Help for Heart ICD Pacemaker Cardioverter-Defibrillator Implant Recipients, Families, Doctors, Medical School and Care Givers, Please add to this blog:)

Help Wanted: This is your chance to be a founding member of a Top Level Help web site. Many perks and respect come with the job :) No experience necessary.

Q. What is an ICD?

A. ICD = Implantable Cardioverter-Defibrillator. Like a pacemaker, it 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 beat.

Q. Is this 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 in the spring of 2002 again verifies the life saving value of these 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 and why?

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. Discuss it with your doctor to understand the benefits and disadvantages of each.

Q. How long does it take to recover from 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 don’t 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.

Q. How much is the ICD going to protrude from my chest and will I look like a freak in a bathing suit?

A. That depends on your body and the type of implant you receive. Most of the new units are very small and appear no larger than a pill bottle lid. It will be easier to see if you are skinny, but it will not make you look like a freak.

Q. Will my husband/wife be afraid to touch me?

A. He or she shouldn’t unless your husband/wife was afraid to touch you before your implant. Even if someone is in contact with you when the device zaps you, that person will not be hurt. At most, a bystander may feel a little tingle. One reader wrote to say his spouse actually enjoyed the feeling during an intimate moment.

Q. What’s the maintenance on this device?

A. Just make sure you make your regularly scheduled interrogations - usually once every three months. If something needs to be done, the professionals will take care of it. Otherwise, you need to do nothing for it - no oil changes, no air pressure checks, no adding of fluids like antifreeze.

Q. Will an ICD change my quality of life?

A. Only if YOU let it become an excuse for not doing things you want to do. The condition you have that requires the implant of the ICD may have a profound impact on your life. But the device itself should be nothing more than a small annoyance when you swing a golf club or tennis racket and demands no attention beyond the routine interrogations. After the surgical wound heals, you can nearly forget about it and go about living life the way you choose.

Q. How much does an ICD cost?

A. Like a car, it depends on the model implanted. Some people need lots of the new whistles and bells for specialized treatments such as CHF - others are fine with the basic monitor and therapy functions. Generally, the basic hardware costs $35,000 and the surgical costs for doing the implant run about $35,000. Much of that is covered by most insurance companies, including Medicare.

Q. How long does an ICD last and why does a pacemaker last longer?

A. Current models can last up to eight years. That can be reduced by the number of times you need “therapy” and will be shorter if you need frequent pacing. A pacemaker lasts longer because its battery demands are much lower - its purpose is simpler requiring much less energy and demanding less power for monitoring and analysis.

Q. I feel scared, depressed, etc. Is this normal?

A. This is very common among all - ICD recipients and their loved ones. In fact, if you do not experience this, you are the exception. Because it’s a pretty normal reaction to needing a piece of electronic hardware inside you to stay alive, it is imperative you find ways to deal with it. For extreme cases, your doctor may prescribe psychotropic drugs such as paxil or xanax.

As time passes, you may be able to stop taking drugs as you find other ways to deal with the fear and depression. Many of us find just “talking about it” is every bit as effective as drugs. Local ICD support groups are great for providing this kind of outlet.
Our online, real-time support groups have given relief to people over the years - as ICD recipients can share thoughts with others who have experienced the same things. Our internet messaging service provides a way to exchange thoughts with others at any time of the day or night. Others prefer posting messages on the Forum… then come later to read responses to their posting (or via email for the list service.)

Scientific research and personal experience have shown the emotional impact is actually greater on our loved ones than us - the implant recipients. Because of that, we make all of our programs available to spouses, significant others, parents, children, and others. Be sure to let your friends and family knows: They are welcome here, too.

Q. Can I still have a heart attack even though I have the ICD or do I become immune?

A. Yes, you can still have a heart attack. An ICD does not prevent a myocardial infarction, which is a blocked artery causing heart muscle tissue to die. Things like exercise, improved diet, reduced stress, and other lifestyle changes suggested in a cardiac rehab program will reduce chances for a heart attack.

The ICD implant will save your life 99% of the time if you have a potentially lethal episode of arrhythmia. (According to current statistics.) Currently, available medications prevent fatal arrhythmias about 85% of the time. So you can see, the ICD does increase your survival odds significantly.

Since arrhythmia is often experienced by people after an MI, your device may act as an early warning system - to announce you have a problem needing prompt attention for situations such as a heart attack, congestive heart failure, or an electrolyte imbalance - all of which can be life threatening.

Q. I feel flutters at times. Are missing heartbeats normal?

A. Actually, most of the time it’s not a “missing” heart beat… but an extra one that we experience in the form of a PVC - pre-ventricular contraction. While discomforting they are not uncommon and only become a problem when there is a long sustained run of them. Many of us take medications to decrease these events - and the ICD is inside us to take care of those which may lead to a dangerous situation.

Suggestion: Don’t stare at your EKG monitor in the ambulance, ER, or CICU looking for these things. If they happen, they happen. Learn to trust your device and your caregivers to respond if necessary. You should NOT worry as that will only make the situation worse - perhaps much worse.

Q. What does a shock (aka: “zap” by us and “therapy” by doctors) feel like? (The #1 question asked.)

A. That’s a tough one. Like a sneeze, everyone’s reaction is different. Some people describe it like being kicked by a mule, others hit by a two by four; still others describe the rush of electricity through their body to ground. Some people black out and may collapse before “therapy” is administered. Others are conscious for the whole thing. The lucky ones feel a little tingle. Suffice it to say, it’s not the most pleasant experience that you will encounter during your life. However, it sure beats the alternative!

Some times a single shock is enough to restore your heart back to a normal rhythm, other times you make be shocked multiple times. This is often referred to as an “electrical Storm.”

