CV_Procs

Cardiovascular Procedures:
ICD's

Definition

Implantable cardioverter defibrillator (ICD) therapy is lifesaving treatment for individuals with ventricular arrhythmias and those at high risk of developing them. An ICD is a small battery-operated device that is implanted in the chest and continuously monitors the heart’s rhythm. These days, implantable defibrillators combine the function of a pacemaker with the function of an external defibrillator. The mechanism monitors the heart’s rate and rhythm. If the heart slows or speeds up too much, the pacemaker element provides pacing to restore a normal heart rate. If the heart begins to beat in a disorganized fashion, the device provides a shock to restore normal rhythm.

Implanted Cardioverter Defibrillator

Š 2008 Nucleus Medical Art, Inc.

Parts of the Body Involved

Heart
Upper chest area

Reasons for Procedure

The ICD is an electronic device designed to detect and treat life-threatening tachyarrhythmias.

Candidates for ICD's have typically...:

Inherited conditions with high risk of ventricular tachyarrhythmia, such as long QT syndrome or hypertropic cardiomyopathy
Survived one or more episodes of ventricular tachycardia, ventricular fibrillation, or sudden cardiac death
Survived a heart attack, with high risk for future cardiac arrest
An enlarged heart muscle that doesn’t function properly
A high likelihood of developing sustained ventricular fibrillation or ventricular fibrillation

Risk Factors for Complications During the Procedure

History of smoking
Obesity
History of excess drinking
Bleeding or blood-clotting irregularities

Prior to Procedure

The following tests may be conducted prior to your procedure:

Chest xray--a test that uses radiation to take a picture of structures inside the body, especially bones

Electrocardiogram--a test that records the heart’s activity by measuring electrical currents through the heart muscle

Electrophysiology study--a test that measures the condition of the heart’s electrical system by electrodes placed on the heart through blood vessels

In the days leading up to your procedure:

Talk to your physician about the medications you are taking. Prescriptions may need to be altered prior to your procedure.

The day before and the day of your procedure:

The night before, eat a light meal and do not eat or drink anything after midnight.
If you must take medications (which have been approved by your doctor), do so only with small sips of water.

Anesthesia

For the implantation of the ICD, light sedation and local anesthesia are used. For testing the ICD once in place general anesthesia is used.

Description of the Procedure

An intravenous line is inserted into the arm to administer a sedative to help with relaxation. The area where the ICD is to be implanted is washed with antiseptic and if necessary, chest hair is removed. A local anesthesia is injected at the insertion site to numb the area.

The physician makes a small incision below the collarbone on the left or right side. The ICD lead, which carries signals between the heart and the ICD, is threaded through a vein in the upper chest to the heart with the assistance of an x-ray monitor. The physician creates a pocket under the skin at the incision site and implants the ICD.

With the ICD in place, sedation is increased. The surgeon will test the ICD function by initiating cardiac arrest and allowing the ICD to shock the heart back into a normal rhythm. Every precaution is taken to ensure this is a safe process. Once it is determined the ICD is working properly and in the right place, the incision is closed with stitches.

After Procedure

The day after your implant, you will typically have an ECG, blood tests, and chest x-ray to ensure the ICD and leads are in the proper position. The ICD function may be checked again, which will require sedation. Your pulse, blood pressure, and incision site will be checked regularly.

How Long Will It Take?

About 1-3 hours

Will It Hurt?

You may feel some pushing and tugging on the skin during the procedure, but the anesthesia should minimize any pain. After the procedure, you may experience some pain or stiffness at the incision site. Your doctor can prescribe pain medication for this.

Possible Complications

Puncture of the heart or lung tissue
Damage to the vein
Infection
Bleeding
Bruising

Average Hospital Stay

1-3 days

Procedure Care

Wound Care and Follow-Up Instructions for All Device Patients:

