Implantable Cardioverter Defibrillator

Implantable Cardioverter Defibrillator (ICD) is a small device that is inserted below the collar bone in order to detect changes in the heart beat and to ensure that it is standard. It is an effective tool for those patients who suffer from ventricular tachycardia, sudden changes in heartbeat, ventricular fibrillation or other heart disorders and keeps them from arrhythmia and cardiac arrest. An ICD monitors the heartbeat effectively by sending electric signals to the heart, as a result of which defibrillation occurs. 

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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

The need for an Implantable Cardioverter Defibrillator can be diagnosed by Electrocardiogram which can sense the electric activity of the heart and hence can detect any abnormalities in the heart beat. Holter and Event monitors can be used instead to check the patterns of heart beat more consistently while one does all daily activities and also alerts the patient in case of arrhythmia. An Echocardiogram is helpful to produce detailed images of the heart by using sound waves. To examine the heartbeat patterns in all situations, the doctor may also conduct Stress tests in which the patient has to exercise. 

During the implantation of an ICD, the patient is connected to an ECG in order to continuously monitor breathing rate, heartbeat and blood pressure. The ICD has lead wires which are inserted inside the heart through the blood vessel by a mesh. The lead wires are tested for their functioning.  The ICD generator is then implanted below the collar bone on the suitable side. If the patient is right handed, it is put on the left side and vice versa. 

Complications of the ICD surgery can include:

  • Infection and Bleeding at site of insertion of the ICD
  • Perforation of the heart muscle 
  • Lungs may collapse
  • Heart Attack
  • ICD not functioning properly
  • Wrong connections of the ICD or Electric Failure 

After the ICD is implanted, the patient is regularly checked for heartbeat, blood pressure and pulse. It is essential to avoid all sorts of strenuous activities- pushing, pulling, and weight lifting after the surgery. The arm on the side which the ICD is implanted should not be lifted excessively. It is essential to contact the doctor in case of Fever, Chest pain, Palpitations and Bleeding / infection at the site of incision. 

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Implantable Cardioverter Defibrillator

Implantable Cardioverter Defibrillator (ICD) is a small device that is inserted below the collar bone in order to detect changes in the heart beat and to ensure that it is standard. It is an effective tool for those patients who suffer from ventricular tachycardia, sudden changes in heartbeat, ventricular fibrillation or other heart disorders and keeps them from arrhythmia and cardiac arrest. An ICD monitors the heartbeat effectively by sending electric signals to the heart, as a result of which defibrillation occurs. 

Symptoms

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

The need for an Implantable Cardioverter Defibrillator can be diagnosed by Electrocardiogram which can sense the electric activity of the heart and hence can detect any abnormalities in the heart beat. Holter and Event monitors can be used instead to check the patterns of heart beat more consistently while one does all daily activities and also alerts the patient in case of arrhythmia. An Echocardiogram is helpful to produce detailed images of the heart by using sound waves. To examine the heartbeat patterns in all situations, the doctor may also conduct Stress tests in which the patient has to exercise. 

Treatment

During the implantation of an ICD, the patient is connected to an ECG in order to continuously monitor breathing rate, heartbeat and blood pressure. The ICD has lead wires which are inserted inside the heart through the blood vessel by a mesh. The lead wires are tested for their functioning.  The ICD generator is then implanted below the collar bone on the suitable side. If the patient is right handed, it is put on the left side and vice versa. 

Risks

Complications of the ICD surgery can include:

  • Infection and Bleeding at site of insertion of the ICD
  • Perforation of the heart muscle 
  • Lungs may collapse
  • Heart Attack
  • ICD not functioning properly
  • Wrong connections of the ICD or Electric Failure 

After Procedure

After the ICD is implanted, the patient is regularly checked for heartbeat, blood pressure and pulse. It is essential to avoid all sorts of strenuous activities- pushing, pulling, and weight lifting after the surgery. The arm on the side which the ICD is implanted should not be lifted excessively. It is essential to contact the doctor in case of Fever, Chest pain, Palpitations and Bleeding / infection at the site of incision. 

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