Q. What should I do after a shock?

A. Sit down, if you’re not already sitting or lying down! If the first shock doesn’t correct the problem you may receive another. You want to avoid further injury as you may fall onto something.

Your doctor should have given you instructions on how to proceed. Generally, if you have received multiple shocks they will want to see you immediately. If you have a single shock and you feel fine, you should still give your EP office a call. They may set up a time in the next couple of days to interrogate your device.

Q. Will I be able to drive? (The second most asked question.)

A. Driving restrictions vary from state to state - many prohibit driving for a period of 3 or 6 months from the date of implant. Others only restrict driving if you’ve blacked out during the last several months. Your doctor, local DMV, or State Police should be able to advise you about whether you may drive.

Even if you are permitted to drive you may want to consider letting someone else drive if that is possible. This is especially true if you faint or blackout due to your condition. Before driving you should be comfortable with the potential consequences if you were to have a shock while at the wheel. A recent study did conclude that Zappers were safer drivers (involved in fewer fatalities) than the general public.

Remember: Having an ICD does not restrict your driving privilege. The reason you have an ICD is what determines whether you can drive.

Q. Will my car’s seatbelt interfere with my device?

A. A seat belt may feel uncomfortable, especially the first few weeks after implant. Some people find that a padded seat belt protector reduces the discomfort. (You can also just wrap the seat belt with a towel.)

Q. I am going on a trip. What do I do about airport security? Will the scanners interfere with my ICD?

A. Make sure that in addition to your passport or other identification that you also have your ICD owner’s card with you when you travel. Generally, you can pass through the scanner, but you may likely set off the alarm. NEVER let the security guard scan you with the handheld wand; it can interfere with your device and change the programming! Have your ICD card handy to show security. Tell them that you have an ICD / pacemaker and you need to be hand searched. Some people are more comfortable requesting a hand search from the start.

Airport security guards are pretty good about this, but most deputies at court houses have yet to receive the training necessary to understand the danger to us. If you run into a uniformed officer determined to use the wand: Demand they call their supervisor to the scene!

Q. What about store security systems?

A. Generally, they do not interfere with your device. Walk thru them. Do not linger between them. In those rare cases where you set off the detector, just show them your ICD implant card and you can continue on your way. If you hear a beeping noise - it may be your ICD telling you to move away from the detectors.

Q. My ICD is making a beeping noise, what should I do?

A. Some ICD’s make audible tones for a variety of situations. Some are programmed to do a “self check” every day at a specific time. If there is a problem, broken lead, low battery, etc. it will make a noise. If there is a more immediate problem the device may emit a constant tone. If your device starts making a tone contact the doctor/hospital that monitors your device. They will advise you what to do next.

In addition some ICD’s will emit a tone if you are too close to a powerful magnetic field. This is often reported by concert fans that stand too close to the huge loud speakers. Move back away from the potential source. If you are clear of the field the noise will disappear.

During your next interrogation ask and they should be able to demonstrate the noises your ICD can make and explain their meanings.

Q. How do they change the ICD batteries?

A. Actually they cannot change the batteries. The ICD is an intact sealed case. When the batteries run low your implant will be replaced. This is not bad because each generation of ICD is smaller and more sophisticated that the generation before, allowing you to get upgraded hardware.

Generally, the replacement is done on an out-patient basis. If the leads are still good, they will open you up, remove the old ICD, and install the new one. Your recovery time will be faster. You will not have the same restrictions about raising you arm and lifting as during the initial implant.

Q. What are interrogations?

A. An interrogation is a periodic visit where the medical personnel with connect your ICD to a computer. They place a device on the skin above your ICD that is about the size of a computer mouse. Using the computer they can download information about events that were detected, therapy administered, make adjustments in the programming, test leads and the device, and verify battery settings. More and more device makers are offering advanced systems that allow the remote monitoring of an ICD over phone lines, cell phones, internet connections, even satellites!

You should bring a list of medications that you are currently taking. In addition, if you have any notes about dates/times when you didn’t feel well, you may want to bring them too.

The results of the interrogation will be printed out and added to your file. You may want to request a copy of your device settings to keep with you, especially if you travel.

It is not painful. You are able to talk and ask questions during the interrogation. If they exercise some of the pacing functionality you may experience some discomfort or facial “flushing” as the technician increases the pace of your heartbeat.

Q. What’s pacing and why do I have it?

A. Almost all implantable Cardioverter-defibrillators have built in circuitry to pace the heart, in addition to familiar “zapping” function to correct V-Tach or V-Fib, when the heart beats too fast. The pacing function starts if the heart beats too slowly. That happens to many of us, especially when we sleep, because some of the anti-arrhythmic medicines we take do slow down the heart beat. Newer ICD models will actually try to pace you out of a dangerous arrhythmia, before giving you a full powered therapy.

Q. What is a NIPS test?

A. NIPS stands for Non-Programmed Stimulation test. So clinics periodically (every year or two - if you have not received a therapy) perform this procedure, others never do this after you are initially implanted. This test is done on an outpatient basis. Under anesthesia, your heart is placed in arrhythmia, and your ICD shocks you back into normal rhythm. If for some reason the device does not work correctly they would restore a normal rhythm with an external defibrillator. The purpose of the test is to verify that all the components are connected and functioning correctly.

Q. What’s inappropriate therapy?

A. Though the programming in the ICD’s is very sophisticated there are situations where physicians may misdiagnose your situation resulting in improper ICD programming, and you get a shock/zap/therapy that is not needed. This is called an inappropriate therapy. Many inappropriate therapy situations can be addressed by reprogramming in your ICD. Others may be avoided by medication. Finally, the ICD manufacturers are always trying to improve their devices to avoid these situations. The vast majority of shocks received are appropriate and life saving therapy.

