An Implantable Cardioverter-Defibrillator (ICD) is a small battery-powered device placed in the chest to monitor heart rhythm and detect irregular heartbeats. An ICD can deliver mild electric shocks via one or more wires connected to heart to fix an abnormal heart rhythm.
ICDs detect and stop arrhythmias. The device continuously monitors heartbeat and delivers electrical pulses to restore a normal heart rhythm when necessary. An ICD differs from a pacemaker — another implantable device used to help control abnormal heart rhythms.
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When there is a rise in rapid heartbeat, the wires from the heart to the device transmit signals to the ICD, which sends electrical pulses to regulate the heartbeat. Depending on the problem, the ICD could be programmed for:
Usually, only one shock is needed to restore a normal heartbeat. Sometimes, however, one might have two or more shocks during a 24-hour period.
Having three or more shocks in a short time period is known as an electrical or arrhythmia storm. If this happens, one must seek emergency care to check for ICD malfunction or if they have a heart problem that's making it beat abnormally.
If necessary, the ICD can be adjusted to reduce the number and frequency of shocks. One may need additional medications to make the heart beat regularly and decrease the chances of an ICD storm.
An ICD can also record the heart's activity and variations in rhythm. This information helps the doctor evaluate the heart rhythm problem and, if necessary, reprogram ICD.
Depending on the patient, a cardiologist may recommend one of the following types of ICDs:
An ICD can also deliver up to four types of electrical signals to the heart:
A subcutaneous ICD (S-ICD) is a newer type of ICD available at some surgical centers. An S-ICD is implanted under the skin at the side of the chest below the armpit. It's attached to an electrode that runs along the breastbone.
This device is prescribed if:
Implanting a subcutaneous ICD is less invasive than an ICD that attaches to the heart, but the device is larger in size than an ICD.
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Arrhythmias are irregular heart rhythms and can be caused by a variety of reasons, including age, heart damage, medications and genetics. The doctor may recommend an ICD if the patient is at risk of a life-threatening ventricular arrhythmia.
A patient is prescribed ICD if:
One might also benefit from an ICD if they have:
There are several factors like past medical history, diagnosis and other related factors that must be considered prior to implanting an ICD. Every patient is unique, therefore careful analysis is an essential prerequisite to determine the correct timing & approach, as well as choose the appropriate type of the device.
ICDs have been very useful in preventing sudden death in patients with known, sustained ventricular tachycardia or fibrillation. Studies have shown that they may have a role in preventing cardiac arrest in high-risk patients who haven't had, but are at risk for, life-threatening ventricular arrhythmias.
Cardiologists recommend that before a patient is considered to be a candidate for an ICD, the arrhythmia in question must be life threatening and doctors have ruled out correctable causes of the arrhythmia, such as:
Many people do not understand their underlying condition such as heart failure or genetic predisposition for risk of sudden cardiac arrest and because ICDs are used primarily to prevent sudden cardiac death, they in turn may not understand the benefits versus the limitations of having an ICD implanted.
Therefore, before the cardiologist decides if the patient needs an ICD, several investigative procedures will have to be executed to isolate the cause of arrhythmia. These could include:
Readings from personal health monitoring devices, like smart watches, etc. can also help. (Ask your doctor if this is an option for you.)
A battery-powered pulse generator is implanted in a pouch under the skin of the chest or abdomen, often just below the collarbone. The generator is about the size of a pocket watch. Wires or leads run from the pulse generator to positions on the surface of or inside the heart and can be installed through blood vessels, eliminating the need for open-chest surgery. An ICD device knows when the heartbeat is not normal and tries to return the heartbeat to normal.
New devices also provide “overdrive” pacing to electrically convert a sustained ventricular tachycardia (fast heart rhythm) and "backup" pacing if bradycardia (slow heart rhythm) occurs. Depending on patient condition, recovery can take anywhere from a few days to a few weeks. Avoidance of high-impact activities and heavy lifting, for at least a month after the procedure is recommended.
Having an ICD is a lifelong commitment. Post recovery regular appointment of a cardiologist is required to program the device. One should continue this about every six months alongside medication, diet and lifestyle changes as suggested.
The batteries in the device last for five to seven years. Another procedure, less complicated procedure is done to replace the batteries. Having an ICD device improves symptoms caused by slow heartbeat, such as fatigue, lightheadedness and fainting. This gives the patient a chance to live a longer, happier and healthier life.
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