Leave the wound dry (do not shower) for 5 days. Do NOT remove steri-strips or suture.
Avoid raising the affected arm above your head for 3 weeks.
Do not life greater than 10 pounds with the affected arm for three weeks.
No driving in the first 24 hours, while using narcotic pain medication, or while the pain persists
- If you have passed out in the past 6 months, Alaska state law may prohibit you from legally driving.
- As your physician whether you are cleared for driving.
Call if you develop wound drainage, worsening pain or fever.
Your first follow-up visit is for a wound check, and in some cases, removal of sutures. Please go to the Alaska Heart Insititute (AHI) Cardiac Device Clinic one week after your device was implanted for your first check. Call (907) 561-3211 for a specific appointment time. If you live out of town, call the AHI Cardiac Device Clinic and they will help coordinate a follow-up visit where you live.
The second follow-up visit should be performed at 6 weeks and is very important in terms of ensuring the longevity of your device. If your first follow-up visit is not with the AHI Cardiac Device Clinic, you will need to call (907) 561-3211 to schedule your second visit with the Cardiac Device Nurse.
It is your responsibility to continue with device follow-up. If you somehow lose contact with the Cardiac Device Clinic, call (907) 561-3211 to arrange your next appointment.
If you received a a biventricular pacemaker or defibrillator, your water pill (diuretic) medicine may become more effective as your heart function strengthens. If you develop lightheadedness or weakness with standing, this may be a sign that your medication requires adjustment. Please call the AHI Cardiac Device Clinic at (907) 561-3211 and arrange for a reevaluation of your medications.

Additional Instructions for Defibrillator (ICD) Patients:

If your defibrillator delivers a shock, you should let us know. If you feel fine after the shock (no chest pain, no dizziness, no lightheadedness), call AHI during regular office hours to schedule an appointment.
If you receive a shock and you do not feel well (chest pain, dizziness, lightheadedness), please call 911 and have the paramedics take you to the Emergency Room. DO NOT DRIVE YOURSELF, CALL 911.
If you receive multiple shocks, please call 911 to have the paramedics take you to the Emergency Room.
If you hear tones or beeps from your device, call AHI to arrange evaluation during the next clinic day.
You are invited to attend ICD Support Group meetings in Anchorage and Fairbanks. This is a useful forum to meet and learn from other defibrillator patients. For more information please contact the Alaska Regional Hospital Cardiovascular Coordinator at (907) 264-2982 or (907) 264-2911.

Outcome

After this procedure, you will gradually be able to return to normal life with a few exceptions.

You will get an ID card to carry that contains important information about your ICD. It is important that you show this card to any doctor, nurse, dentist, or other healthcare professional at the beginning of an office visit or hospital admission.

If you have questions regarding electromagnetic interference (EMI), consult the manufacturer's recommendations for your specific device. Because strong magnets can interfere with your ICD functioning, you must avoid strong electric or magnetic fields. Examples include:

Large magnets (like those used in junk yards)
Arc or resistance welders
MRI
Airport security wands (show your ICD card and request a hand search)
Ham or CB radio antennae
Heavy-duty electrical equipment
Powerful stereo speakers

Keep cellular phones at least six inches from your ICD. Do not carry phone in the “on” position in a pocket over or within six inches of the ICD, and hold the phone to the ear on the opposite side of the ICD.

If your heart requires a shock from your ICD, you are likely to feel it. You may feel dizzy or lightheaded prior to the shock—this is from the tachycardia or fibrillation. The shock administered by the ICD may feel like a light thump or a strong kick in the chest. If you feel a shock, try to stay calm and sit or lie down. If someone is with you, ask them to stay. If you feel okay after the shock, contact your doctor’s office to let them know you felt a shock. This is not an emergency, but your doctor may want you to come in for a check-up.

Cardiac Resynchronization Defibrillator Therapy

Cardiac resynchronization defibrillator (CRT-D) therapy combines the benefits of defibrillation with synchronous biventricular pacing capabilities. Biventricular pacing re-coordinates mismatched contractions of the heart's ventricles to improve cardiac output in individuals. CRT-D therapy is used in individuals who qualify for an ICD and who also have moderate to severe heart failure. CRT-D is also indicated for individuals with poor pumping function, as expressed by low left ventricular ejection fraction, and conduction delays to the ventricles, as expressed by long QRS duration.

These following symptoms are medical emergencies. Call 911 if:

You feel lightheaded or dizzy and do not feel a shock
You are still feeling symptoms after a shock
You feel three or more shocks in a row

Call Your Doctor If Any of the Following Occurs

Signs of infection, including fever and chills
Redness, swelling, increasing pain, excessive bleeding, or discharge from the incision site
Coughing, chest pain, shortness of breath, or severe nausea or vomiting

Implanted Cardioverter Defibrillator Š 2008 Nucleus Medical Art, Inc.