If you do receive an “inappropriate therapy,” don’t be surprised if you wish that your doctor, nurse, etc would receive a little “inappropriate therapy” themselves. Especially, if they caused the problem by the settings.

Q. What are phantom zaps?

A. Publisher, Jon Duffey is credited with first joining the words to form the name “Phantom Zap,” having authored the term for an article he wrote in early 1995.

This, like the depression and anxiety is pretty common. Many Zapper readers report being zapped (usually as they are going to sleep or waking up) but their subsequent ICD interrogation shows nothing happened. OK, there was no 700 volt dose of therapy. But it sure felt like the real thing. Your doctor may tell you it was just your imagination, but that doesn’t mean it is not a real problem that needs to be addressed. Some report relief by going to a hypnotist.

One important thing to help stop these annoying episodes is to understand what is happening. Like the term ” Phantom Zap,” Duffey is responsible for this idea. It’s only a theory but thinking about it this way has helped many accept them and gradually make them go away:

*

When your device was implanted, you were asleep.

*

After the device is implanted, doctors test the device to make sure it works on you. (See NIPS above)
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Even though you were unconscious, the event was burned into your memory - but a section of memory that is not easily accessed when you are awake.
*

However, in that brief period between being wake and going to sleep - or during that period when you awaken from a nap or sleep - THOSE memories are accessed.
*

In that limbo state, what you experience is every bit as real as an actual dose of therapy.
*

Ultimately, when you accept them as a flashback of a reality from your past (the testing after implantation) they seem to lose their reason for being (raison d’être) and fade away.

Q. What’s an ejection fraction?

A. With each beat, a healthy heart will pump out 55% to 60% of the blood in it. After a heart attack or other ailment that damages the heart muscle, that number (the ejection fraction) is reduced. The government standard for disability approval is usually anything under 30%. Heart patients, not excluded for a heart transplant for reasons of age or other health problems, become “candidates” for transplant when their EF drops below 19%.

Medical science is making significant progress finding ways to boost heart patients’ EF. Among those are a variety of medicines such as coreg (carvedilol.) Others are finding relief - with an increase in EF - from a relatively new therapy in the United States called EECP which was developed in China. Unfortunately, not every drug or procedure works for everyone. Each of us needs to explore the options with our doctors.

Q. My doctor won’t talk with me or answer my questions. What should I do?

A. Remind your doctor, that you are the patient. You’ve got the condition. You deserve the right to understand your treatment and have your questions answered. If your doctor doesn’t correct that behavior immediately, then FIRE him or her ASAP - and find someone you can trust! A lack of confidence in your caregiver can lead to other problems and not all of them are emotional. You (or your insurance) pays them. They work for you. If you are not getting what you want, need, and deserve - you are throwing money… and your health… away. You should consider this action even if the doctor is great, but an incompetent staff prevents you from getting the appropriate care.

When you fire a doctor, make sure your medical records are transferred to the new physician - completely and immediately. Without those, your new care givers will have an incomplete picture of what makes you a unique patient.

Q. What’s the difference between an EP and cardiologist?

A. Think of it this way.

1. Consider your cardiologist as your heart’s plumber. His specialty is your pipes.

2. Consider your electrophysiologist (EP) as your heart’s electrician. His specialty is your wiring.

Q. Can I still work with an ICD?

A. That all depends on your condition and your line of work. Many ICD owners still work without a problem. For others the condition that caused the need for the ICD is significant enough that they qualify for social security disability. Some people need to find a different type of work – for example you may no longer be qualified to be a front line police officer, or a steel worker balancing on a girder hundreds of feet above the ground, if you have the potential of getting a 700 volt zap.

Q. Can I still have sex? What will happen to my partner if I receive a shock? (The #3 most asked question - more often than the one above if keeping track of priorities!)

A. Many zappers can attest to having happy and fulfilling sex lives. Sex does elevate your heart rate, similar to exercise. If you were to receive a shock during sex, they say your partner would feel a slight tingling and the electrical energy dissipates.

Many of us with an ICD do experience trouble in this area, but it is NOT the implanted device causing problems - beyond the mental issues. Many of the medications we take have a profound impact on love making equipment. That does NOT mean you should stop taking your pills! Work with your doctor to find alternatives and solutions to this situation.

Q. Can I still golf? Ride a bike? Run? Swim? Play football? Dance? Play the violin?

A. You will be able to do many of the activities that you were able to do before the implant. You should always talk with your doctor before resuming any of these activities. Some activities like contact sports that could damage your device or cable may be prohibited. Others like swimming may be discouraged, or allowed with certain restrictions. (After all what’s the advantage of saving your life, if you drown in the process!)

Quite a few ZAP• Folks have run marathons and triathlons, climbed mountains (such as Machu Pichu,) 100 mile bike races, or played 36 holes of golf a day for 3-4 days. While these are extremes many others do participate in varying levels of physical activity. Mowing a lawn can be an achievement! Your doctor may suggest that you participate in cardiac rehab where you exercise under controlled circumstances, under close supervision to learn the appropriate levels and types of exercise for your situation.

Many ICD owners are also on medication to lower their heart rate. As a result, they may find it difficult getting the heart rate elevated into the “target zone” for exercise. Your physician may suggest that you still exercise, but do not attempt to elevate your heart rate significantly.

Your ICD monitors your heart rate and when it exceeds a certain threshold it delivers a shock. If you are an active exerciser, your doctor may have to adjust your settings to ensure that an elevated heart rate during exercise does not result in an “inappropriate therapy?”

Q. Can I ride amusement park rides?

A. You better talk this over with your doctor. Your specific condition may, or may not make it an unsafe adventure. The publisher has had no problem on wild roller coasters, but did get zapped watching his college team play basketball. Different kinds of excitement affects each of us differently.

