Implantable Cardioverter Defibrillator (ICD)
An ICD is a small metal device put inside your body to help regulate your heartbeat.
Your ICD has two parts:
Why do I need an implantable cardioverter defibrillator (ICD)?
You need an ICD when the electrical system of your heart is not working as it should. When the electrical system is not working, you may have:
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Very slow heartbeat
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Fast heartbeat
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Dizziness
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Fainting spells
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Shortness of breath
How does an ICD help my heart?
The ICD watches your heartbeat. It looks for beats that are not normal. The ICD will send electrical energy to keep your heart beating at a rate that is healthy for you.
The ICD can be programmed to send:
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Small, rapid electrical impulses to pace a fast heartbeat.
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Stronger, electrical energy - a shock to stop a fast heartbeat.
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Small, slow electrical impulses to keep the heart from beating too slowly.
ICD stands for:
Implantable - a device that can be placed in the body under the skin
Cardioverter - an electrical device that sends low-to moderate energy (shock) waves to the heart
Defibrillator - an electrical device that sends high-energy waves to the heart
An ICD may be advised for patients with life-threatening fast heartbeats.
Another type of ICD has added features of “biventricular pacing” or “cardiac resynchronization.” This ICD is used to treat heart failure. In many people with heart failure, the left and right ventricles pump at different times. The ventricles are no longer pumping together as they should. This reduces the heart’s efficiency as a pump and allows blood to “slosh” around inside it. This action wastes the heart’s precious energy and may cause heart failure to worsen. Biventricular pacing is set to stimulate (pace) both heart ventricles to pump together by placing a lead on the right and left ventricle. This improves blood flow to the lungs and rest of the body. A smooth pumping action also causes less wear and tear on the heart muscle.
How is an ICD inserted?
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You will be given warm blankets, and a sterile drape will cover your body in the EP (Electrophysiology) lab.
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You may receive relaxation and pain medications through your IV.
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Your skin is numbed with medicine where the incision is made. The incision is about three inches long.
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The doctor places a small lead (wire) into a vein usually near your collarbone. The wire is moved through the blood vessel into the heart where it is positioned.
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The doctor will place one to three wires into the heart.
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The lead(s) are attached to the ICD generator.
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The ICD is placed under the skin below your collarbone.
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The procedure takes about one to three hours.
What happens right after the ICD is inserted?
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After your ICD is inserted, you will return to your hospital room. The nurses will check your pulse and blood pressure often until you are fully awake.
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The nurses will assist you with activities. You must limit use of the arm on the side of the generator for one month. This is to ensure that the leads which attach to the generator and to your heart do not move.
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You may have some incision pain. Your nurse will give you an ice pack and/or pain medication to relieve the discomfort. Tell your nurse how you feel and if you are having any pain.
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You will be able to eat and drink once you are awake.
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You will be on bedrest for one hour.
Home care guidelines
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There will be a bandage over the insertion site. Do NOT remove this bandage. The doctor will remove it at your follow-up appointment. The bandage is waterproof and can be worn in the shower.
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If the edges of the bandage become unsealed, reseal by placing your hand over the edges for warmth.
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Notify Bryan Heart if any drainage reaches the border of the bandage.
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Do not put any ointments, creams or lotions on your incision.
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Wear loose clothing to prevent irritating the incision.
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You may use an ice pack on the incision for 24 hours after you leave the hospital if your incision remains swollen and tender.
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To avoid nausea, follow a light diet for the first 24 hours after your procedure and take pain medication with food if these have been given to you by your doctor.
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Your doctor may send you home with an arm immobilizer.
Replacing the battery and leads ICD batteries usually last for four to seven years before they need to be replaced. Because the battery is sealed inside the generator, replacing a battery requires replacing the entire generator. The leads will be tested at the same time. If a new lead is needed, the procedure will be like your original implantation. If the leads are not changed there is no restriction in activity.
Exercise to include early on:
Do these exercises six to seven repetitions of each exercise: 4 times a day.
