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Hi, my name
is Dave Navarro. I have had a ICD for 8 years. This is my 2nd ICD
and I will try to give you answers,
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Q. What is an I C
A. ICD means Implantable Cardioverter-Defibrillator. Like a
pacemaker, it(Medtronic, Guidant, St Jude) is a device to
correct cardiac arrhythmia. This device usually has a pacing
function to overcome slow beats. The cardioversion-defibrillation
circuitry provides a short burst of high voltage electricity to
disrupt the "fluttering" when a heart races as fast as 300+
beats per minute, and restore a normal (sinus rhythm) heart
Q. Is this Treatment REALLY medically necessary?
A. YES, if your doctor has performed an electrophysiology study
and determined you are likely to suffer potentially fatal
arrhythmia. Research posted again verifies the life saving
value of these Treatment devices: Suggesting it for most people
who survive a heart attack that resulted in significant damage
to the heart muscle. See below to understand how an ICD
improves your chance of survival.
Q. Where is the ICD implanted ?
A. In the old days, the devices were implanted left of the
belly button with a long cable running under the breast, up near
the collar bone, and down into the heart. Now that engineers
found ways to make the ICD smaller, they are usually implanted
in the left upper chest - eliminating some of the persistent
pain that goes with the long cable which can move around.
Q. Do I have other options for placement?
A. Previous implants may limit your choices. With a previous
pacemaker, your ICD may be implanted on the right side.
Depending on your body type, you may have the implant just under
the layers of skin. Some prefer to have it deeper, imbedded
under muscle tissue: A sub-pectoral implant. Ask your doctor to
understand the benefits and disadvantages of each.
Q. How long does it take to recover from ICD surgery and for
the wound to heal?
A. It depends on the individual and whether there are other
health problems needing attention. Most people leave the
hospital the day after their initial implant, or a few hours
after a replacement surgery.
The wound should heal in a couple weeks. You can reduce the
scarring by using an aloe and vitamin E solution after your
wound is sealed.
Q. Why did they tell me not to lift my arm over my shoulder or
lift anything heavy for six weeks after my implant?
A. Besides inserting the ICD into your body they also had to
run 1 or more leads (wires) from the device into your heart.
They dont want them to be pulled out, broken, or disconnected.
During this six week period your body will start to heal over
these leads. You can then return to a normal life.
Help Wanted: This is your chance to be a founding member of
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No experience necessary.
The process of implantation of an ICD
is similar to implantation of a pacemaker.
Implantable Cardioverter Defibrillator
Answers to your questions about
implanted defibrillators and more!
An implantable cardioverter-defibrillator
(ICD), also known as an automated implantable cardioverter-defibrillator
(AICD), is a small battery powered electrical impulse generator
which is implanted in patients who are at risk of sudden cardiac
death due to ventricular fibrillation. The principles of cardiac
arrhythmia detection and treatment are incorporated into the
implantable device. In current variants the ability to revert
ventricular fibrillation has been extended to include atrial and
ventricular arrhythmias as well as the ability to perform
biventricular pacing in patients with congestive heart failure and
to pace should there be any marked bradycardia.
The process of implantation of an ICD is similar to implantation of
a pacemaker. Similar to pacemakers, these devices typically include
electrode wire/s which pass through a vein to the right chambers of
the heart, usually being lodged in the apex of the right ventricle.
ICDs constantly monitor the rate and rhythm of the heart and can
deliver therapies, by way of an electrical shock, when the
electrical manifestions of the heart activity exceeds the preset
number. More modern devices can distinguish between ventricular
fibrillation and ventricular tachycardia (VT), and may try to pace
the heart faster than its intrinsic rate in the case of VT, to try
to break the tachycardia before it progresses to ventricular
fibrillation. This is known as fast-pacing, overdrive pacing, or
anti-tachycardia pacing (ATP). ATP is only effective if the
underlying rhythm is ventricular tachycardia, and is never effective
if the rhythm is ventricular fibrillation.