Those of us with an abdominal implant site may not be able to handle rapid direction changes, which may damage the leads. Some rides also use powerful electromagnets, and the radiation field could affect device programming. That could be catastrophic! Park administrators can tell you which rides pose this kind of problem.

Q. What are all those alphabetical codes/abbreviations my doctors and nurses use?

A. There are a bunch of them. This list of cardio codes was compiled by Eileen Yeisley, RN:

ICD/Pacemaker Abbreviations

A-A Interval: Interval between two paced atrial contractions. When there is an atrial contraction for each ventricular beat, the A-A Interval is the same as beats per minute or heart rate. A-A Interval is usually measured in milliseconds (ms); one ms is 1/1000 of a second. A normal A_A Interval is between 600 and 1000 milliseconds or 60 to 100 beats per minute.

AICD: Automatic Implantable Cardioverter Defibrillator. AICD is a Guidant trademark.

ADL: Activities of Daily Living. Includes activities like feeding oneself, bathing, brushing one’s teeth, etc.

AF: Atrial Fibrillation. Although not usually a life threatening arrhythmia, atrial fibrillation can cause a loss of ‘atrial kick’; responsible for about 25% of cardiac output. It is a condition where the muscle cells of the atria do not contract at the same time but each cell at its own rate. This results in a ‘quivering’ of the atria instead of a contraction that would push the blood into the ventricles.

AP: Atrial Pace; when a pacemaker or ICD paces the atria (stimulates it to contract).

AS: Atrial Sense; when a pacemaker or ICD senses depolarization of the atria when the heart depolarizes on it’s own. The muscle must depolarize to initiate a contraction.

AV: Atrioventricular; meaning of the atrias and the ventricles.

BBB: Bundle Branch Block; a block in conduction of electrical activity in one of the three bundle branches.

BOL: Beginning of Life; a term used to describe the battery condition of a new pacemaker or ICD.

BPM: Beats Per Minute; the number of beats the heartbeats in one minute; normal is between 60 and 100. Also known as your pulse (i.e. a pulse of 80 means a heart rate of 80 bpm). bpm = 60,000 divided by milliseconds

CO: Cardiac Output; the amount of blood the heart ejects in one minute. It is the stroke volume (amount of blood ejected in a single heartbeat) times beats per minute; usually measured in liters per minute.

CPR: Cardiopulmonary Resuscitation

EGM: Electrogram; an “EKG” measured from within the heart instead of from patches placed over the chest. Because it is less likely to pick up other electrical stimuli from other muscles it tends to be more accurate.

EMI: Electromagnetic Interference; interference that can upset the workings of pacemakers and ICD’s; caused by high-energy forces; MRI’s, arc welders, transformers, can all cause interference with pacemakers/ ICD’s.

EOL: End of Life; a term used to describe the battery condition of a used up pacemaker or ICD. When and ICD or pacemaker is approaching EOL your cardiologist will schedule surgery for a replacement.

EP: Electrophysiologist; a cardiologist who specializes in electrical problems or arrhythmias of the heart.

EPS: Electrophysiology Study; there are two main workings of the heart: 1. the plumbing and 2. the electrical circuits. A cardiac catheterization studies disease in the ‘plumbing of the heart’ (blockages in the arteries of the heart) and electrophysiology studies disease in the electrical circuits of the heart).

ICD: Implantable Cardioverter Defibrillator

IPG: Implantable Pulse Generator; pacemaker.

mA: Milliampere; 1/1000 of an ampere; used to describe current flow of a pacemaker or ICD.

ms: Millisecond; used in EP studies to measure beats per minute and the different waveforms of electrical activity of the heart. 1/1000 of a second. To convert beats per minute to milliseconds: ms = 60,000 divided by bpm

NGB: Generic Pacemaker code; code used to describe pacemaker functions. Usually 3 or four letters. DDDR is a common code for pacemakers and ICD’s. The first letter signifies the chamber paced. V means Ventricle, A is Atrium, D is both or Dual, O is none and occasionally S is used by some manufacturers to mean Single. The second letter indicates the chamber that is sensed (the ICD/ pacemakers detection of electrical activity). The third letter indicates the pacers response to sensing; T means it will trigger pacing, I means it will inhibit pacing D means it will do both inhibiting and triggering, and O means none. The fourth letter is for programmability functions—Rate responsiveness. P is simple Programmable; M is Multiprogrammable; C is Communicating functions (telemetry); and R is Rate Responsive. If a fourth letter is present it is usually rate responsive. Therefore, a pacemaker or ICD that is DDDR means the pacemaker is pacing electrical activity in both the atrium and the ventricle and it is sensing activity in both the atrium and the ventricle. When it senses an event it will either trigger a response or inhibit pacing and the rate is responsive (the pacing rate will change in response to sensors that detect changes in metabolic needs to increase the cardiac output).

NSR: Normal Sinus Rhythm. The a normal EKG waveform.

PAC: Premature Atrial Complex. If the atria conduct a beat before it should they will not fill properly before contracting. If this occurs in the ventricle it is called a PVC or premature ventricular contraction. Both can lead to ventricular tachycardia although it is more common with PVCs.

PMT: Pacemaker Mediated Tachycardia. As the name implies, an induced tachycardia in persons who have either an ICD or pacemaker. This is a fairly rare tachycardia since the development of features in newer pacemakers. Anytime a pacemaker or ICD feels they have a racing heart rate it should be checked out by their EP.

PSVT: Paroxysmal Supraventricular Tachycardia; Paroxysmal means abrupt onset and termination. SVT is an abbreviation for Supraventricular Tachycardia. This is a tachycardia that originates above the ventricles. It is often difficult to distinguish the difference between SVT and ventricular tachycardia by looking at the EKG signals.

