What is an Implantable Cardioverter Defibrillator?
BDS (Bachelor of Dental Surgery), 10 years of experience
What is the meaning of an Implantable Cardioverter Defibrillator?
A small, battery-operated device that is placed in the chest to detect and stop arrhythmias (irregular heartbeats) is known as an implantable cardioverter-defibrillator (ICD). An ICD helps in continuously monitoring the heartbeat and delivering electric shocks, if required, to restore the normal heart rhythm.
An ICD is required when the heartbeat of an individual is extremely fast, which prevents the heart from pumping sufficient blood to the rest of the body, or if the person is at a high risk of developing arrhythmia. In this article, we will be discussing in detail implantable cardioverter-defibrillators.
- What are the different types of Implantable Cardioverter Defibrillators?
- What are the different parts of an Implantable Cardioverter Defibrillator?
- What are the different types of electrical signals that can be delivered by an Implantable Cardioverter Defibrillator?
- What is the purpose of an Implantable Cardioverter Defibrillator?
- What is the diagnostic procedure for an Implantable Cardioverter Defibrillator?
- How to prepare for an Implantable Cardioverter Defibrillator?
- What is the procedure for Implantable Cardioverter Defibrillator insertion?
- How to care after an Implantable Cardioverter Defibrillator surgery?
- What are the risks of Implantable Cardioverter Defibrillators?
- What is the cost of Implantable Cardioverter Defibrillator surgery in India?
What are the different types of Implantable Cardioverter Defibrillators?
The different types of ICD are:
- Traditional ICD: This device is implanted in the chest, and the leads or wires are attached to the heart. The implantation of this type of ICD requires invasive surgery.
- Subcutaneous ICD: This type of device is implanted at the side of the chest below the armpit, underneath the skin. It is attached to an electrode running along the breastbone. This device is larger than a traditional ICD and does not attach to the heart.
The heart has four chambers, namely the right and left atria (upper chambers), and the right and left ventricles (lower chambers). An ICD can also be classified according to the area of the heart to which the electrical signals are sent, as follows:
- Single-chamber ICD: It sends electrical signals to the right ventricle of the heart.
- Dual-chamber ICD: It sends the electrical signals to the right ventricle and right atrium of the heart.
- Biventricular device: It sends the electrical signals to the right atrium, right ventricle, and left ventricle of the heart.
What are the different parts of an Implantable Cardioverter Defibrillator?
The different parts of an ICD include:
- Pulse generator: It contains electrical circuits and a battery, that help in reading the electrical activity of the heart.
- Electrodes or leads: These are wires that go through the veins to the heart. They help in connecting the heart to the rest of the device. An ICD can have one, two, or three leads.
- Built-in pacemaker: Most of the ICD’s have a pacemaker that is built-in. The heart may need pacing if it beats too fast or too slowly, or in case a patient gets a shock from the ICD.
What are the different types of electrical signals that can be delivered by an Implantable Cardioverter Defibrillator?
An ICD can deliver four types of electrical signals to the heart:
- Cardioversion: It gives a strong electrical signal that feels like a thump to the chest. It is used to reset the rhythm of the heart to normal when a very fast heart rate is detected. (Know more about- What is Coronary Angiography? )
- Antitachycardia: It provides a low-energy pulse to reset a quick heartbeat. You may feel nothing or may feel a small flutter in the chest.
- Defibrillation: It restarts the heart by sending a very strong electrical signal. This is an extremely painful sensation but lasts only for a second.
- Bradycardia: A heartbeat that is too slow is restored to its normal speed. The ICD works like a pacemaker in this case. A defibrillator may sometimes slow down the heart rate to a dangerous level. Bradycardia pacing helps the rhythm to return to its normal level. ( Know more about- What is Cerebrovascular Diseases?
What is the purpose of an Implantable Cardioverter Defibrillator?
An ICD is needed in the following conditions:
- Ventricular tachycardia (a very fast and dangerous heart rhythm)
- Ventricular fibrillation (quivering or erratic pumping of blood from the heart)
- History of heart disease
- History of heart attack ( Know more about- What is Heart Attack? )
- Cardiomyopathy (a thickened or enlarged heart muscle, which may be referred to as dilated or hypertrophic) ( Know more about- What are the causes of Cardiomyopathy? )
- Heart failure (failure of the heart in pumping enough blood to the body)
- Congenital heart defects (heart defects present at birth), like the long QT syndrome
What is the diagnostic procedure for an Implantable Cardioverter Defibrillator?
- Blood tests: These tests are done to check for the level of the various blood parameters, and the presence of any underlying medical conditions like diabetes and thyroid problems.
- Chest x-ray: This test is done to check for the organs in the chest region, like the heart and lungs.
- Electrocardiogram (ECG or EKG): This test helps in measuring the electrical activity of the heart. It helps in diagnosing heart problems, and to check if the heart is beating too fast, too slow, or not at all.
- Echocardiogram: Sound waves are used to create pictures of the heart. It shows the structure and size of the heart, and how blood flows through the heart.
- Holter monitoring: A small, wearable device, known as a Holter monitor, can be worn for one or two days to spot irregularities in heart rhythms.