Many modern ICDs use a combination of various methods to determine
if a fast rhythm is normal, ventricular tachycardia, or ventricular
Rate discrimination evaluates the rate of the lower chambers of the
heart (the ventricles) and compares it to the rate in the upper
chambers of the heart (the atria). If the rate in the atria is
faster than or equal to the rate in the ventricles, then the rhythm
is most likely not ventricular in origin, and is usually more
benign. If this is the case, the ICD does not provide any therapy.
Rhythm discrimination will see how regular a ventricular tachycardia
is. Generally, ventricular tachycardia is regular. If the rhythm is
irregular, it is usually due to conduction of an irregular rhythm
that originates in the atria, such as atrial fibrillation.
Morphology discrimination checks the morphology of every ventricular
beat and compares it to what the ICD believes is a normally
conducted ventricular impulse for the patient. This normal
ventricular impulse is often an average of a multiple of beats of
the patient taken in the recent past.
The development of the ICD was
pioneered at Sinai Hospital in Baltimore by a team including Stephen
Heilman, Alois Langer, Morton Mower, Michel Mirowski, and Mir Imran,
with the help of industrial collaborator Intec Systems of
Pittsburgh. Mirowski teamed up with Mower and Staewen, and together
they commenced their research in 1969 but it was 11 years before
they treated their first patient. Imran was the young engineer who
was able to turn the benchtop idea into a working device. Using
analogue tape recordings of patients heartbeats, Imran developed
algorithms and hardware that are the foundation of todays ICD's and
Cardiac Rhythm Management industry. Similar developmental work was
carried out by Schuder and colleagues at the University of Missouri.
More than a decade of research went into the development of an
implantable defibrillator that would automatically sense the onset
of ventricular fibrillation and deliver an electric countershock
within 15-20 seconds, converting the rhythm to sinus rhythm.
Improved versions were programmed to be able to detect ventricular
tachycardia, often a forerunner of ventricular fibrillation. These
were then called implantable cardioverters.
The work was commenced against much skepticism even by leading
experts in the field of arrhythmias and sudden death. There was
doubt that their ideas would ever become a clinical reality. In 1972
Bernard Lown, the inventor of the external defibrillator, stated in
the journal Circulation - "The very rare patient who has frequent
bouts of ventricular fibrillation is best treated in a coronary care
unit and is better served by an effective antiarrhythmic program or
surgical correction of inadequate coronary blood flow or ventricular
malfunction. In fact, the implanted defibrillator system represents
an imperfect solution in search of a plausible and practical
The problems to be overcome were the design of a system which would
allow detection of ventricular fibrillation or ventricular
tachycardia. Despite the lack of financial backing and grants, they
persisted and the first device was implanted in February 1980 at
Johns Hopkins Hospital by Dr. Levi Watkins, Jr. Modern ICDs do not
require a thoracotomy and possess pacing, cardioversion, and
A number of clinical trials have
demonstrated the superiority of the ICD over AAD (antiarrhythmic
drugs) in the prevention of death from malignant arrhythmias. The
SCD-HeFT trial (published in 2005) showed a significant all-cause
mortality benefit for patients with ICD. Congestive heart failure
patients that were implanted with an ICD had an all-cause death risk
23% lower than placebo and an absolute decrease in mortality of 7.2
percentage points after five years in the overall population.1
Reporting in 1999, the Antiarrhythmics Versus Implantable
Defibrillators (AVID) trial consisted of 1,016 patients, and deaths
in those treated with AAD where more frequent (n=122) compared with
deaths in the ICD groups (n=80, p < 0.001)
Initially ICDs were implanted via thoracotomy with defibrillator
patches applied to the epicardium or pericardium. The device was
attached via subcutaneous and transvenous leads to the device
contained in a subcutaneous abdominal wall pocket. The device itself
acts as an electrode. Most ICDs nowadays are implanted transvenously
with the devices placed in the left pectoral region similar to
pacemakers. Intravascular spring or coil electrodes are used to
defibrillate. The devices have become smaller and less invasive as
the technology advances. Current ICDs weigh only 70 grams and are
about 12.9 mm thick.