PVC: Premature Ventricular Contraction; occurs when the electrical signal that causes the muscle to contract comes too soon. The ventricle does not have enough time to fill before contracting. When PVC’s occur several times in a row and too close together, there is a danger of developing ventricular tachycardia or ventricular fibrillation. Although everyone has PVC’s, persons with damaged heart muscle have many more.

SCD: Sudden Cardiac Death; a condition in which the heart develops a lethal arrhythmia and is unable to pump enough blood to sustain life. If untreated, the person with these lethal arrhythmias will die in minutes. The most lethal arrhythmia is ventricular fibrillation. It is different from a heart attack; a heart attack is a condition where blood vessels that supply blood to the heart are blocked and cause the heart muscle to die (that is the plumbing of the heart is defective). In sudden cardiac death, the electrical system of the heart is defective.

SSS: Sick Sinus Syndrome; also called sick sinus node dysfunction. A condition where the natural pacemaker of the heart (the sinus node or SA node) initiates slow or irregular heart beats. Persons with this syndrome, if symptomatic, are surgically implanted with a pacemaker.

SV: Stroke Volume; the amount of blood ejected by the ventricle in one contraction. The stroke volume times the beats per minute is the cardiac output.

SVT: Supraventricular Tachycardia; a tachycardia that is initiated above the ventricles. It includes atrial tachycardia, atrial flutter and reentrant tachycardia that are not ventricular. It tends to be a catch all phrase of those arrhythmias that are not easily distinguishable from each other with an EKG.

VF: Ventricular Fibrillation; a lethal arrhythmia in which the muscle cells of the ventricles contract at a different rate resulting in a ‘quivering’ of the ventricles. There is little or no cardiac output. A person in VF will live only 4-6 minutes before brain death occurs. A person with VF is said to be experiencing sudden cardiac death. VF can occur without warning. It is also the hardest arrhythmia to defibrillate back into a normal sinus rhythm. Electrophysiologists usually test ICD’s by putting the patient into VF and defibrillating the patient to see how many joules it will take to get the patient out of VF.

VP: Ventricular Pace; when a pacemaker or ICD paces the ventricles (stimulates it to contract).

VS: Ventricular Sense; when a pacemaker or ICD senses depolarization of the ventricles when the heart depolarizes on it’s own. The muscle must depolarize to initiate a contraction.

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This entry was posted on Saturday, July 1st, 2006 at 1:27 am and is filed under Implantable cardioverter defibrillator. You can follow any responses to this entry through the RSS 2.0 feed. Responses are currently closed, but you can trackback from your own site.
26 Responses to “Help for Heart ICD Pacemaker Cardioverter-Defibrillator Implant Recipients, Families, Doctors, Medical School and Care Givers, Please add to this blog:)”

1. Laura Says:
July 1st, 2006 at 1:27 am

“If I seem unusually clear to you, you must have misunderstood what I said.” -Alan Greenspan
2. Laura Says:
July 3rd, 2006 at 7:14 am

Guidant Defibrillator Recall Lawyers, Any good ones?
3. Laura Says:
July 3rd, 2006 at 7:32 am

Cardiac rehabilitation is a comprehensive exercise, education, and behavioral modification program designed to improve the physical and emotional condition of patients with heart disease.
4. Laura Says:
July 3rd, 2006 at 7:35 am

Living with an implantable defibrillator means taking certain precautions. For instance, patients are advised to avoid walking through or lingering near metal detectors or any device that emits a strong magnetic field.
5. Laura Says:
July 3rd, 2006 at 7:41 am

Phillips HeartStart™ Home AED Defibrillator

Can HeartStart™ be used on a person with a pacemaker or ICD?
It is all right to use the HeartStart™ on a person with an implanted device such as a pacemaker or ICD, but do not place the pads directly over the implant. You can tell where an implant is located by a lump in the skin and a scar.

It is also all right to use HeartStart™ on someone wearing an oxygen mask.
6. Laura Says:
July 3rd, 2006 at 8:21 am

In June of 2005, Guidant Corporation recalled thousands of their Implantable Cardioverter Defibrillator (ICD) due to a manufacturing defect that may cause the device to short-circuit or malfunction. It is alleged that Guidant knew of the problems with their heart defibrillators and failed to publicly disclose the life-threatening defects until FDA intervention and public scrutiny.

These popular ICDs are implanted into patients with congestive heart failure, abnormally fast heart rhythms/ tachycardia or irregular heartbeats to shock their faltering heart. According to the American Heart Association, 64,000 implantable defibrillator operations are performed on U.S. patients each year. Approximately 24,000 defective Guidant ICDs have been implanted in U.S. patients.

[Jump directly] to the complaint form link at the bottom of the page,
or continue reading more about defibrillator failure.

The initial defibrillator in question was the Ventak Prizm 2DR, Model 1861, manufactured on or before April 16, 2002. However, Guidant has increased the recall to now include all of the following models:

# VENTAK PRIZM 2 DR (Model 1861)
# VENTAK PRIZM AVT
# CONTAK RENEWAL (Model H135)
# CONTAK RENEWAL 2 (Model H155)
# VITALITY AVT
# RENEWAL 3 AVT
# RENEWAL 4 AVT

After further investigation by Guidant and the FDA, the FDA uncovered more reports of device failures and deaths linked to Guidant ICDs. To date, Guidant has recalled or issued warnings for over 80,000 heart defibrillators, including its best selling Contak Renewal 3.

Class I Guidant Recall: PRIZM 2 DR, CONTAK RENEWAL, CONTAK RENEWAL2

In a Class I recall, there is a reasonable probability that if a particular device is malfunctioning, the malfunctioning device will cause serious adverse health consequences or death.

