Overview

An Implantable Cardioverter Defibrillator (ICD) is a small electronic device that monitors your heart rhythm and can deliver electrical pulses or shocks to restore normal heart rhythm when dangerous arrhythmias are detected. Unlike a standard pacemaker that only treats slow heart rhythms, an ICD can also treat life-threatening fast heart rhythms (tachycardia) and cardiac arrest. The device is implanted under the skin, usually in the upper chest area, with leads (thin wires) that connect to your heart.

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The Procedure

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Pre-Procedure Evaluation: Your doctor will conduct a thorough assessment including medical history review, physical examination, and diagnostic tests such as ECG, echocardiogram, and possibly other heart tests (for example: Holter monitor, implantable loop recorder, cardiac MRI or cardiac CT scans) to determine if an ICD is right for you.

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Preparation: You will likely be asked not to eat or drink for at least 6 hours before the procedure. Your healthcare team will provide specific instructions about medications you should take or temporarily stop.

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Anesthesia: The procedure is typically performed under conscious sedation (medication to help you relax) or general anesthesia, depending on your specific situation and your doctor's recommendation.

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During the Procedure

1. Accessing the vein: The surgeon makes a small incision, usually below your collarbone. A large vein is accessed through this incision.

2. Lead Placement: Using X-ray guidance, one or more leads (thin, insulated wires) are guided through the vein into your heart. The leads are positioned in specific chambers of your heart to monitor heart rhythm and deliver electrical therapy when needed.

3. Testing the Leads: The leads are tested to ensure proper placement and function.

4. Connecting the ICD: The ICD generator (about a third the size of an iPhone) is connected to the leads and placed in a pocket created under the skin in your upper chest.

5. Device Programming and Testing: The device is programmed to recognize your heart rhythm and set appropriate therapy thresholds. In some cases, your doctor may test the device by inducing a rapid heart rhythm and ensuring the ICD responds appropriately.

6. Closure: The incision is closed with absorbable sutures and covered with a sterile dressing.

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After the Procedure

• Hospital Stay: You will typically stay in the hospital overnight although many patients are discharged the same day.

• Recovery: Mild pain or discomfort at the incision site is normal and can be managed with simple pain medication. Most patients can return to normal activities within a few days, though strenuous activities should be avoided for several weeks.

• Wound Care: You will receive specific instructions on how to care for your incision site to prevent infection.

• Follow Up: Regular follow-up appointments are essential to check the device function and battery life. Modern ICDs can be monitored remotely, with data transmitted to your healthcare provider via your mobile phone.

• ICD Card: You will receive an ICD identification card that should be carried with you at all times.

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Benefits

• Life Saving Protection: The ICD can detect and treat life-threatening heart rhythms, potentially preventing sudden cardiac death.

• Continuous Monitoring: The device provides 24/7 monitoring of your heart rhythm and can respond immediately to dangerous arrhythmias.

• Improved Survival: For patients at high risk of sudden cardiac arrest, ICDs have been shown to significantly improve survival rates.

• Peace of Mind: Many patients report feeling more secure knowing they have protection against life-threatening heart rhythms.

• Dual Functionality: Many modern ICDs also function as pacemakers, treating both slow and fast heart rhythms.

• Data Collection: The device records information about your heart's activity, which can help your doctor optimise your treatment.

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Risks and Considerations

While ICDs have proven benefits, there are some risks and considerations:

• Infection: There is a small risk of infection at the implantation site, which may require antibiotics or device removal in severe cases.

• Bleeding or Bruising: Some bleeding or bruising around the incision area is common but usually resolves on its own.

• Lead Complications: The leads may dislodge, fracture, or develop other problems that require additional procedures to fix.

• Inappropriate Shocks: The device may occasionally deliver shocks when they are not needed, which can be uncomfortable.

• Device Malfunction: Although rare, there is a small risk that the device might not function correctly.

• Battery Replacement: The battery typically lasts 5-10 years, after which the generator needs to be replaced through a minor surgical procedure.

• Electromagnetic Interference: Certain electronic devices or machinery may interfere with ICD function, though this is less common with newer devices.

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Living with an ICD

• Driving Restrictions: You may have temporary driving restrictions after ICD implantation or if you experience a shock. Your doctor will advise you on specific guidelines.

• Activity Restrictions: You should avoid activities that could damage the device or leads, such as contact sports. Your doctor will provide guidance on what activities are safe.

• Electronic Devices: Most household electronics are safe to use, but you should maintain a safe distance (usually 6 inches) from certain devices like strong magnets, induction hobs, or poorly shielded power tools.

• Security Systems: Airport and other security systems may detect your ICD. Carry your ICD card and inform security personnel about your device.

• Medical Procedures: Inform all healthcare providers about your ICD before undergoing any medical procedures, especially MRI scans, as some may require special precautions.

• Emotional Impact: Adjusting to life with an ICD can be challenging. Some patients experience anxiety or depression, particularly after receiving a shock. Support groups and counselling can be helpful.

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What to do if you receive a shock

• Single Shock with Quick Recovery: If you receive a single shock and feel fine afterward, contact your doctor as soon as possible.

• Multiple Shocks or Poor Recovery: If you receive multiple shocks or don't feel well after a shock, call emergency services (999) immediately.

• Record Details: Try to note what you were doing when the shock occurred, any symptoms you experienced before the shock, and how you felt afterward.

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Conclusion​​

An Implantable Cardioverter Defibrillator is a sophisticated device that can provide life-saving therapy for patients at risk of dangerous heart rhythms. While there are some risks and lifestyle considerations, the benefits of having an ICD often outweigh these concerns for patients who meet the criteria for implantation.

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This leaflet is intended for informational purposes only and should not replace professional medical advice. Please consult your healthcare provider for any questions or concerns regarding your health or treatment options.