- Event recorder: An event recorder is similar to a Holter monitor, but can be worn for a longer time. The person needs to push a button when symptoms are felt.
- Electrophysiology study: One or more flexible tubes, known as a catheter, are guided by the doctor through a blood vessel into the heart. The sensors on the tip of each catheter send signals and record the electrical activity of the heart. This helps in identifying the area causing an irregular heartbeat.
How to prepare for an Implantable Cardioverter Defibrillator?
- If you are allergic or sensitive to any medications, latex, iodine, or anesthetic agents, inform your doctor.
- Tell your doctor about any medical disorders or conditions that you may be having.
- Inform your doctor about any medications or supplements that you may be currently taking.
- You will be asked to not eat or drink anything after midnight, the day before the surgery.
- The doctor may ask you to stop taking any blood-thinning medications like aspirin or warfarin a few days before the procedure.
- The doctor may prescribe an antibiotic medication to be taken before the procedure.
- Any medication to be taken before the procedure should be taken with a small sip of water.
What is the procedure for Implantable Cardioverter Defibrillator insertion?
- The procedure is generally performed under general anesthesia (the patient is fully asleep during the procedure).
- One or more insulated, flexible wires or leads are guided by the doctor into the veins near the collarbone to the heart.
- X-ray images are used as a guide while putting the leads.
- The ends of the leads are attached to the heart.
- The other end of the leads is attached to the shock generator that is implanted beneath the collarbone, under the skin.
- The procedure of implanting an ICD takes a couple of hours.
- After the ICD is in place, the doctor will test and program it according to the heart rhythm needed of the patient.
- ICD testing may require speeding up the heart and then shocking it back into its regular rhythm. The ICD can be programmed depending on the problem with the heartbeat in two ways:
- Low-energy pacing: The patient may feel nothing at all or a painless fluttering in the chest when the ICD responds to the mild changes in the heartbeat.
- High-energy shock: In serious heart rhythm problems, the ICD may deliver a high-energy shock. This shock could be extremely painful but lasts only for one second.
- Normally, only one shock is required for the restoration of a regular heartbeat. Some people may however need two or more shocks within a period of 24 hours.
- Three or more shocks given in a short period of time is known as an arrhythmia or electrical storm, which requires immediate medical care.
- The ICD can later be adjusted to reduce the frequency and number of shocks.
- Medications may be given to make the heartbeat regular and decrease the risk of an ICD storm.
How to care after an Implantable Cardioverter Defibrillator surgery?
- You will usually be released on the same day of the ICD procedure.
- It is normal to have some swelling and tenderness for a few weeks after the procedure.
- The doctor may prescribe a pain medication to relieve the pain and discomfort.
- Avoid abrupt movements, like raising the left arm above the shoulder, for up to eight weeks to avoid movements of the leads till healing has been completed.
- Avoid strenuous activities, heavy lifting, swimming, above-the-shoulder activities for four weeks after the surgery.
- Contact sports should be stopped completely after the procedure.
- Driving and other daily activities can be resumed after consultation with your doctor.
- Place your mobile phones at a distance of six inches from the ICD site.
- Carry an ID card when going to the airport or passing through a security system.
- Inform your doctor when you go for any other medical procedures, as certain procedures like radiofrequency, MRI (magnetic resonance imaging) scan, MRA (magnetic resonance angiography), etc. may not be recommended if you have an ICD.
- Headphones and wireless chargers may have a magnetic substance that may interfere with an ICD and should be kept at least six inches away from the ICD.
- One should stand at least 2 feet away from high-voltage transformers, welding equipment, and motor-generator systems.
- Keep magnets at least 6 inches away from the ICD site.
- An ICD can last for three to six years. Follow-up appointments with the doctor every six months after the procedure are recommended.
What are the risks of Implantable Cardioverter Defibrillators?
The risks of implantable cardioverter-defibrillator include:
- Swelling
- Bleeding around the heart, which could be life-threatening ( Know more about- Home remedies for high cholesterol )
- Bruising
- Infection
- Damage to the blood vessels
- Pneumothorax (collapsed lung)
- Regurgitation (leaking of blood through the heart valve) where the lead is placed
- Cardiac perforation due to shifting of the leads or device
What is the cost of Implantable Cardioverter Defibrillator Surgery in India?
The total cost of implantable cardioverter-defibrillator surgery in India can range from around INR 3,00,000 to INR 6,00,000. However, many prominent hospital doctors in India specialize in implantable cardioverter-defibrillator surgery. But the cost varies across different hospitals.
If you are coming from abroad, apart from the cost of implantable cardioverter-defibrillator surgery, there will be an additional cost of living in a hotel and the cost of local travel. After the procedure, the patient is kept for one day in the hospital and ten days in the hotel for recovery. So, the total cost of implantable cardioverter-defibrillator surgery in India comes to a total of INR 3,80,000 to INR 7,00,000.
We hope that we could answer all your questions regarding implantable cardioverter defibrillators through this article.
If you need more information about an implantable cardioverter-defibrillator, you can contact a Cardiologist.
We only aim to provide you with information through this article. We do not recommend any medication or treatment to anyone. Only a qualified doctor can give you the best advice and correct treatment plan.