Class II Guidant Recall: VENTAK PRIZM AVT, VITALITY AVT, and RENEWAL AVT Devices, CONTAK RENEWAL 3 and 4, RENEWAL 3 and 4 AVT, and RENEWAL RF Devices

In a Class II recall, the malfunctioning product may cause temporary or medically reversible adverse health consequences. These Guidant devices are said to be subject to a memory errors.

Accusations against Guidant

Currently Guidant faces over 100 individual and class action lawsuits related to its defibrillator and pacemaker products. Guidant may also face a civil lawsuit by the federal government for failure to disclose its product’s potentially fatal defects. Medical professionals and legal professionals believe that Guidant withheld pertinent information about defibrillator malfunctions and mechanical design defects. It is alleged that Guidant learned of their ICDs life-threatening defects in 2002 but did not disclose this information to the public until 2005 while heavily marketing their products worldwide.

Guidant designs, manufactures, and distributes products focused on the treatment of cardiac arrhythmia, heart failure and coronary and peripheral disease. Guidant is pending acquisition by Boston Scientific Corp. for $27 million.

Medical professionals advise that if you have a Guidant defibrillator, talk to your doctor as soon as possible to find out more about your medical options.

If you have the device implanted, had the device replaced or plan to have it replaced, whether or not you suffered complications from at this time, you may be entitled to compensation.

The Cost of Guidant Defibrillator Recall
Guidant Defibrillators are Disposed Of
Guidant Defibrillator: Check before it’s Too Late
Guidant Defibrillator Recall: Shocking Report

Guidant Defibrillators In the News
May-15-06: The public needs to be made more aware of life-threatening malfunctions of implantable cardiac devides such as the Guidant Defibrillator. [FORBES]

Apr-26-06: Study claims rate of defibrillator failures has increased significantly in recent years. [MEDICAL NEWS TODAY]

Apr-17-06: Cuts in government reimbursement for defibrillators and stents could reduce amount Medicare pays hospitals for heart implants.[BOSTON.COM]

Apr-10-06: The Guidant Corporation’s first trial over a recalled defibrillator, scheduled to start in Texas this month, was postponed because a witness will be unavailable during the Passover period. [NEW YORK TIMES]

Mar-23-06: Widow files a wrongful death lawsuit against Guidant as she discovers the real cause of her husband’s death: defective Guidant Ventak defibrillator. During the funeral, the device that was still implanted in his heart started beeping, indicating a device malfunction. [PIONEER PRESS]

Feb-22-06: Guidant reveals two repairs made to the Ventak Prizm 2 in 2002 that did not receive approval by the FDA. This admission means that Guidant may have been breaking a federal law by manufacturing and marketing an unapproved defibrillator. [MSNBC]

Oct-13-05: FDA Update on Guidant ICD recall: Prizm and Contak Renewal implantable defibrillators. [FDA]

Sep-16-05: New FDA Study reveals that between 1990 and 2002 over 17,000 pacemakers and implanted cardioverter defibrillators, or ICDs were surgically removed due to device malfunctions. [MSNBC]

July-15-05: Family learn about cardiac defibrillator recall after father’s death. [FIRST COAST NEWS]

July-01-05: The has FDA put a severe rating on two makes of Guidant implantable defibrillators that have been recalled. The models designated are the Ventak Prizm 2 DR and the Contak Renewal 1 and Contak Renewal 2. The recall of these devices is considered of the highest priority. [INVESTORS.COM]

Jun-17-05: Guidant Corp. recalls 50,000 defibrillators after finding that flaws in the devices were more far reaching than had been disclosed in the previous month. [INDIANAPOLIS STAR]

Jun-17-05: FDA announces Guidant Corporation’s recall of implantable defibrillators and cardiac resynchronization therapy defibrillators. [FDA]
7. Laura Says:
July 3rd, 2006 at 8:38 am

http://www.defibrillator-help.com
http://web-traffic-help.com
http://www.teenfreelancer.com
http://www.suretrafficflow.com
8. William Says:
July 7th, 2006 at 4:01 pm

“Use what talents you possess. The woods would be very silent if
no birds sang there except those that sang best.”

- William Blake
9. cyborgs Says:
July 7th, 2006 at 5:40 pm

Defibrillator-help.com

cool cyborgs roam the planet
10. cyborgs Says:
July 7th, 2006 at 5:43 pm

CYBORGS
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These photographs use digital media to create dissembodied essences, a merging of human anatomy and coded possibilities
11. cyborgs Says:
July 7th, 2006 at 5:49 pm

The first cyborg as response to new technology: Industrial Revolution, the body, and electricity.

The new body from reanimated (electrified) body parts
Frankenstein myth meets robotics: the origin of the dystopian, urban, industrial context of cyborgs
12. Laura Says:
July 9th, 2006 at 11:13 pm

Title: Medtronic Announces Japanese Introduction of Cardiac Resynchronization Therapy with Defibrillator Capabilities for (FinanzNachrichten)

In conjunction with the Japan Heart Rhythm Society annual meeting currently underway in Tokyo, today Medtronic ( Nachrichten / Aktienkurs ) announced Ministry of Health, Labor and Welfare (MHLW) approval of the Medtronic InSync III Marquis(TM) cardiac resynchronization therapy-defibrillator (CRT-D) in Japan.
13. Laura Says:
July 9th, 2006 at 11:13 pm

Title: ONLY 0.14% (Sharewatch)

The company said the Japanese Ministry of Health, Labor and Welfare granted both the approvals for the implantable InSync III Marquis cardiac resynchronization therapy-defibrillator.
14. Laura Says:
July 9th, 2006 at 11:14 pm

Title: Hills library receives automated defibrillator (Rochester Eccentric)

Patrons and employees at the Rochester Hills Public Library have an extra measure of protection now that the building is equipped with a life-saving device that can aid someone suffering from cardiac arrest.
15. Laura Says:
July 9th, 2006 at 11:14 pm

Federal health officials are releasing records about recent heart-defibrillator implants, but are withholding the identities of the doctors involved.
16. Steve Says:
July 10th, 2006 at 7:41 pm

Dave Navarro rides again

Defibrillator help

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17. steve Says:
July 10th, 2006 at 7:46 pm

http://v84u.com/
18. Larsen Says:
July 10th, 2006 at 7:53 pm

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Implantable Defibrillator

An implantable defibrillator is a device that monitors your heart rate. It uses batteries to send electric signals to a heart that’s beating too slow, similar to a pacemaker.

