Patient Information
WHAT DOES AN ICD DO?
An implantable cardioverter-defibrillator (ICD) is an electronic device that constantly monitors the rate and rhythm of your heartbeat. It can help if your heart beats too fast. If the rhythm of your heartbeats is very irregular and your heart cannot supply enough blood to the rest of your body, an ICD can help you. By recognizing and stopping life-threatening problems with your heartbeat, an ICD can save your life.
HOW DOES AN ICD WORK?
An ICD is really an amazing computer. It is small (about the size of a pager) and can be easily put into your chest. The device works by sensing when your heart is beating abnormally—too fast, too slow, or too irregularly. If this happens, the ICD will send out electrical shocks to make the heart beat normally. You may have seen heart paddles being used on TV to shock an unconscious person who has no heartbeat. An ICD works the same way the paddles do except that it uses much smaller versions that are inside your chest and work automatically. You do not have to be at a hospital or with medical providers for your ICD to fix your heart problem.
WHO SHOULD GET AN ICD?
An ICD is beneficial for several types of patients:
• A person with a fast, abnormal heart rate and rhythm, called
ventricular tachycardia
• A person who has had a heart attack or suffered cardiac arrest
• A person who has fainted from a serious, life-threatening heart rhythm, called ventricular fibrillation
• A person who has a blocked coronary artery
• A person with a condition that involves abnormal heart muscle, such as an enlarged heart (dilated cardiomyopathy) or a thickened heart muscle (hypertrophic cardiomyopathy)
• A person who has a heart defect that makes the heart beat abnormally.
WHAT PROBLEMS DOES AN ICD ADDRESS?
An ICD can correct several problems:
• When your heart beats too slowly, the ICD sends out small amounts of energy to make your heart beat at a normal pace. In this way, it acts just like a pacemaker.
• When your heart beats too fast, the ICD sends out small amounts of energy to make it beat at a normal pace and with a normal rhythm.
• If your heart is beating in a seriously abnormal rhythm, the ICD can deliver more energy to return your heart rhythm to normal.
• If your heart is beating dangerously fast and cannot supply your body with the blood it needs, the ICD can deliver a high-energy shock to make your heart beat normally.
HOW SHOULD I PREPARE FOR THE SURGERY?
The surgery to insert the ICD into your chest is relatively minor. Talk to your health care provider about how to take your medications before the procedure. Medications that thin your blood, such as aspirin, ibuprofen (Advil, Motrin, others), clopidogrel (Plavix), or warfarin (Coumadin) and/or heparin, may need to be stopped 1 to 5 days before the surgery. Don't drink or eat anything for at least 8 hours before the ICD is inserted. If you need to take some of your medications within 8 hours of your surgery, you will have to take them with just a small sip of water.
WHAT IS INVOLVED?
Implanting your ICD will probably take 1 to 3 hours. You will be given medication to make you numb and a sedative that will put you in a relaxed state. You will be aware of what is happening, but you should not feel pain. The ICD will be programmed at this time and tested to make sure that it is working properly. Because the testing will involve electrical shocks, you will be given some medicine to make you sleep during this time. You will probably stay in the hospital for 1 to 2 days after surgery, and the device will probably be evaluated one more time before you leave the hospital. You will not have to be asleep for this or any other checks done later.
After the procedure, you may have some pain for a few days or possibly weeks. You will be given some pain medication when you leave the hospital. After that, nonaspirin pain relievers, such as acetaminophen (Tylenol) or ibuprofen, should control any slight discomfort you may have. You should be able to return to normal activities very soon after the surgery. Some strenuous activities may be restricted for the first 4 weeks. You are not likely to have problems resulting from electrical interference with the ICD. Your health care provider will tell you if there is anything you need to avoid. In addition, you will have to discuss with your health care provider when you can drive, as there are guidelines for this from the American Heart Association.
Your ICD will need to be checked every 3 to 6 months to ensure that it is working properly. Most ICDs will last for up to 7 years. A replacement can be inserted as an outpatient surgery. This surgery will be even more minor than the first surgery. JAAPA