What to Expect During
Implantable cardioverter defibrillator (ICD) implantation surgery
generally takes place in an operating room, cardiac catheterization,
or electrophysiolgy (EP) laboratory. The room will be full of
equipment and medical personnel. You will be asked to lie on a bed
with safety straps placed over your legs. Your arms are secured at
your sides, as it is important that the arms remain still during the
Your chest is then washed again and drapes are placed over the
implant area. You will receive one or more shots of numbing medicine
in your chest area. Because of the drapes, you won't see the shot.
The doctor may touch the area and ask if you are losing sensation in
your upper chest.
There are several methods of ICD implantation. The type of surgery
you will undergo depends upon many factors, including prior
surgeries and type of device. There are four main steps to any ICD
- Lead Placement
- ICD Placement
- Additional Testing
The implantation procedure begins with the placement of one or more
leads (depending upon which will provide the best therapy for you).
Transvenous means through the vein. With this method, the physician
makes a small incision near your collarbone and maneuvers one or
more leads through a vein into your heart. The tip of each lead
(called the electrode) is positioned next to the inside heart wall (endocardium).
The ICD is then implanted under the skin in a specially prepared
pocket, usually in the right or left upper chest. This is the most
common technique used today.
The term thoracotomy is general and refers to several types of
open-chest procedures. A thoracotomy is used to sew patch leads on
the outside of the heart (epicardium). The leads are insulated wires
connected to thin oval patches made of rubber and wire mesh.
This approach is similar to a thoracotomy; however, the incision is
made over the breastbone, or sternum, and the leads are advanced
into the heart. This is the type of operation that is commonly used
in coronary bypass and heart valve surgery.
This approach is also similar to a thoracotomy; however, the
incision is made slightly to the left of the sternum.
Once implanted, the leads are tested to ensure they will perform.
The medical team provokes, or induces, a rhythm disorder and allows
the device to deliver therapy. If the therapy is inadequate, the
lead is moved to a different position in the heart. It is not
uncommon to have to reposition a lead to get most effective therapy.
Once testing is completed and your physician is assured that the
leads are in good position, the ICD is connected to the leads. The
device is then usually placed under the skin either near the
collarbone or somewhere above or at the waistline.
Once the ICD is implanted, additional testing is performed to ensure
the system will effectively correct your arrhythmia. If the test
results are unsatisfactory, the problem may be with the device. Only
after the leads and ICD are tested successfully is the procedure
Heart and Vessel Procedures
ICD (Defibrillator) Implantation
What Can I Do to Prepare for My Defibrillator Implantation?
Your doctor or nurse will give you specific instructions about
preparing for your ICD implant. Common guidelines involve whether
you should continue or stop certain medications, if you should avoid
eating or drinking in the hours before surgery and what the hospital
check-in procedures are.
What Happens During the Procedure?
The procedure to implant an ICD has been greatly simplified over the
years. During the surgery, you will be attached to several monitors.
Usually, the medication you will be given makes you very relaxed and
Determining Where to Implant
The ICD system may be implanted in either your chest or your
abdomen. Your doctor will determine the best way to implant your
pulse generator. Your age and the size of your heart will be
considered. Your doctor will also consider whether you have ever had
chest surgery. Your activities and lifestyle may suggest where the
ICD is implanted. Overall, the method selected will offer the
greatest safety for you.
Just as the best position of the pulse generator is determined for
each individual, lead placement is customized for each patient as
well. Some patients may require an additional lead for treating fast
rhythms. This lead can be placed just under the skin next to your
rib cage through a small cut in your left side. Or, sometimes an
additional lead is placed on the outside of the heart. These steps
are taken to insure that the ICD system can adequately sense the
life-threatening rhythms and deliver the appropriate energy to treat
Placing the Pulse Generator and Leads
After numbing the area of the implant, the doctor will make a small
pocket under the skin for the pulse generator and will place the
lead or leads. For most patients, the leads are placed inside the
heart. The doctor opens a vein, usually through a small cut near
your collarbone. The doctor can then thread the lead through the
vein and position it inside your heart chamber. The tip of the lead
rests against the inner heart wall.