Implantable Defibrillator $24,900

Package Includes:

Attending Doctor/Surgeon’s fees, nursing, material cost, pre and post procedure consultations and physical examination.
All medications, medical supplies and drugs used during the in-patient hospital stay.
Room fees for a private air conditioned room. Notes…Room includes bathroom, TV, telephone. Room includes accommodations for one guest.
Meals. The type of cuisine will be served as what is available at the hospital.
Rental of pre-activated cellular phone for use during stay. Note: Phone usage charges are not included in price.
All diagnostic tests, laboratory, radiology etc. before and after the procedure as required for the procedure and as advised by the attending physician/surgeon.
Package Excludes:

Any incidental healthcare/medical costs related to treatment of any unrelated illness. Additional requested procedures will be charged separately.
If required, visits by specialists other than the attending physician will charged at an additional $15 per visit.
Costs of investigations additionally required but not listed in the initial proposal.
Charges of inpatient stays in excess of stipulated days in the initial proposal. Note: Pharmacy, laundry, food will be added to the package price on a per diem basis at normal hospital rates.
Out patient and expenses incurred before or after the hospital admission.
Items of a personal nature such as in room soft drinks, telephone charges and guest meals will be charged at the normal rates in effect.
Take home medications.
Any incidental transfer/travel costs.
Sim card and value of telephone calls made through rented cellular phone
Travel costs
Services Provided at a Nominal Extra Cost:

All transfers - Airport to Hotel, Hospital, Hotel, Airport
Full/part time bilingual assistant
Personal caretaker
Recovery period short-term activities such as yoga and meditation.
Personal Chef.
Local sight seeing car with air conditioning.
Internet ready laptop computer.
Booking for international and national travel arrangements.
Air evacuation, air or surface ambulance.
Notes :

Patients will be charged extra for items not included in the package.
Room upgrades, if requested, are charged at the difference of the room rates.
No further discounts of any kind may be applied to package prices.
No refund will be given if stay is shorter than listed in initial proposal.
Prices are subject to change without prior notice.
Payment Terms: Upon receipt of the formal proposal related to the overall cost of the procedure, the full payment must be paid through wire transfer, account payee check or Western Union transfer. Additional fees will be collected in full before flight back to the U.S. The currency quotes are subject to exchange rate fluctuations.

Procedure prices are listed in U.S. Dollars. The prices are for general comparison and shopping purposes “only” - Prices vary by individual circumstances and medical condition - Prices vary by provider & location - Prices may change without notice - Prices do not include travel expenses and miscellaneous other costs - More exact quotes will be given after the completion of an initial evaluation - Final costs will be determined once the travel itinerary is completed. To get a formal proposal or more information call toll free (888) 380-6337. *To Get Lower Prices - Travel Outside the U.S Needed

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Journal Report
04/16/2002

Implantable defibrillators cost-effective for preventing sudden death

DALLAS, April 16 - In the first study of its kind, an implantable cardioverter defibrillator (ICD), a device used to treat heart rhythm abnormalities, was found to be moderately cost-effective for preventing sudden cardiac death, according to a report in today’s rapid access Circulation: Journal of the American Heart Association.

ICDs deliver electrical shocks to the heart to eliminate abnormal rhythms such as ventricular fibrillation or ventricular tachycardia. In the Antiarrhythmics Versus Implantable Defibrillators (AVID) trial, the device was shown to be superior to therapy with antiarrhythmic medications for reducing all causes of death in survivors of ventricular fibrillation (irregular, chaotic heart rhythm that begins in the heart’s lower chambers). It was also a better choice for people with ventricular tachycardia (an often serious rapid rhythm originating in the lower chambers) and ejection fractions of 40 percent or less. Ejection fraction is a measure of the heart’s pumping ability.

AVID is the first study to prospectively determine the cost-effectiveness of ICDs for secondary prevention in the United States, according to lead author Greg Larsen, M.D, a staff cardiologist at the Portland VA Medical Center and associate professor of medicine at the Oregon Health and Sciences University, Portland, Oregon. The study looked only at treating patients who had had life-threatening arrhythmias and were at risk for another life-threatening event. Researchers compared life gained and costs due to ICD treatment with that of antiarrhythmic drug therapy.

To find out which treatment was more cost-effective, researchers compiled data on charges for initial and repeat hospitalizations, emergency room and day surgery stays, and the costs of antiarrhythmic drugs from 1,008 patients. These included 505 patients with an ICD.

Detailed records of all other medical encounters and expenses, including outpatient services and prescription costs, were collected on a subgroup of 237 patients, who were a balanced representation of the larger trial, geographically and medically.

“We called these the ’shoebox patients,’ because we told them we wanted all their bills - just bring them in a shoebox,” says Larsen.

The researchers converted the charges to 1997 costs. Three-year survival data from AVID were used to calculate the base cost effectiveness (C/E ratio). Six-year, 20-year and lifetime C/E ratios were also estimated.

The researchers determined that the largest expense for these patients is inpatient care, which makes up between 73 percent of total costs for drug therapy patients and 84 percent for ICD patients. At three years, the cost for the drug treatment group was $71,421. For the defibrillator group it was $85,522. The ICD provided a 0.21-year average survival benefit, putting the cost-effectiveness ratio at $66,677 per year of life saved.

