An Implantable Cardioverter Defibrillator (ICD) is a small, pager-sized device that is placed under the skin and continually monitors the heart rate. It detects an irregular heartbeat and delivers an electrical shock to restore normal rhythm. People with heart failure are more prone to certain heart arrhythmias that put them at risk for sudden cardiac death. ICDs are implanted in people to prevent such arrhythmias from occurring. Most people with ICDs have survived a cardiac arrest or suffer from irregular heart rates and have decreased heart function. However, people with other conditions, like a weakened heart muscle or hypertrophic cardiomyopathy, also may be eligible for the devices.
In one study, researchers analyzed data from more than 12,400 Medicare patients, aged 65 and older, who received an ICD after sudden cardiac arrest or a nearly fatal fast heart rhythm. Nearly 80 percent of the patients survived two years after receiving the implanted device, according to the study published in the Journal of the American College of Cardiology.
Implanted Cardioverter Defibrillator
What Does an ICD Do?
An ICD monitors the heart rate. If it detects a dangerous rhythm, it sends a shock of electricity to return the heartbeat to a normal pattern. Most units also can function as pacemakers. Some include special features to strengthen the heartbeat. An ICD is placed under the skin near the collarbone. Wires from the device are attached to the heart during the short procedure.
Joe, 69, has a long history of heart disease. He received an ICD after passing out due to an irregular heart rhythm. “It is like having a built-in paramedic with me every place I go,” says Joe about his ICD. “Knowing it is there is a tremendous comfort. I know I do not have to worry about sudden death. I expect the machine to do the job.”
Patients typically resume their normal activities after the procedure. They must make some changes, though, like avoiding MRI scans, heat therapy (used in physical therapy), high-voltage or radar machinery, or contact with radio or TV transmitters. Carrying a cell phone close to the ICD also should be avoided.
Adjusting to the Technology
It takes most people time to psychologically adjust to the device. Anxiety is common. “The first couple of months I was very aware,” says Lisa, 34, who has hypertrophic cardiomyopathy, a genetic condition that increases her risk of sudden cardiac death. She received an ICD five years ago and trusts it more than her own heart.
“An ICD needs careful consideration,” says Lisa “It is going to be part of your life from here on out. Make sure all your questions are answered before the implant. I do not do anything that is going to get my heart rate so high that I am going to test the boundaries of the device,” she says. “But I have a normal life and do not let it get in the way.”
Lisa is not alone in her concern. There is increasing evidence that patients who have an ICD experience symptoms of anxiety. Patients worry about increasing their heart rate and activities that could test the limits of the device.
Joe’s ICD has jolted his heart twice. After the first shock, while walking up a steep grade, his doctor adjusted the device’s parameters. A second shock occurred four years later. “It felt like the kick of a mule in my chest,” Joe says. “I do not limit my activities at all. It might go off. I have had two experiences. But it is an instantaneous thing, and it goes away. I am fine afterward.”
Joe has walked over five miles during a relay race. He scuba dives, walks four miles daily, exercises with weights, and does push-ups and sit-ups. “Before scuba diving, I called Medtronic (the manufacturer) to find out whether my ICD was capable of taking depths,” Joe says. He also contacted the company before traveling abroad to obtain a list of the medical facilities familiar with ICDs.
Rachel, who received her first ICD after experiencing sudden cardiac arrest at age 33, has not been so lucky. She has felt the kick 57 times. She exercises regularly and at first blamed that activity for triggering the ICD to deliver its jolt. However, then shocks occurred while watching television, in a restaurant, and during a speaking engagement. “It got to the point that I was afraid to go out of the house,” Rachel says. “I had to push through that by connecting with other people and going to support groups. Taking it a step at a time, you do it.”
Rachel has worked through her anger, anxiety, and depression. She describes it as a grieving process for her former self. Some people seek help with emotional aspects from a mental health counselor. Even with the multiple shocks, Rachel knows her ICD has saved her life and has no regrets. “Without this defibrillator, I would not be where I am today,” she concludes. “It has given me some of the best years of my life.”
If you are considering an ICD contact a healthcare provider to determine if an ICD is right for you. Be prepared to discuss the physical and psychological adjustments of the device.
If you have concerns or are experiencing symptoms, please consult your healthcare provider immediately. Dr. Shmuel Shapira of LewisGale Physicians can answer all of your questions regarding cardiac diseases and treatments. You can call the practice at (540) 772-3430 or book an appointment online below.