So you need an Internal Cardioverter Defibrillator (ICD)
An Internal Cardioverter Defibrillator (I.C.D.) consists of a small box containing a computer and battery. It is the size and weight of a pack of playing cards. It can be implanted into your body where it is capable of observing your heart rhythm continuously. It can be programmed to treat an abnormal rhythm which could endanger your life. To be considered for one of these boxes you will usually have already experienced a life threatening heart rhythm disturbance. These disturbances occur in the lower chambers of your heart and are referred to as Ventricular Tachycardia [VT] and Ventricular Fibrillation [VF].Ventricular Tachycardia.
This is a life threatening problem with the rhythm of the heart where the ventricles beat very quickly. This interferes with the pumping of the blood around the body which can cause dizziness, loss of consciousness and sudden cardiac arrest.
Ventricular Fibrillation.
This is similar to ventricular tachycardia only the heart beats even faster and more erratically, over 300 beats each minute, and the electrical action is quite disorganized. Very little blood is pumped from the heart and around the body. A person with ventricular fibrillation becomes unconscious very quickly.
Your doctor will have done some tests, the results of which will have convinced him that the best treatment for you is an ICD. The implantation of the ICD is a simple procedure. You will usually have visited our Cardiac Catheter Suite before whilst having your tests. You will now make a return visit. The procedure will take about two hour. You will be given a sedative injection which will make you drowsy. Local anaesthetic will be injected into an area on the left side of your chest just below your collar bone. A small incision [cut] will be made and a small tube inserted into a large vein. Through this tube a wire will be passed into the lower chamber on the right side of your heart [your right ventricle]. Occasionally two wires will be required. In this case a second wire will be passed, this time into the upper chamber on the right side of the heart [your right atrium]. The wire is then tested and attached to the ICD box which contains the batteries and computer.
A small pocket will now be formed under the muscle and the box will be carefully positioned in the pocket. Before the procedure is complete your doctor will want to do some tests to make certain that the ICD is working properly. You will be given extra sedation at this stage. When the tests are completed your doctor will close the wound using a few stitches and a small dressing will then be applied. The stitches will dissolve and so will not need removing. After the procedure you will be transferred, on a trolley, back to your bed on the ward. You can expect to stay in hospital for 2 nights after the ICD has been implanted. On your return to the ward the nurses will observe your blood pressure, pulse and wound site. They will recommend that you remain in bed overnight being careful not to move about too roughly. You will be quite sore and uncomfortable so do ask the nurses if you would like a pain-killer. You may be started on antibiotic tablets as a precaution against any infection. Please ask if you need any help or have any concerns. The day after your ICD has been implanted you will slowly start walking about. You may be a little unsteady at first but this will quickly improve. As the day goes on you will gain more confidence and by the next day you will be ready to go home.
Throughout this period you will need a lot of support and guidance. You will have questions to ask and you will want to learn what effect the ICD will have on your life and the lives of those close to you. This help and guidance will be made available to you from the moment your doctor decides that you need an ICD. We have a specialist nurse who will visit you on a number of occasions both before and after the ICD is fitted. She will be able to explain why the doctors have recommended this treatment and what you should expect. She will give you the opportunity to see a video and will provide you with information about your ICD. You may like to ask a family member or close friend to watch the video with you. It is often reassuring for those near to you to understand what is happening and for them to have the opportunity to ask questions. When you are discharged home you will be given an appointment to return to an Out Patients Clinic within one month. At this clinic your ICD will be checked and you will be able to ask questions. The check is simple and does not cause any discomfort. A communication device [about the same size as the ICD] is placed over your ICD box and through this we will be able to make checks and gain information. After this appointment you will be asked to return again to Out Patients in 3-6 months.
You will be given a list of contact numbers so that if you have any problems there will always be someone to give you advice. A list of these numbers can be found on the last page of the booklet. We provide a 24 hour Helpline. We also have a support group which meets and gives you the opportunity to chat to other people who, like yourself, have had an ICD fitted. All the information will be given to you before you are discharged home. It is advisable to take it easy for the first few weeks.
Important Recommendations that will ease your recovery:
- Let the hospital know immediately if your wound becomes red or swollen or starts to ooze.
- If you have a temperature please let the hospital know immediately.
- If you are unsure about your medication please contact your doctor. Do NOT stop or change any medication without seeking advice from your Cardiologist.
- Do not wear tight clothing. This could rub and cause you some discomfort over the site of your ICD.
- Avoid any heavy lifting, stretching of your arms, excessive pushing or pulling. These actions could effect
- the box and wires in the first few weeks until they are settled in position.
- Keep your wound dry for the first week then shower or bathe as normal.
- Walking and exercise is good for you but don�t overdo it. Return slowly to normal. Don�t push yourself.
- Avoid any contact sports which could result in a blow to your implant site.
- ALWAYS carry your identity wallet with you. Dentists, doctors and emergency personnel will need to know that you have an ICD.
The Box is there to save your life Here are some answers to commonly asked questions to help you to get to grips with your situation:
An ICD is a device which delivers electric shocks to the heart in order to correct an excessively fast or erratic heart rate or rhythm. It will not prevent such a rhythm from happening, but will correct it and so save your life. Some ICDs try to do this first by pacemaking to override the heart�s own rate and will only shock if this fails.