“The defibrillator patients lived longer, but they paid extra to get that extra life. The ratio of the additional amount paid for the additional survival benefit is the cost-effectiveness number,” Larsen says.

According to Larsen, the conventional wisdom about cost-effectiveness ratios is that something is a “bargain” below about $50,000 per year of life saved, “so the defibrillator is just on the margin of that bargain. It’s on the high side but not out of reason.”

The researchers also found that six- and 20-year C/E ratios remained stable between $68,000 and $80,000 per year of life saved.

This is only the beginning when it comes to cost-effectiveness studies on the devices, Larsen says. “The cost effectiveness issue is going to be a very big part of the defibrillator story during the next year or two as more and more people look to ICDs for treatment.”

For example, there may be changes in some of the big expenses from the ICD group, such as how often the ICD battery may need to be replaced, he says. At three years, 18 percent of the people in this study had to have new batteries. It’s also possible that in-patient costs could go down - this study showed shorter hospital stays over time.

“Clearly the cost of these devices is high but the medical care costs are high as well. As the authors point out, ICDs are moderately cost effective in these patients,” says David Faxon, M.D., president of the American Heart Association. “We need to continue to study cost effectiveness issues and determine the best practice policies for patients.”

Co-authors are Alfred Hallstrom, Ph.D.; John McAnulty, M.D.; Sergio Pinski, M.D.; Anna Olarte, M.Sc.; Sean Sullivan, Ph.D.; Michael Brodsky, M.D.; Judy Powell, B.S.N.; Christy Marchant, R.N., M.B.A.; Cheryl Jennings; Toshio Aklyama, M.D., Ph.D.; and the AVID investigators.

American Heart Association

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19. results containing Dave Navarro Says:
July 10th, 2006 at 7:54 pm

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20. http://www.defibrillators.com/news/ Says:
July 10th, 2006 at 8:06 pm

http://www.defibrillators.com/news/
21. west Says:
July 10th, 2006 at 8:09 pm

Yes, people with heart conditions are at greater risk, but all too often, young and healthy people die due to their heart just stopping. It’s called “Sudden Cardiac Arrest” and it’s not friendly.

Imagine you are riding your bicycle on a sunny, spring day, and suddenly your heart goes into immediate arrest. You will pass out immediately, and if there’s no AED nearby, your death is imminent. Supposedly, death due to Sudden Cardiac Arrest is painless, but imagine all the people who love you…your mother, your father … your grandparents … your grandchildren … your children, your brothers and sisters …. your husband or your wife.

Sudden Cardiac Arrest can wipe out a life in the blink of an eye. It seems pretty ominous. It’s estimated that approximately 450,000 people die this way each year. (By comparison, 41,000 people die in car accidents each year). According to the American Heart Association, each minute that passes after your heart stops, your chance of survival decreases by 10%.

When an Automated External Defibrillator is used within a few minutes, it increases survival rate by up to 80%.

Sudden Cardiac Arrest can strike anyone, and anytime. While you can definitely take precautionary measures to descrease your risk, it’s not something you can directly prevent against. It’s something you need to prepare for. As scary and fearful as unexpected death is to you, think of how it would affect your loved ones - how deeply the people you love would miss you.

http://home.freeuk.net/celwkn/html/body_defibrillator_group.html

Monk Fryston, Hillam & Burton Salmon Defibrillator Group

A thank you!

The launch of our defibrillator scheme in May 2004 would not have been possible without the generosity and hard work of many people in all three villages and the surrounding area. Enough money was raised to purchase a life saving defibrillator machine which is now available for use at heart related 999 incidents in any of our villages. This can significantly increase the chances of survival in the case of a heart attack by getting help to the patient during the first few minutes.
We rely completely on our volunteers - known as “responders” - who are available to use the defibrillator on a rota basis by being “on call” - usually from home. We aim to provide as much cover as possible during the 24 hour period to respond to heart related 999 calls in any of our villages. We are sent by the ambulance service.
All of our responders receive regular training which is provided at no cost to them by the ambulance service. We now have a total of 28 qualified responders. Thanks to them we have been able to provide cover for approximately 70% of the time (day & night) so far. Since the launch of our scheme on 1st May 2004, we have had 4 call outs. None has required use of the defibrillator.
We would like to thank everyone who has contributed to the success of the scheme.
To secure the long term success of the scheme and to provide greater coverage, we need to continue to attract new volunteers. Could you or someone you know spare a little bit of time and perhaps save a life?
Training is local and informal - we usually train in Monk Fryston Church Hall. Initial training takes about 10 hours and responders receive around 5 hours refresher training every six months after that. There is no minimum time a volunteer has to remain with the group and no minimum number of times a volunteer has to provide cover - although many choose to provide regular cover where their other commitments allow. All help is greatly appreciated.

The name Heart Sparks and the logo were the result of a competition for pupils at Monk Fryston School.
The original appeal to raise the money needed was started by a small group of dedicated local people who enlisted the support of their local communities. Congratulations to everyone involved.
Many of the volunteers came forward at a public meeting which was held in Monk Fryston Church Hall in November 2002.

If you can help or would like more information, please contact Heart Sparks at enquiries@heart-sparks.freeserve.co.uk or telephone John Colton on 01977 671172.

UPDATE - June 2005
In January 2005, WYMAS informed us that they would no longer pay for the training of reponders. The actual cost of re-training the group based on its present size would be at least £500 per year. WYMAS has been assisting the group by looking for alternative sources of funding for annual training and this has included approaching the three Parish Councils - Monk Fryston, Hillam & Burton Salmon.
The group continues to operate at around 60% cover, but we have lost 2 responders recently so taking into account those who are unable to cover for the time being, our active strength is around 15 (this takes into account responders who attend in pairs).