Implantable Cardioverter Defibrillator

An electronic device that is used to constantly monitor the heart rhythm is known as an implantable cardioverter defibrillator or ICD. When a very fast heart rhythm is detected, energy is delivered by the ICD to the heart muscle, allowing the heart to beat in a normal rhythm once again.

An ICD is required if you have a very fast heartbeat that prevents the heart from supplying blood to the rest of the body, or if you are at an increased risk of developing arrhythmia or heart rhythm problems because of a weak heart muscle.

Types:
The different types of ICD include:

  • Traditional ICD: It is implanted in the chest with the wires or leads attached to the heart. Invasive surgery is needed to place this type of ICD.
  • Subcutaneous ICD: This type of ICD is implanted underneath the skin, at the side of the chest. It is attached to an electrode running along the breastbone. It does not attach to the heart.

The heart has four chambers, the upper chambers are known as the atrium (right and left), and the lower chambers are known as the ventricles (right and left). Depending on the heart chamber that the ICD sends electrical signals to, the different types of ICD include:

  1. Single-chamber ICD: This type of ICD sends electrical signals to the right ventricle.
  2. Dual-chamber ICD: This type of ICD sends electrical signals to the right atrium and right ventricle.
  3. Biventricular ICD: This type of ICD sends electrical signals to the right ventricle, left ventricle, and right atrium. It is used in cases of heart failure (the heart fails to pump sufficient blood to the rest of the body).

Parts:
The different parts of an ICD are:

  1. Pulse generator: It contains electrical circuits and a battery to read the electrical activity of the heart.
  2. Leads or electrodes: These are wires (one to three in number) that can go through the veins to the heart, and connect the heart to the rest of the device. 
  3. In-built pacemaker: There is a built-in pacemaker in most ICD’s. The heart may require pacing if the heartbeat is too slow or too fast, or if you have a shock from ICD.
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Purpose:
An ICD may be used in the following cases:

  • Ventricular fibrillation (quivering or erratic pumping of blood)

  • Ventricular tachycardia (an extremely fast heart rhythm)

  • Previous heart attack

  • History of heart disease

  • Cardiomyopathy (enlarged or thickened heart muscle)

  • Heart failure

  • Inherited, congenital (present at birth) heart defects like long QT syndrome

The symptoms that start to appear which indicate the requirement of an ICD are- 

  • Pain in the chest

  • Tachycardia and Bradycardia 

  • Dizziness and Weakness

  • Shortness of breath

  • Fainting 

  • Sweating

  • High blood pressure

  • Sleep apnea

  1. Electrocardiogram (ECG): An ECG is performed to measure the electrical activity of the heart, and diagnose problems with the heartbeat of the patient.
  2. Echocardiogram: This test uses sound waves to create images of the size and structure of the heart, and how blood flows through the heart.
  3. Holter monitoring: The Holter monitor is a wearable device that keeps track of the rhythm of the heart and spot irregular heart rhythms that has been missed by an ECG. It is usually worn for one or two days.
  4. Event recorder: An event recorder is similar to a Holter monitor and requires the person to push a button when symptoms are felt. It can be worn for a longer time than a Holter monitor.
  5. Electrophysiology study: Flexible tubes called catheters are guided through a blood vessel into the heart. It helps in the identification of the area causing an irregular heartbeat.

 

The procedure can be performed in two different ways:

1. Endocardial or transvenous approach:

  • This procedure is performed under local anesthesia (the area of the procedure is numbed).
  • The surgeon makes small incisions or cuts in the chest.
  • The lead is inserted through the cut into a vein, which is guided to the heart with the help of x-rays.
  • One tip of the lead is attached to the heart muscle, and the other end is attached to the pulse generator.
  • The generator is placed under the skin of the upper chest.
  • The patient usually stays in the hospital for one day after the procedure.