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Shoulder rolls and shrugs: Move your shoulder up and down, forward and backward.
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Small arm circles: Lean forward, let your arm hang loosely, swing clockwise, then counterclockwise.
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Walking arm up wall: Stand facing a wall with your feet apart. Slightly bend your elbow and place your fingers on the wall at shoulder level. Walk your fingers up the wall.
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Do not lift the elbow on the defibrillator side higher than the shoulder (except when doing “walking arm up wall” exercise)
Activity for the first month:
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Do not lift more than 10 pounds for 30 days, unless your doctor instructions you differently.
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Do not bike, bowl, play tennis or golf.
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You may sleep on the side where the device was placed if it does not hurt to do so.
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You may return to work in two to three days after the procedure unless otherwise instructed by your doctor.
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Do not drive for 7 days.
After the first month:
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There are no activity restrictions, except you must avoid contact sports forever. If you have passed out (fainted) due to your heart rhythm, contact your Department of Motor Vehicles for guidelines regarding driving and your medical condition.
Precautions:
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It is OK to be near electrical devices such as a microwave, hairdryer, toaster, computer, electric blanket, power tools and small stereo speakers.
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Talk on your cell phone on the side away from the defibrillator. Do not carry the cell phone in your shirt pocket.
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Stay away from magnetic fields, such as large electrical transformers, electric welding, electrocautery and chain saws.
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Call your doctor to discuss options if an MRI is needed.
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If you have other concerns about interference with your ICD, ask for more information or contact your cardiologist’s office.
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If you have any surgery in the future, tell the surgeon that you have an ICD.
Call your cardiologist immediately if you have signs of infection which are:
It is extremely important that infection be diagnosed early because the wires go directly to your heart. If you have diabetes, carefully monitor your blood sugar. High blood sugar increases your risk of infection.
If you do experience bleeding from the site, place a heavy object such as a 5-pound bag of sugar/flour or a heavy book over the site, and contact your doctor.
Call your cardiologist if you hear beeping tones from your ICD - Strong magnetic fields may cause your device to make beeping tones.
What to do if the device fires (you receive a shock)
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First, and foremost, remain calm since the purpose of the device is to deliver therapy.
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If you feel fine after one shock, have no more symptoms and have a normal pulse, report the shock to your cardiologist’s office during regular business hours, Monday-Friday, 8 a.m. to 5 p.m. and send a transmission.
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Write down the date, time, how you were feeling and what you were doing when the device fired. If you wish, use a logbook to record when the device fires. Share the information with your doctor at your next appointment.
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If you don’t feel well or receive more shocks, go to your local hospital emergency room and notify your cardiologist. Dial 911 if you need help. If you are dizzy, lie down. This may help so you do not pass out, and it lessens the chance of getting hurt if you fall.
Follow-up support
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You will receive a home monitoring device which will be given to you while you are in the hospital or shipped to your home usually within one month after discharge from the hospital. The monitor will be used for follow-up care of your ICD.
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Follow-up checks will be scheduled about every three months to check your ICD. This is to verify proper functioning of your ICD. You will receive a letter after your hospital dismissal with instructions for a follow-up evaluation.
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Buy a Medic-Alert bracelet or chain that says, “Implantable defibrillator/pacemaker.” Wear this at all times.
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You will receive a temporary ICD identification (ID) card in the mail shortly after you return home. You will receive a permanent ID card from the company within six to eight weeks. It will have the type, model number, and date you received your device. Carry this card with you at all times.
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Continue to take all medications as prescribed by your doctor. Please keep a current list of your medications and how much you take of each one. Bring this list with you to each appointment.
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When you have dental work, your device does not need to be turned off as long as the dental equipment is in good working order. If you require a dental exam or procedure within six months after your ICD implant, please contact your dentist for antibiotic medication. After six months, you will not need antibiotic medication for dental work.
To contact Bryan Heart, call (402) 483-3333 or toll free 1-866-895-5611