electrical equipment, radio transmitting towers, ham radios, certain surgical instruments, and cellular phones. (When using a cellular phone, use it on the ear farthest from your ICD. Don't carry the cell phone in your breast pocket either.) Do not linger between store anti-theft detectors. Walk quickly through them, as they also create a magnetic field. Avoid leaning directly over the open hood of a running car, as the engine also generates an electrical field.
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10. What should I do when I have an event?
Your usual symptoms of a fast heart may accompany an event. When you experience an event, find a place to sit or lie down and elevate your feet if possible. Ask someone to stay with you for about 15 minutes. Since low-energy pulses may be enough to slow your heart rhythm, you won't always feel your ICD working. If a shock is needed, you may feel it as a light thump or as a kick to the chest. Whether you feel it working or not, you can rely on your ICD to provide you with the proper treatment.
Seldom will a person need additional medical treatment following an event. Should an event occur and you feel okay afterward, contact your doctor's office to alert them. (This is not an emergency, so call during regular business hours.) Should your event be more serious, have a family member or associate contact 911. Times when you would call emergency include when:
- you still feel symptoms after a shock;
- you feel three or more shocks in a row;
- your symptoms don't go away and you feel no shock; or
- you stay unconscious for more than 30 seconds, following your blood pressure dropping during an event.
11. Will my insurance cover this?
Depending on the type of coverage, most commercial insurance carriers will pay the major share of the cost. You should always consult your insurance company to determine proper coverage.
12. Who should I contact with questions about this test?
Feel free to consult your doctor.
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