Experience | Leaflets | Support | Patient+ | Guidelines | Weblinks | News | Products | Other
This is a PatientPlus article. PatientPlus articles are written for doctors and so the language can be technical. However, some people find that they add depth to the articles found in the other sections of this website which are written for non-medical people.
Implantable Cardioverter Defibrillators
Post your experienceTachyarrhythmias can be treated with either anti-arrhythmic drugs or an Implantable Cardioverter Defibrillator (ICD). The first ICD was implanted in 1980. ICDs sense and terminate life-threatening arrhythmias and reduce mortality.1
Implantable cardioverter defibrillators (ICDs) are battery powered, implantable devices that deliver an electrical shock to restore normal sinus rhythm when a life-threatening arrhythmia is detected.1
They are:
- Similar in size to a pacemaker
- Placed under the skin in the pectoral region
- Have a lead in the right ventricular apex
By 2002, 2321 patients in the UK had received an ICD - less than half the expected rate compared to some other countries.
NICE Guidance (Implementation advice 2007) recommends that ICDs should be considered for patients in the following categories:1
- Sustained VT causing syncope
- Sustained VT with ejection fraction less than 35%
- Ejection Fraction less than 30% without VT
- After surgery for congenital heart disease (when there is a risk of VT)
- Previous cardiac arrest (due to VT or VF)
- MI complicated by non-sustained VT, or inducible VT on electrophysiological testing, or an ejection fraction less than 35%
- Familial conditions (for example long QT syndrome, hypertrophic cardiomyopathy, Brugada syndrome)
The ICD leads are inserted via a vein under local anaesthesia. During implantation the unit is tested under conscious sedation. ECG storage provides a retrievable record of the onset and termination of arrhythmias. Programming changes are made with a unit placed over the defibrillator.
Current ICD devices use tiered pacing, recognizing cycle length and can initiate the following appropriate therapy, all via single lead:1
- Anti-bradycardia pacing (like a normal pacemaker).
- Pacing pulses (may cause brief palpitations or a feeling of dizziness) - adaptive bursts to end a VT.
- Cardioversion shocks for persisting VT (if pacing pulses fail, low energy cardioversion shocks are given to terminate VT with the minimum of pain).
- Defibrillation shocks (high energy shocks - feels like being kicked in the chest unless unconscious). Observers will notice the jolt. No harm comes to anyone touching the patient when they receive the shock.
Postoperatively
- It is safe to have a bath or shower after 3-4 days.
- Keep the arm on the same side as the defibrillator below shoulder level until after first ICD check-up (there is a small chance the leads can move).
- Do gentle arm and shoulder exercises to keep the arm mobile.
- Following recovery (4-6 weeks) increase your level of activity if possible.
- A programmer is used to check device settings (takes about 15 minutes).
- Chest x-ray is used to check lead positions.
- Battery length is 6-7 years.
More information
- Change of ICD is like having a first ICD fitted, except new leads are not put in.
- You may have some warning that your ICD is about to deliver a shock (palpitations, or feeling dizzy). Afterwards you should recover quite quickly.
- After the first shock contact the implant centre to have the device checked.
- It is not necessary to have the device checked after every shock unless you feel unwell.
- If the device gives several shocks, dial 999 for an ambulance- the ICD will be checked to find out why.
Lifestyle changes
- Keep your ICD card with you at all times (make, model and settings of the device).
- Sexual activity - the device will not cause any harm, even if a shock is delivered to you during intercourse.
- Electrical equipment (such as drills) can be safely used. Electromagnetic interference (radios, fridges, cookers, computers and microwaves) will not affect your ICD.
- Travel: the ICD may set off the airport security alarm. Your ICD will be unharmed provided you walk briskly through the arch. Many ICD clinics carry a list of ICD-friendly insurance companies.
- Arc welding - should be avoided.
- Mobile phones - keep handsets 6 inches away from ICD (hold the phone over the ear on the opposite side to the device).
- Driving - patients must notify DVLA following initial implantation and should not drive for 6 months. There are detailed guidelines, but in summary driving is curtailed:
- 6 months off after a shock is delivered, with certain exceptions - agreed by DVLA
- 1 month off following revision of the electrodes or alteration of anti-arrhythmic drug treatment
- 1 week off after a defibrillator box change
- Group 2 drivers (LGV/PCV) are permanently barred
Document references
- Arrhythmia - implantable cardioverter defibrillators (ICDs) (review), NICE Technology Appraisal (Jan 2006)
DocID: 187
Document Version: 21
DocRef: bgp25255
Last Updated: 30 Nov 2007
Review Date: 29 Nov 2009
The authors and editors of this article are employed to create accurate and up to date content reflecting reliable research evidence, guidance and best clinical practice. They are free from any commercial conflicts of interest. Find out more about updating.
Patient UK Hearing Impairment Survey
Patient UK are grateful to the 550 people who took part in this survey.
To see the results click here.
If you'd like to leave your feedback, please go to our interactive forum.
Experience | Leaflets | Support | Patient+ | Guidelines | Weblinks | News | Products | Other
Related pages in Patient UK
Your Experience (^ top of page)
Please add your experience about this condition / medicineHealth Topic information leaflets related to this topic (^ top of page)
ArrhythmiasSupport Groups related to this topic (^ top of page)
ICD Patient and Family Heart Support Group (Implantable Cardioverter Defibrillator)PatientPlus articles related to this topic (^ top of page)
Adult Cardiopulmonary Arrest
Amiodarone
Broad Complex Tachycardia
Defibrillation and Cardioversion
Dizziness, Giddiness and Feeling Faint
ECG A Methodical Approach
Inserting Temporary Pacemakers
Pacemaker Syndrome and Pacemaker Complications
Pacemakers and Pacing
Torsades de Pointes
Ventricular Fibrillation
Ventricular TachycardiasUK guidelines related to this topic (^ top of page)
Guidelines on PacemakersLinks to other selected websites related to this topic (^ top of page)
Arrhythmias / Heart BlockPatient UK Newspaper (^ top of page)
Recent related news items
500,000th heart pacemaker fitted
Sandwiches 'caused fainting fits'
Pacemaker that is recharged by the heart is developed by scientists
MP3 earphones could prove fatal for heart patients, says report
'Artificial muscle' could help thousands of sufferers of debilitating heart rhythm disorderAll news by related topic
Pacemakers newsRelated Products (^ top of page)
Medical equipment

Books

Other - Useful resources (^ top of page)
Pictures, diagrams, photos, images, etc.Evidence based medicine
Online textbooks and journals
UK Guidelines
Online Videos
Medline
Other good health sites
Want to search some more? Use the Google Search box below to search our site.
Disclaimer: Patient UK has no control over the content of any external links above. Inclusion does not imply endorsement by Patient UK.
Want to advertise on this site? Find out how >>
Here you can follow a link to view existing patient experiences on this subject, or to add your own
This will offer you the usual PDF options i.e. document navigation, search, zoom and formatted print
Note: this is the best way to print the document
Note: this will open in a new window
Note: this will open in a new window
Here you can follow a link to view existing patient experiences on this subject, or to add your own
This will offer you the usual PDF options i.e. document navigation, search, zoom and formatted print
Note: this is the best way to print the document
Note: this will open in a new window
Note: this will open in a new window