How does the ICD know when to work?
It contains a computer which monitors your heart rate. The ICD is programmed to deliver a shock if the heart rate exceeds a particular figure for more than a given time.
Will I know when the ICD is going to fire?
Maybe. When your heart rhythm becomes erratic you may faint and wake up when the defibrillator has given a shock. Other people have a feeling of faintness or palpitations just before a shock is triggered but you may get no warning depending on your particular condition.
How will I know when the ICD works?
You will feel a big �thump� in your chest. You may cry out involuntarily, see a flash of light and have a spasm affecting all your muscles. Some people fall down but many remain standing. It can be painful and a bit frightening. If your ICD paces you back to normal the only thing that you may feel is slight faintness and palpitations, or even nothing at all. Some people have minor muscle aches for short periods following a shock.
What should I do when the ICD "goes off ".
1. Most important of all � DON�T PANIC.
2. Sit or lie down until you feel well enough to carry on, then go home.
3. Ask someone to stay with you if possible.
4. If your symptoms do not go away or you are concerned call an ambulance (dial 999).
5. Get in touch with the hospital and let them know that your ICD has gone off.
6. If you have been taken to a local hospital, tell them that you have an ICD and show them your identity sheet. They will contact your Cardiologist.
7. If you quickly feel "back to normal" after a shock, you may carry on as normal.Where appropriate you will have pills to take to calm your heart. Never stop them without medical advice. Some people feel that physical or mental stress can set their heart off. If this is the case with you then try to avoid these situations.
What happens if somebody is touching me when the ICD gives a shock?
Nothing. They will come to no harm whatsoever.
How will this affect my family?
Many people find that their family and friends become very anxious about them. They might keep checking up on you. They may not wish to leave you on your own in the house or let you go out unaccompanied. This is not suprising and quite a normal reaction under the circumstances. You may find it a bit irritating. Like you they need to adjust, so be patient.
What special precautions should I take because of the ICD?
1. Avoid strong magnetic fjords such as are found around some industrial electric motors, security metal detectors and the backs of audio speaker cabinets. Very rarely magnetic fields could switch your ICD off. If they do so you will hear it bleeping for a short while. If this happens get immediate medical help and explain what has happened. DO NOT PANIC.
2. If you have a mobile phone it must always be at least 15cms (6 inches) away from your ICD.
3. Because you may faint or lose control when the device goes off, you should avoid ladders, non fenced heights, bicycles and horse riding. Similarly you should not go swimming alone and when walking in remote areas always take a friend along. Being without a companion where others are about is fine. Some people feel more confident if they carry a mobile phone.
4. Avoid pressure over the place where the device has been implanted, [for example tight clothing, belts or straps of bags or rucksacks.
Not to start. The Driver and Vehicle Licensing Agency [DVLA] must be told about your condition. They will then withdraw your driving licence. You may get it back after 6 months free of shocks depending on certain conditions [ask to see the DVLA guidelines].
It all depends on what you have to do. You should not work at heights, drive [unless you have got your license back] or handle dangerous machinery such as lathes or chainsaws. Check with your doctor if you are unsure. Remember to avoid magnetic fields. Your underlying heart condition may restrict or delay your return to work.
You can play any sport that your heart will stand but you should avoid contact sports because of the possibility of receiving a blow on the box. If in doubt do check with your doctor as he may feel that some types of exercise may not be advisable.
Continue as normal. If the box goes off it might give your partner a fright, or �buzz�, but no harm will come to either of you. The only thing that could stop you would be if the activity was enough to start the abnormal rhythm which would set the device off. In this case speak to your doctor who may be able to help.
You should try to take your holidays reasonably close to a hospital with a Coronary Care Unit and not too far from a hospital where the staff are familiar with your ICD. Check with your hospital before booking as they will be able to give you advice.
What should I do if I think something is wrong with my device?
Contact the team who look after you and follow their advice. In an emergency go to your nearest hospital. Staff there will contact your Cardiologist.
What if the battery goes flat?
Your regular checks will make sure that you will not get to that point.
Where will I find a magnetic field?
In the presence of:
Large magnets.
Large stereo audio speakers [close to ICD].
Arc welders.
"Running" car motors [close to ICD]. Avoid leaning over an engine with the ignition switched on.
Large boat motors [close to ICD].
Magnetic wands such as used by Airport security.
Battery powered cordless tools, drills, screwdrivers etc.
Power generators.
Junkyard magnets.
Construction site magnets.
High tension wires [more than a few metres away there should not be a problem].
Cellular phones. Hold at least 15cms. away from device.
Industrial transformers.
Large generators and power station.
Amateur and CB radios.
Transmitter masts or large antennae (including those used to control toy cars and model airplanes).
Electronic surveillance devices [anti-theft devices].
A piece of hospital equipment known as an MRI scanners can temporarily interrupt the function of your device so should be avoided. This equipment is always kept in a room marked with a sign warning you of the presence of a magnetic field.Other medical equipment can prevent your ICD from functioning properly, for example:
Radiotherapy, diathermy and cauterization.
It is important to show your identification wallet before undergoing any medical treatment and to ask the doctor to get in touch with your Cardiologist.
If you are not sure about a particular situation do not hesitate to contact your doctor. Most household appliances, tools and office machines are not a problem as long as they are well maintained and regularly serviced.
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