2. Epicardial or surgical approach:

  • This is the less common method used for an ICD.
  • This procedure is performed under general anesthesia (the patient is put asleep during the procedure).
  • The doctor places the generator in a pocket that is created under the skin in the lower abdomen.
  • The patient usually stays in the hospital for 3 to 5 days after this procedure.

Once the leads are in place, they are tested by the doctor to make sure that they are working properly and are in the right place.
Small amounts of energy are sent through the leads into the heart, causing the contraction of the heart. This is known as the lead function test or pacing.
After the leads have been tested, the doctor connects them to the ICD device.
The doctor then uses a programmer or external device for making the final device settings.
The procedure may take two to four hours to complete.

Complications of the ICD surgery can include:

  • Infection
  • Bleeding
  • Swelling
  • Bruising
  • Damage to the blood vessels
  • Regurgitation (leakage of blood through the heart valve)
  • Pneumothorax (collapse of lungs)
  • Movement of the leads or device causing heart perforation

 

  • It is normal to have some pain and tenderness after the procedure.
  • The doctor may prescribe a pain killer to relieve the pain and discomfort after the procedure.
  • Avoid heavy lifting and strenuous activities for at least one month after the procedure.
  • Avoid driving for at least six months after the procedure. Driving can be resumed only if one can go for long periods of time without any shock (approximately 6 to 12 months), or if one does not faint after a shock.
  • Follow-up appointments with your doctor every three to six months after the procedure are required. The doctor will program your device.
  • The battery in the device lasts for approximately five to seven years. A separate procedure will be required to replace the batteries.
  • Certain objects like security systems, medical equipment like MRI machines, and power generators may interfere with the performance of the device, and hence you should avoid them.
  • Keep mobile phones and smartwatches at least six inches away from the ICD device.
  • Carry an ID with you, stating what type of ICD you have.
  • Contact your doctor if you have any problems with the ICD device, or if it delivers a shock for restarting the heart.

 

Implantable Cardioverter Defibrillator Cost in Bengaluru

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Implantable Cardioverter Defibrillator

An electronic device that is used to constantly monitor the heart rhythm is known as an implantable cardioverter defibrillator or ICD. When a very fast heart rhythm is detected, energy is delivered by the ICD to the heart muscle, allowing the heart to beat in a normal rhythm once again.

An ICD is required if you have a very fast heartbeat that prevents the heart from supplying blood to the rest of the body, or if you are at an increased risk of developing arrhythmia or heart rhythm problems because of a weak heart muscle.

Types:
The different types of ICD include:

  • Traditional ICD: It is implanted in the chest with the wires or leads attached to the heart. Invasive surgery is needed to place this type of ICD.
  • Subcutaneous ICD: This type of ICD is implanted underneath the skin, at the side of the chest. It is attached to an electrode running along the breastbone. It does not attach to the heart.

The heart has four chambers, the upper chambers are known as the atrium (right and left), and the lower chambers are known as the ventricles (right and left). Depending on the heart chamber that the ICD sends electrical signals to, the different types of ICD include:

  1. Single-chamber ICD: This type of ICD sends electrical signals to the right ventricle.
  2. Dual-chamber ICD: This type of ICD sends electrical signals to the right atrium and right ventricle.
  3. Biventricular ICD: This type of ICD sends electrical signals to the right ventricle, left ventricle, and right atrium. It is used in cases of heart failure (the heart fails to pump sufficient blood to the rest of the body).

Parts:
The different parts of an ICD are:

  1. Pulse generator: It contains electrical circuits and a battery to read the electrical activity of the heart.
  2. Leads or electrodes: These are wires (one to three in number) that can go through the veins to the heart, and connect the heart to the rest of the device. 
  3. In-built pacemaker: There is a built-in pacemaker in most ICD’s. The heart may require pacing if the heartbeat is too slow or too fast, or if you have a shock from ICD.

