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Implantable Cardioverter-Defibrillator

Heart Failure: Should I Get an Implantable Cardioverter-Defibrillator (ICD)?

Key points to remember:

  • Your doctor may suggest an ICD if you are at risk of having an abnormal heart rhythm that could cause sudden death. Test can show if you are at risk.
  • Many medical facts play a role in whether you should get an ICD. For example, the amount of blood your heart pumps (ejection fraction) helps your doctor decide if an ICD is right for you. Your doctor also will consider other health problems you may have.
  • An ICD constantly checks your heart rate and rhythm. It is designed to fix a dangerous abnormal heart rhythm and prevent sudden death.
  • The shock from an ICD hurts briefly. It’s been described as feeling like a punch in the chest. But, the shock is a sign that the ICD is doing its job to keep your heart beating. The ICD can also use painless electrical pulses to fix a heart rate that is too fast or too slow.
  • Even with an ICD, your doctor may also advise you to take medicine to reduce your chance of having a deadly abnormal heart rhythm. Some abnormal heart rhythms may be fixed with a procedure called catheter ablation, which destroys some of the heart tissue where the abnormal rhythm starts.

How can heart failure affect heart rhythm?

When you have heart failure, the lower chambers of your heart (the ventricles) can’t pump as much oxygen-rich blood as the body needs. Some people who have heart failure may also have abnormal heart rhythms that can cause sudden death.

The heart may beat so fast that the ventricles don’t have time to fill with blood. This type of abnormal rhythm is called ventricular tachycardia. Sometimes the heart quivers, or flutters, and stops pumping blood. This is called ventricular fibrillation. If these abnormal rhythms are not fixed right away, the person may die.

How can an ICD help?

An implantable cardioverter-defibrillator (ICD) is a battery-powered device that can fix an abnormal heart rhythm and prevent sudden death. The ICD is placed inside the chest. It’s attached to one or two wires (called leads) that go into the heart through a vein.

An ICD is always checking your heart rate and rhythm. If the ICD detects a life-threatening rapid heart rhythm, it tries to slow the rhythm to get it back to normal. If the dangerous rhythm does not stop, the ICD sends an electric shock to the heart to restore a normal rhythm. The device then goes back to its watchful mode.

An ICD can also fix a heart rate that is too fast or too slow, without using a shock. It can send out electrical pulses to speed up a heart rate that is too slow or it can slow down a fast heart rate by matching the pace and bringing the heart rate back to normal.

Before putting the ICD in your chest, your doctor will program it to send electrical pulses or a shock when needed. Whether you get pulses, or a shock depends on the type of problem that you have and how the doctor programs the ICD to respond to it.

How is the ICD placed?

Your doctor will put the ICD in your chest during minor surgery. You will not have open-chest surgery. You probably will have local anesthesia. This means that you will be awake but feel no pain. You also will likely have medicine to make you feel relaxed and sleepy.

Your doctor makes a small incision in your upper chest. He or she puts one or two leads (wires) in a vein and threads them to the heart. Your doctor will then connect the leads to the ICD. Your doctor programs the ICD and then puts it in your chest and closes the incision.

In some cases, the doctor may be able to put the ICD in another place in the chest so that you don’t have a scar on your upper chest. This would allow you to wear clothing with a lower neckline and still keep the scar covered.

Most people spend the night in the hospital, just to make sure that the device is working and that there are no problems from the surgery.

You may be able to see a little bump under the skin where the ICD is placed.

Who might want an ICD?

An ICD often is placed in people with heart failure, who have survived a dangerous abnormal rhythm. The ICD would protect them if they get another abnormal heart rhythm.

It also may be offered to people with heart failure who haven’t had an abnormal heart rhythm but are at risk for one.

You will have tests to see whether you are at risk for abnormal heart rhythms. These may include an electrocardiogram (EKG, ECG), an echocardiogram, or an electrophysiology study.

Your doctor will use these test results and your medical history to figure out if an ICD could help you. Your doctor will also rely on guidelines that help find out who might benefit from an ICD. These guidelines will likely change often, because experts are doing new research and creating new technology. You and your doctor can work together to decide whether you want to get an ICD.

Many medical facts play a role in whether you should get an ICD. Your doctor will look at whether:

  • You’re taking medication to treat heart failure and to prevent abnormal heart rhythms.
  • You’re expected to live more than 1 year.
  • Your ejection fraction is lower than normal.
  • You have passed out from previous abnormal heart rhythms.
  • You have had a heart attack.
  • You have class II or III heart failure. This means that you have some trouble doing everyday activities because of your heart failure symptoms.

What are the benefits of an ICD?

An ICD can prevent sudden death from an abnormal heart rhythm. ICDs may also help people who have heart failure live longer. This benefit has been shown in people older than 65 years.

  • ICDs can help lower the risk of dying suddenly from a heart problem. In studies, ICDs lowered the number of people who died because of a heart problem from about 16 out of 100 people to about 7 out of 100 people.
  • ICDs might also help lower the risk of death from causes other than sudden cardiac death. In studies, ICDs lowered the number of people who died from any reason from about 30 out of 100 people to about 20 out of 100 people.
  • An ICD combined with a pacemaker (cardiac resynchronization therapy, or CRT) can also help people live longer and stay out of the hospital.

What follow-up do you need after getting an ICD?

You will need regular monitoring and check-ups with your doctor to make sure that the ICD is working.

It is important to keep taking medications for heart failure. You will need to follow a healthy lifestyle to treat heart failure. This may include watching how much fluid you consume, eating healthy foods that are low in sodium, and not smoking.

If the ICD gives you a lot of shocks, your doctor may prescribe the rhythm-control medicine, amiodarone. This medicine helps prevent abnormal heart rhythms and may keep the ICD from sending shocks too often. Your doctor may also suggest catheter ablation to lower the number of times the ICD shocks you. Catheter ablation can lower the chance of

some abnormal heart rhythms, such as atrial fibrillation or ventricular tachycardia. These rhythms can cause the ICD to shock you.

ICDs run on a battery that lasts from 5 to 8 years. To replace the battery, you will need minor surgery.

If you get an ICD, you may have to be careful not to get too close to some devices with strong magnetic or electrical fields. These include MRI machines, battery-powered cordless power tools, and CB or HAM radios. Most everyday appliance are safe.