ICD

• ICD:

  • Implantable cardioverter defibrillator
  • These are clever little devices able to monitor cardiac rhythms, detect potentially dangerous rhythms such as sustained ventricular tachycardia or ventricular fibrillation and deliver therapy via programmable anti-tachycardia pacing in addition to low energy and high energy shocks
  • In the context of chronic heart failure, the use of an ICD is indicated because people with a low ejection fraction are at high risk of Sudden Cardiac Death (SCD)
• What are the main indications for the use of ICD?

  • you have already had a life-threatening abnormal heart rhythm and are at risk of having it again
  • you haven’t had a life-threatening heart rhythm, but tests show you are at risk of one in the future. This is usually because you have inherited faulty genes and may have a condition such as Cardiomyopathy, Long QT syndrome or Brugada syndrome
  • you have heart failure and are at risk of developing a life-threatening heart rhythm. This is called cardiac resynchronisation therapy with a defibrillator, or CRT-D. This single device combines a pacemaker with an ICD. The leads and the CRT-D work together to make sure that the ventricles beat in time
• Describe the surgical procedure for ICD insertion

  • ICDs are inserted under local anaesthetic but with sedation, so you'll feel very sleepy
  • It can take anything from one hour to three or more hours to implant an ICD
  • The time it takes will depend on the type of device you are given
  • You'll often (but not always) need to stay overnight in hospital and your ICD will be checked thoroughly before you leave
• What does an ICD device do exactly?

  • An ICD is placed under the skin, usually in the space just below the collar bone (clavicle) to monitor your heart rate. Thin wires connect the ICD to the heart, where it's always checking your heart rate and rhythm. It monitors your heart rhythm through the electrodes.
  • If an ICD notices a dangerous heart rhythm it can deliver one or more of the following treatments:
  • Pacing – a series of low voltage electrical impulses (paced beats) at a fast rate to try and correct the heart rhythm.
  • Cardioversion – one or more small electric shocks to try and restore the heart to a normal rhythm.
  • Defibrillation – one or more larger electric shocks to try and restore the heart to a normal rhythm.
• Is attendance at a cardiac rehabilitation programme advocated following ICD

  • It's important to have regular follow-up appointments at your ICD clinic, so you can have your ICD checked. Your appointments may be every 3 to 12 months, depending on the type of ICD you have and if it has delivered any treatment. You’ll need to have follow-up appointments for the rest of your life.
  • Some ICD checks may be done remotely with the information from your ICD sent via a signal on the device or a home docking station to your health care professional, so there is sometimes no need to attend hospital.
  • You may have to make some changes to your lifestyle, for instance, if you drive or take part in contact sports. You also need to be aware of how some electronic devices, such as TENS machines or airport security systems, can affect your ICD.
• Following ICD insertion, the person should not lift their arm on the ICD side above 90 degrees for six weeks – why is this?

  • Preventing Lead Displacement
  • Allowing the Leads to Anchor Properly
  • Reducing Stress on the Surgical Incision & Pocket
  • Minimizing the Risk of Shoulder Injury (Frozen Shoulder)