If your heart condition requires two-chamber pacing, another lead is
positioned in the upper right chamber (atrium) of your heart. This
dual-chamber lead system allows the pulse generator to watch and
treat the areas of heart that your doctor has determined need
Testing the System
After the leads are in position, they are tested to make sure they
sense your heart signals clearly. The leads are then stitched to
nearby tissue so that they won't move. The leads are connected to
the pulse generator.
During the operation, the whole ICD system will be tested to make
sure it is working properly. For this test, your doctor will start
an arrhythmia in your heart. The ICD system will sense the rhythm
and give the programmed treatment.
What Happens Right After the Procedure?
After the operation, you may be in the hospital for the first day or
two. This allows the doctors and nurses to watch and record your
heart rhythm with an ECG machine. When you are ready, you will be
allowed to return home.
Testing Your ICD
Before you leave the hospital, your doctor may test the ICD again.
Your experience of ICD therapy will be as unique as you are. People
with abnormal heart rhythms may experience unusual sensations during
their arrhythmias, but not everyone feels their arrhythmias. Your
ICD system will deliver treatment based on what it senses even if
you don't feel any symptoms. You may, however, feel sensations
during therapy delivery. These feelings have been described in a
variety of ways.
* Antitachycardia pacing You may not feel pacing therapy when it
is delivered to your heart. You may have a feeling of fluttering in
your chest. Most patients who receive ATP therapy say it is
* Cardioversion These low-energy shocks are stronger than pacing
pulses. Many patients say cardioversion is mildly uncomfortable. It
feels like a thump on the chest.
* Defibrillation Many patients faint or become unconscious shortly
after a very fast VT or VF rhythm starts. As a result, they do not
feel these high-energy shocks. Of those patients who are conscious,
some describe the shock like a "kick in the chest." Usually, the
shock comes suddenly. The sensation lasts for only a second. While
many find the shock reassuring, other patients may feel anxious for
a short time after shock therapy is delivered.
* Bradycardia pacing These pacing pulses are very low energy and
typically are not felt by patients.
Before leaving the hospital, some patients also perform an exercise
treadmill test. This test helps your doctor watch your heart rhythm
with the ECG machine and know that your ICD is working.
Paul Stanley, a singer and
guitarist with rock band Kiss, was forced to pull out of a show in
California on Friday after his heart started beating at more than
twice the normal level, he said on his Web site.
The apparent tachycardia happened while the band was rehearsing for
a performance at a casino in San Jacinto, California, about 90 miles
east of Los Angeles.
"My heart spontaneously jumped to 190 plus beats per minute, where
it stayed for over an hour necessitating paramedics to start an IV
and give me a shot to momentarily stop my heart and get it into a
normal pattern," Stanley, 55, wrote on his site (http://www.paulstanley.com)
A normal heart rate at rest is about 60 to 80 beats a minute,
according to the American Heart Association.
Tachycardia, or rapid heart rate, can cause palpitations, shortness
of breath, chest pain, dizziness, lightheadedness, fainting or near
fainting, the group said on its Web site (http://www.americanheart.org).
Stanley said he was advised performing would be risky, and the show
went on without him. Fellow principal Gene Simmons told fans the
group would play as a trio, and turned the show into a tribute to
his ailing bandmate.
A call to Kiss manager Doc McGhee for an update on Stanley's
condition was not immediately returned late on Saturday.
Stanley, born Stanley Eisen, and Simmons co-founded Kiss in New York
City in 1973. Adored by fans, despised by critics, the group made a
name for itself performing in white face make-up and ghoulish
Hits during its heyday included such anthems of teen rebellion as
"Rock and Roll All Nite" and "Shout It Out Loud." Stanley released a
solo album last year.
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