ICD Implantation

Overview of ICD Implantation in India

An Implantable Cardioverter Defibrillator (ICD) is a small, battery-powered device that is implanted underneath the skin in the chest. It will monitor your heart rhythm and deliver shocks to restore normal heart rhythms should you be experiencing life-threatening rapid heart rhythms, such as Ventricular Tachycardia (VT) or Ventricular Fibrillation (VF). An ICD can also be used in patients at a high risk for developing life-threatening arrhythmias due to heart muscle disease.

An ICD is not comparable to a pacemaker. A pacemaker stabilizes or prevents slow heart rates or arrhythmias; one key difference is that an ICD has the ability to deliver an electric shock while a pacemaker does not.

What Is An Implantable Cardioverter Defibrillator?

An Implantable Cardioverter Defibrillator (ICD) is a device used to correct life-threatening irregular (arrhythmic) heartbeats. An ICD will continuously monitor your heart; if the device senses an irregular heartbeat that is life-threatening, it will provide an electrical shock to your heart to restore its normal rhythm. Many ICD devices are also combined with a pacemaker.

An ICD is surgically implanted beneath the skin in your chest; the ICD contains a pulse generator that provides the electrical energy to shock your heart back to normal, and the generator also contains a lead (thin wire) that connects the generator to your heart. In some instances, an ICD will contain more than one lead if it is also intended to be utilised as a pacemaker. The pulse generator itself is approximately the size of a stopwatch and contains a battery and parts that monitor the heart's electrical impulses. The leads are inserted into your heart's heart chambers in order to monitor and shock your heart as necessary.

The Subcutaneous ICD is a specific type of ICD; it is much smaller than the traditional ICD (between the size of an AAA battery and the size of a credit card), and it is implanted via a lead (thin wire) that travels underneath the skin to the outside of the heart and will produce a shock to your heart if necessary.

Alternative Names

The implantable cardioverter-defibrillator (ICD) can also be called a "cardiac defibrillator" or an "implantable defibrillator." The term "cardiac defibrillator" focuses on how the ICD treats certain types of potentially life-threatening arrhythmias or abnormal heartbeats, and the term "implantable defibrillator" underscores its placement inside a person’s body. The two terms are commonly used interchangeably; however, there is not a separate device for either the treatment of arrhythmias or the placement of a defibrillator inside the body. All define the same type of device that helps to protect a person from dying from a cardiac rhythm problem and prevent sudden cardiac arrest.

Types of ICD Implantation:

There are four main types of Implantable Cardioverter-Defibrillators, or ICDs.

First, the single-chamber ICD. It’s pretty straightforward — it uses a lead in the right ventricle to step in and deliver energy when your heart needs it. Then there’s the dual-chamber ICD. This one has leads in both the right atrium and the right ventricle, giving it a bit more control over heart rhythms.

Next up is the biventricular ICD. Doctors usually go with this one for people with heart failure. It sends signals to the right atrium, right ventricle, and left ventricle, all at once. That helps the heart beat in a more coordinated way. For about two-thirds of folks who still have symptoms despite medication, this device actually makes a real difference.

Finally, there’s the subcutaneous ICD, or S-ICD. Unlike the others, it sits just under the skin — not inside a blood vessel — and delivers a shock if your heart’s rhythm goes haywire. It can pace the heart briefly right after a shock, but it doesn’t provide long-term pacing support.

Procedure:

Before The Procedure

• You may likely be requested to abstain from food and liquids for a few hours prior to receiving an ICD.
• Before the surgery, discuss your medications with your healthcare team and enquire about continuing them.
• After the ICD operation, make plans for someone to drive you home, and make sure you have help while you heal.

During The Procedure

• A medical worker will put an IV into your arm or hand, and he/she can also give you a tranquilliser so that you can relax. During the process, electrodes are attached to your chest (and in some cases, your legs) in order to check your heartbeat.
• You may stay awake, or you may be given drugs to put you into a condition of sleep, like general anaesthesia. The surgeon will cut a hole in the chest and then cut a blood vessel on the neck to the collarbone, and then he will insert a flexible wire to lead to the heart. The wires get connected to the heart and are connected to a shock generator that is implanted under the skin.
• It is normally done in a few hours. After the ICD is put in, it will be tested and coded to your specific heart rhythm. It may also be able to provide low-energy pacing (resulting in slight flutter) or higher-energy shocks (painful but lasting no more than a second) to treat irregular heartbeats.
• One shock is usually sufficient; however, in case of several shocks in a not very long time span (arrhythmia storm), contact emergency help. The ICD is reprogrammable, and drugs can be added to minimise shocks and manage the heartbeat.

After The Procedure

Youth normally can go home the day following their ICD procedure.

The swelling and discomfort in the area of ICD insertion could persist for days or weeks. Pain relief may be prescribed to you by your doctor. Talk with your physician regarding the avoidance of aspirin and ibuprofen that can increase the chance of bleeding.

To ensure you do not lose the device wires, you should not suddenly move your left arm over your shoulder and store it there during the eight weeks. Your medical team will give advice on the time when you can drive and get back to normal life.

The first four weeks do not allow:

• Vehement sports or activities that require actions of lifting the left arm over the shoulder, such as golf, tennis, swimming, or vacuuming.
• Heavy lifting
• Strenuous exercise