Symptoms

Purpose:
An ICD may be used in the following cases:

  • Ventricular fibrillation (quivering or erratic pumping of blood)

  • Ventricular tachycardia (an extremely fast heart rhythm)

  • Previous heart attack

  • History of heart disease

  • Cardiomyopathy (enlarged or thickened heart muscle)

  • Heart failure

  • Inherited, congenital (present at birth) heart defects like long QT syndrome

The symptoms that start to appear which indicate the requirement of an ICD are- 

  • Pain in the chest

  • Tachycardia and Bradycardia 

  • Dizziness and Weakness

  • Shortness of breath

  • Fainting 

  • Sweating

  • High blood pressure

  • Sleep apnea

Diagnosis

  1. Electrocardiogram (ECG): An ECG is performed to measure the electrical activity of the heart, and diagnose problems with the heartbeat of the patient.
  2. Echocardiogram: This test uses sound waves to create images of the size and structure of the heart, and how blood flows through the heart.
  3. Holter monitoring: The Holter monitor is a wearable device that keeps track of the rhythm of the heart and spot irregular heart rhythms that has been missed by an ECG. It is usually worn for one or two days.
  4. Event recorder: An event recorder is similar to a Holter monitor and requires the person to push a button when symptoms are felt. It can be worn for a longer time than a Holter monitor.
  5. Electrophysiology study: Flexible tubes called catheters are guided through a blood vessel into the heart. It helps in the identification of the area causing an irregular heartbeat.

 

Treatment

The procedure can be performed in two different ways:

1. Endocardial or transvenous approach:

  • This procedure is performed under local anesthesia (the area of the procedure is numbed).
  • The surgeon makes small incisions or cuts in the chest.
  • The lead is inserted through the cut into a vein, which is guided to the heart with the help of x-rays.
  • One tip of the lead is attached to the heart muscle, and the other end is attached to the pulse generator.
  • The generator is placed under the skin of the upper chest.
  • The patient usually stays in the hospital for one day after the procedure.

2. Epicardial or surgical approach:

  • This is the less common method used for an ICD.
  • This procedure is performed under general anesthesia (the patient is put asleep during the procedure).
  • The doctor places the generator in a pocket that is created under the skin in the lower abdomen.
  • The patient usually stays in the hospital for 3 to 5 days after this procedure.

Once the leads are in place, they are tested by the doctor to make sure that they are working properly and are in the right place.
Small amounts of energy are sent through the leads into the heart, causing the contraction of the heart. This is known as the lead function test or pacing.
After the leads have been tested, the doctor connects them to the ICD device.
The doctor then uses a programmer or external device for making the final device settings.
The procedure may take two to four hours to complete.

Risks

Complications of the ICD surgery can include:

  • Infection
  • Bleeding
  • Swelling
  • Bruising
  • Damage to the blood vessels
  • Regurgitation (leakage of blood through the heart valve)
  • Pneumothorax (collapse of lungs)
  • Movement of the leads or device causing heart perforation

 

After Procedure

  • It is normal to have some pain and tenderness after the procedure.
  • The doctor may prescribe a pain killer to relieve the pain and discomfort after the procedure.
  • Avoid heavy lifting and strenuous activities for at least one month after the procedure.
  • Avoid driving for at least six months after the procedure. Driving can be resumed only if one can go for long periods of time without any shock (approximately 6 to 12 months), or if one does not faint after a shock.
  • Follow-up appointments with your doctor every three to six months after the procedure are required. The doctor will program your device.
  • The battery in the device lasts for approximately five to seven years. A separate procedure will be required to replace the batteries.
  • Certain objects like security systems, medical equipment like MRI machines, and power generators may interfere with the performance of the device, and hence you should avoid them.
  • Keep mobile phones and smartwatches at least six inches away from the ICD device.
  • Carry an ID with you, stating what type of ICD you have.
  • Contact your doctor if you have any problems with the ICD device, or if it delivers a shock for restarting the heart.

 

FAQ Section

1) What is an implantable cardioverter-defibrillator?

An implantable cardioverter-defibrillator is a pager-sized device which is placed in the patient's chest to reduce his or her risk of dying if the lower chambers of their heart go into a dangerous rhythm and stop beating effectively, leading to cardiac arrest.

