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Implantable Cardioverter Defibrillator (ICD)
What is it?
An
ICD is an electronic device that constantly monitors your heart rate and rhythm.
When it detects a very fast, abnormal heart rhythm, it delivers energy to the
heart muscle. This causes the heart to beat in a normal rhythm again.
How
does it work?
The
ICD has two parts:
-
Leads – monitors the heart rhythm, delivers energy used for pacing,
cardioversion and/or defibrillation.
-
Generator – houses the
battery and a tiny computer. Energy is stored in the battery until it is
needed. The computer receives information from the leads to determine what
rhythm is occurring.
There are different types of ICDs:
-
Single Chamber – a lead is attached in the right ventricle. If needed,
energy is delivered to the ventricle to help it contract normally.
-
Dual Chamber – leads are attached in the right atrium and the right
ventricle. Energy is delivered first to the right atrium and then to the
left ventricle, helping your heart to beat in a normal sequence.
-
Biventricular ICD – leads are attached in the right atrium, the right
ventricle and the left ventricle. This technique helps the heart beat in a
more balanced way and is specifically used for patients with heart failure
The ICD computer monitors the heart rhythm, identifies abnormal
heart rhythms, and determines the appropriate therapy to return your heartbeat
to a normal heart rhythm. Your doctor programs the ICD to include one or all of
the following functions:
-
Anti-tachycardia Pacing (ATP) – When the heart beats too fast, a
series of small electrical impulses are delivered to the heart muscle to restore
a normal heart rate and rhythm.
-
Cardioversion – A low energy shock is delivered at the same time
as your heartbeat to restore a normal heart rhythm.
-
Defibrillation – When the heart is beating dangerously fast, a
high-energy shock is delivered to the heart muscle to restore a normal
rhythm.
- Bradycardia pacing – When the
heart beats too slow, small electrical impulses are sent to stimulate the heart
muscle to maintain a suitable heart rate.
What
should I expect?
You
will lie on a bed and the nurse will start an intravenous line (IV) in your arm
or hand. This is so you may receive medications and fluids during the
procedure. You will be given an antibiotic to prevent infection and a medication
through your IV to relax you and make you drowsy, but it will not put you to
sleep.
The nurse will connect you to several monitors. The monitors allow the doctor
and nurse to check your heart rhythm, blood pressure and other measurements
during the pacemaker implant.
Your left or right side of your body, from your neck to your groin will be
shaved and cleansed with a special soap. Sterile drapes are used to cover you
from your neck to your feet. A strap will be placed across your waist and arms
to prevent your hands from coming in contact with the sterile field.
The
ICD may be implanted in two ways:
-
Endocardial (transvenous) – A
small incision is made under the collar bone. The lead is placed into a vein and
guided inside your heart chamber. The generator is placed under skin in the
upper chest and attached to the lead(s).
-
Epicardial (outside your heart) – This requires open heart
surgery. Instead of placing the lead through a vein and guiding it to the heart,
it is sewn onto the heart. Your doctor will decide if this approach is necessary
for you.
The ICD implant takes about two to five hours to perform. After the procedure, you
will be admitted to the hospital for about one to three days.
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