Electrophysiology Program
Implantable Cardioverter Defibrillators (ICD)
What Is An ICD?
The letters ICD stand for Implantable Cardioverter
Defibrillator. An ICD is capable of functioning as a pacemaker;
however, its main task is to monitor and act on life threatening
heart rhythms like ventricular tachycardia and ventricular
fibrillation. An ICD is like having a mini paramedic squad in
your chest. If you would go into a life threatening heart rhythm
the device would detect it and deliver an electrical current or
shock to get your heart back into a normal rhythm.
Who should get an ICD?
Patients who have heart damage either from a heart attack or
for other reasons and have decreased pumping function are
possible candidates. Unexpected death or
sudden cardiac death
due to heart rhythm problems is the most common cause of death
in patients with heart disease. Several studies have been done
to look at ICDs and patients with heart damage. These studies,
particularly SCD-HeFT (Sudden Cardiac Death in Heart Failure
Trial) and MADIT II (Multicenter Automatic Defibrillator
Implantation Trial) showed a significant reduction (30%) in
mortality (death) in patients who had an internal defibrillator
than those who did not. All of these patients in the studies
were also on optimal medical therapy.
The centers for Medicare and Medicaid Services (CMS) recently
announced expanded coverage for the implantation of ICDs because
of the positive results of these studies. Eligible patients
include the following:
- Documented episodes of ventricular tachycardia or
ventricular fibrillation not due to reversible causes like
an acute heart attack.
- Documented inherited conditions that predispose patients
to sudden cardiac death such as
long QT syndrome.
- Patients who have had a prior heart attack (more than 40
days) and an ejection fraction of < 35%.
- Patients with dilated cardiomyopathy from causes other
than a heart attack for at least 9 months and an ejection
fraction <35%.
There are some other criteria that must be met to be eligible
including optimal medical therapy. Discuss this with you
cardiologist.
ICD Referral Form
Where Is The ICD Implanted?
The device is implanted (depending on individual anatomy)
either within the pectoral muscle or underneath the skin on the
left or right side of the chest.
What Is The Necessary Follow-up Care For an Internal
Cardioverter Defibrillator (ICD)?
Follow-up care is a life-long commitment. The device clinic
located in the hospital is where a clinician using a programmer
will check your ICD. Remember these devices have been around for
a long time and with proper care they can help you feel good for
many years to come. The first follow up appointment occurs 2
weeks after implantation to assure the site is healing well and
that the device is functioning properly. After that, follow up
with the device clinic occurs every three months.
What Are My Limitations After I Receive My Device?
- The wound site is only to be cleansed with a washcloth
and no showering or bathing for a period of two weeks. The
adhesive strips at the incision area will come off by
themselves.
- Care must be taken in raising the arm that is on the
same side as the device. Do not raise this arm any higher
than the height of your outstretched arm.
- It is advisable that no driving be done for two weeks
after implantation of the device. Further instructions will
be given at the two-week follow-up appointment.
Frequently Asked Questions
Will I be able to use my microwave oven?
Yes, you may use any of the electrical appliances in your
home. These include electric shavers, sewing machines, and all
of your kitchen appliances...even your microwave oven. However,
make note that some old microwave ovens (20 years or older) have
proven faulty and any current leaking from one of these older
microwaves could cause temporary confusion to your pacemaker.
Should you ever be around one of these antiques, walk away and
stay 4-5 feet from the oven when it is in use. But today's
microwave ovens are very safe and you do not have to be the
least bit concerned about any interference from them.
I travel by air, what about airport security?
The metal casing of the device, which is stainless steel, and
some of its components will trigger the security screening
devices at airports. If this happens, simply show your pacemaker
identification card to the security guard (the function of your
pacemaker is NOT affected by these airport devices).
PLEASE NOTE: If you have an
implanted ICD because of the internal components, the device
will trigger airport security alarms. The use of strong magnets
over the device may adversely affect its function and even
render it non-operational. Not all ICDs will be affected by a
magnet. Consult with your physician.
Will I be able to use my cellular phone?
Studies have determined that to avoid any potential
interference, individuals using cellular phones are advised not
to hold the phones directly over their pacemaker or
defibrillator. When certain cellular telephones are held too
close (within 6 inches or 15 centimeters) to some implanted
medical devices, studies indicate that there may be some
temporary effects. Potential effects are due to the radio
frequency signal of the phone. Any effect would be temporary and
simply moving the phone away will return the pacemaker or
defibrillator to its previous state of operation. Because
cellular phone technology continues to evolve, and because of
the great variety of cellular phones, pacemakers, and
defibrillators, an absolute recommendation cannot be made to
cover every phone and every patient. Therefore, to ensure no
adverse effects are encountered, the following standard use
guidelines have been developed by the industry.
**Maintain a distance of 6 inches (15 centimeters) between a
handheld personal cellular phone and the implanted device.
**Portable and mobile cellular phones generally are capable
of transmitting higher power levels than hand-held personal
phones and a larger separation is recommended for digital phones
capable of transmitting power levels above three watts.
Will I be able to have a CAT Scan or MRI?
Yes, you can safely have a CAT Scan, however a MRI (Magnetic
Resonance Imaging) is a different story. Because of the
potential for damage to the device and/or induction of life
threatening arrhythmias, the use of MRI is contraindicated in
Pacemaker and ICD patients.
Static magnetic, alternating magnetic and radio frequency (RF)
fields produced by MRI may adversely affect the operation of
ICDs and Pacemakers. |