2) Why is ICD done?

An ICD is surgically placed under the patient's skin, usually below his or her left collarbone. One or more flexible, insulated wires run from the ICD through the patient's veins to his or her heart. Because the implantable cardioverter-defibrillator constantly monitors for abnormal heart rhythms and instantly tries to correct them, the device helps treat cardiac arrest, even when the patient is far from the nearest hospital

3) How is an ICD different from a pacemaker?

A pacemaker is a small device that’s placed under the skin of the patient's chest or abdomen to control abnormal heart rhythms. An ICD is a small device placed in your chest or abdomen if you have an irregular heartbeat or are at risk for sudden cardiac arrest. The biggest difference between an ICD and pacemaker is that pacemakers only give low-energy electrical pulses to restore a regular heartbeat but an ICD continually monitors heart rhythm and can send low- or high-energy electrical pulses to correct abnormal heart rhythm. ICDs initially send low-energy pulses to restore heart rhythm. But they switch to high-energy pulses when the low-energy shocks are ineffective.

4) Should you go for ICDs or a pacemaker?

ICDs are more effective if you are at high risk for or with a history of sudden cardiac arrest and may need these more powerful, high-energy electrical pulses to restore your regular heartbeat. In addition to that, most new ICDs can act as both a pacemaker and a defibrillator.

 

5) How an ICD works

An ICD is surgically placed under the patient's skin, usually below his or her left collarbone. One or more flexible, insulated wires run from the ICD through the patient's veins to his or her heart. The implantable cardioverter-defibrillator constantly monitors for abnormal heart rhythms and instantly tries to correct them and can send low- or high-energy electrical pulses to correct abnormal heart rhythm. ICDs initially send low-energy pulses to restore heart rhythm. But they switch to high-energy pulses when the low-energy shocks are ineffective.

6) How is the procedure done?

A small incision, approximately 2 to 4 inches long, is made in the upper chest area, just below the collarbone. 1 or 2 leads are guided through a vein into the heart and are connected to the defibrillator. The defibrillator settings are programmed, and the device is tested to ensure it is working properly to meet the patient's medical needs. The defibrillator is inserted beneath the skin, and the incision in the chest is closed. 

7) How long does the patient need to stay in the hospital?

The procedure to implant a defibrillator does not require open heart surgery, and most people go home within one day.

8) What typed of anesthesia is used during the surgery?

Before the surgery, medication can be given to make the patient sleepy and comfortable. Generally, the ICD surgery is performed under local anesthesia. 

9) Who needs an ICD?

A person may need an ICD if he or she has a dangerously fast heartbeat or a chaotic heartbeat that keeps their hearts from supplying enough blood to the rest of their body (ventricular fibrillation). A person can be a candidate for an ICD if he or she had sustained ventricular tachycardia, survived a cardiac arrest, or fainted from ventricular arrhythmia.

10) What are the risks associated with ICD implantation?

Although uncommon, several risks are associated with ICD implantation:

  • Allergic reaction to the medications used during the implantation
  • Bleeding around the heart that can be life-threatening
  • Blood leaking through the heart valve where the lead is placed
  • Collapsed lung (pneumothorax)
  • Damage to the vein where the leads are placed
  • Infection at the implant site
  • Swelling, bleeding or bruising 

11) What is the cost of ICD ( Implantable Cardioverter Defibrillator ) Implantation in India ?

The Cost of ICD ( Implantable Cardioverter Defibrillator ) Implantation in India varies across different cities and hospitals.

Cost of ICD ( Implantable Cardioverter Defibrillator ) Implantation in India
CITY COST
Cost of ICD Implantation in Mumbai      INR 300000- INR 350000  
Cost of ICD Implantation in Bangalore INR 280000- INR 340000
Cost of ICD Implantation in Delhi INR 280000- INR 340000
Cost of ICD Implantation in Chennai    INR 270000- INR 330000