Implantable Cardioverter Defibrillator

Your doctor has determined that you are at risk for serious arrhythmias or abnormal heart rhythm which may lead to sudden cardiac death, and has recommended that you may receive an implantable cardioverter defibrillator (ICD). Sudden cardiac death (SCD) claims approximately 450,000 lives in the U.S. each year. Since the early 1980s, thousands of people at risk for SCD have received ICDs.

Ventricular arrhythmias, or abnormal rhythms coming from the bottom of the heart, are most commonly responsible for SCD. Ventricular tachycardia, an abnormally fast rhythm, is one example, and results in less blood being pumped out of the heart with each contraction. This, in turn, can result in lightheadedness and loss of consciousness. This abnormal rhythm may progress to ventricular fibrillation, or a chaotic, ineffective rhythm. Ventricular fibrillation results in essentially no blood being pumped out of the heart and requires an electrical shock (defibrillation) to restore normal cardiac activity. This shock is administered by trained personnel, usually when the ambulance is called, in the emergency room, or while a person is in the hospital.

An ICD is a surgically implanted device that is able to directly monitor the heart's rhythm, and correct a life-threatening arrhythmia. ICDs offer various therapies to restore normal cardiac rhythm. ICDs have the capability of terminating certain types of ventricular tachycardia by pacing the heart, without having to deliver an electrical shock. ICDs also house pacemakers, in case the heart rhythm is too slow (bradycardia).

Surgery
A small incision will be made just beneath your collar bone on either the left or right side of your chest. You will be sedated with medication through an intravenous line. You will be sleeping, but you will be breathing on your own. A local anesthetic will also be given. The lead, or the wire that goes down into the right ventricle of your heart, is fed through a vein and positioned under fluoroscopy. The generator is then connected to the lead. A small pocket will be made in your chest where the generator will be implanted just beneath your skin. During the implant procedure, your cardiologist may put you into an abnormal ventricular rhythm in order to assess the effectiveness of the ICD.

The ICDs have a battery-life of approximately five to seven years, which is monitored closely during routine visits with your doctor. When your doctor has determined that the battery is nearing depletion, the pulse generator will need to be replaced. This usually involves staying overnight in the hospital, as the lead system generally does not have to be replaced.

Guidelines After Surgery
After you return home from the hospital, it is important to monitor your incisions closely for any sign of infection. Report to your doctor any fever, redness or swelling, or drainage at incision sites. Do not bathe or shower for at least five days after surgery.

If you receive a shock from the ICD, or if you feel any symptoms of your arrhythmia, you should report these to your doctor. He will then determine appropriate therapy for you. This may include adding or changing medication or reprogramming your ICD.

1. If you receive a shock from your ICD, you should notify your doctor, but don't panic. He may want you to come to the office to examine you and assess the functioning of the ICD, or he may just want to see you at your next scheduled office appointment. If you have more than 2 shocks close together, or feel ill in any way (dizziness, clamminess, palpitations) you should call an ambulance to bring you to the emergency room.
2. Always tell any surgeons, doctors, or dentists treating you about your device. Refer them to your cardiologist if they have any questions.
3. You may continue to use most household appliances safely, including:
   • television set
   • microwave oven
   • VCR
   • AM/FM radio
   • toaster, blender, electric knife, can opener
   • washer, dryer
   • drills and tablesaws (unless magnetized)
   • personal computer
4. Carry your I.D. card in your wallet or purse at all times. Inquire about a medic alert bracelet or necklace.
5. If family members are interested in a CPR class, please let your nurse know.

Situations To Avoid

1. You should avoid all situations in which you would be exposed to strong electrical or magnetic fields including the following:
   • electrical power plant
   • ignition systems
   • stereo speakers
   • magnetic wands used by airport security. You may walk through metal detector gates, and may trigger the alarm, but this will not harm your device. The wand used by security personnel will harm your device, so avoid this situation.
   • industrial equipment such as arc welding equipment and power generators
   • magnetic resonance imaging (MRI) scanners, diathermy, and electrocautery machines (Consult your cardiologist before any of this equipment is used.)
2. Avoid prolonged direct exposure of the surgical site to the sun.
3. Avoid any activity that involves rough contact to your chest or abdominal area such as contact sports.
4. Never place a magnet on or near your ICD generator site.
5. Cellular phones should be kept 6 inches away from your generator.

Follow-Up
Patients are generally seen by the cardiologist a week or two after discharge from the hospital.

If you have any questions or concerns please do not hesitate to ask your doctor or nurse.