1. What does ICD stand for?

Implantable cardioverter-defibrillator

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2. What is the benefit I will get by putting an ICD?

An ICD is put to prevent sudden death due to abnormal electric current arising in the heart. It is put in patients who have had abnormal heart rhythms documented on ECG/ Holter that are life-threatening. It is also put in patients with heart diseases that predispose them to have such abnormal rhythms. Once the ICD is implanted it will act only at the time of an abnormal rhythm. If your heart beats normally then your ICD will just silently monitor your rhythm. It is also required in those with heart failure who have weak hearts that pump poorly. Such patients with weak hearts are prone to developing abnormal life-threatening electric currents.

 

3. What is the cost of an ICD?

The cost of an ICD depends on the model used. It can range from 3.2 lakhs to 9 lakhs approximately. The cost of the entire package including getting admitted, having the ICD fixed, bed charges, nursing care, and doctor’s fees will cost you approximately 3.2 lakhs to 11 lakhs all-inclusive depending on the device and ward you choose.

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4. How long will I need to stay in Vellore to get the ICD done?

Once you have the date of the procedure fixed, you will need to plan for a 4-day stay in Vellore which will include a 3-day hospital stay to get the ICD done.

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5. What are the types of ICDs?

ICD can be a single or double chamber. They may or may not be MRI-compatible. The details of their functions will be explained to you by a doctor.

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6. Is a double-chamber ICD better than a single chamber?

For certain types of conditions that require pacing in the top chamber, a dual-chamber ICD is recommended. Sometimes for conditions like hypertrophic cardiomyopathy with a lot of abnormal currents coming from the top chamber of the heart, a dual-chamber ICD may be preferred. Irrespective of whether it is a single or double chamber the ICD will save your life from sudden death due to abnormal currents.

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7. Would it hurt me when I undergo the procedure of having an ICD implanted?

No, it will not hurt you as the procedure will be done under local anesthesia. It will only hurt as much as a mosquito bite, the moment when the local anesthesia injection is given. After that injection is given, the medicine will act, and you will not have any pain.

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8. How long will the procedure take?

The procedure will take around 3 to 4 hours which includes a great deal of time that is devoted to doing it in a sterile fashion to minimize the risk of infection.

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9. Who will do my procedure?

Your procedure will be done by one of the six consultants in the Cardiac Electrophysiology Unit. They include  Dr. John Roshan, Dr. Sirish Chandra Srinath, Dr. Anand, Dr.Hariharan Dr.Yogesh, and Dr. Haynes. All of them have vast experience in doing these procedures. If you have been a private patient of one of them then the particular doctor you saw will do your procedure. In case your doctor is unwell and not available, your procedure will be done by one of the other five to not keep you waiting.

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10. Will I be awake during the procedure?

You will be awake for the procedure and can have a chat with your doctor as he does it. However, you may feel sleepy due to the medicines given and you are welcome to take a nap if you feel inclined to do so. We will wake you up after it is over.

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11. Will my heart pumping improve after the ICD? Will I feel better?

The ICD has no effect on your heart pumping. Putting an ICD will not make your heart pumping increase. The medicines that you take can help improve your heart pumping and make you feel better.

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12. How does an ICD prevent sudden death?

An ICD recognizes an abnormal electric current in the heart that can cause sudden death based on the abnormal rhythm that it results in. Once it does so, it tries to pace the heart at a faster rate to suppress the abnormal current. This is called anti-tachycardia pacing. If the abnormal rhythm persists the ICD gives an electric shock to the heart and makes the rhythm normal.

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13. Will the electric shock that is given by the ICD hurt?

The electric shock will momentarily hurt if one is conscious. A dull ache and post-traumatic stress may sometimes follow this. However, when one has an abnormal electric current that is life-threatening, he usually loses consciousness. So, he does not feel the shock. In addition, the ICD is programmed to try anti-tachycardia pacing [ATP] first and it will shock only if ATP fails.

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14. Can the ICD also work as a pacemaker?

Yes, an ICD can also work as a pacemaker if necessary, though the vice versa is not true.

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15. How long does the battery last? Does it need to be changed?

The ICD battery life is usually around 8 years. However, the battery life varies depending on individual use. It gets over early if it is used a lot due to the individual having a lot of abnormal electric currents in his heart.

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16. What are the possible complications? 

The chance of having a complication during or after an ICD procedure is very rare; less than 1 in 100 chance. The complications can include swelling in the operation area due to bleeding or a tear in the heart due to the ICD lead causing a perforation. The most important and dreaded complication is an infection. We take a lot of pains to ensure that there is strict asepsis maintained during the procedure. Patients particularly those with diabetes need to get their dental, skin, or urinary infections promptly treated. If an infection in any part of the body is neglected it will spread to the ICD. The other potential complication is an inappropriate shock and the post-traumatic stress disorder that may follow it.

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17. What is an inappropriate shock? 

The ICD should give your heart an electric shock when it has an abnormal life-threatening electric current causing an abnormal heart rhythm. These abnormal currents come from the lower heart chambers. However, one can have abnormal currents coming from the top chambers in the heart as well. These rhythms are not life-threatening and do not require a shock. However, the ICD device sometimes mistakes them to be life-threatening and so gives an inappropriate shock. When a patient has a shock, he should come for a check-up within a month. If your doctor finds that your shock was inappropriate, then he will change your device programming to minimize the chances of this happening again.

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18. Are there any restrictions after implanting an ICD?

While standard airport metal detectors are generally considered safe for people with ICDs, it's wise to inform security personnel and request alternative inspection methods, such as a pat-down, if you have one. It is best to avoid standing near a metal detector or leaning on one any longer than is necessary. If the security insists on using a handheld metal detector, ask them not to hold the wand near your device longer than necessary.

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Passing through a metal detector or scanner is unlikely to harm your device. However, the metal in the device will cause their detector to alarm. So, It is good to carry the International Cardiac Device Identification Card to convince the security officials that you are not carrying a weapon on you.

Mobile phones can be used but they should not be kept within 6 inches from the ICD. They should not be placed in the shirt pocket on the side of the device. The mobile phone should be used with the ear on the opposite side of the ICD.

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You can use Bluetooth earphones even after ICD implantation. However, they should be kept 6 inches or 15cm away from the device, as their magnets can interfere with normal ICD function. One must avoid placing headphones or earbuds in a shirt pocket or draping them around the neck, which could put them too close to the ICD. 

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ICD function can be affected by powerful magnetic or electro-magnetic fields such as found to occur with MRI, Surgical shortwave Diathermy, Trans-cutaneous electrical nerve-stimulation (TENS), induction cookers, electric fences, electric power drills, motor boat engines, arc-welding equipment, jumper cables, 15-30W wireless radios, magnet therapy that requires the wearing of magnets, Ab stimulators with current, electronic body fat scales. Hence all this equipment is best avoided.

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Electric shavers and electric blankets should be kept at least 6 inches away from the device. If you have an MRI-compatible device then you may undergo an MRI if required after turning the MRI mode on. CT scanning can usually be safely done in people with ICDs though occasionally Xrays can result in a device reset. Gasoline ignition systems need to be atleast 12 inches away which means driving a car is not an issue. Lithotripsy for kidney stones can affect ICD function. It should be used with caution if necessary with monitoring of device function postprocedure and during follow-up.

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Radiation therapy used for cancer treatment can damage the circuitry of ICDs. The degree of damage is unpredictable – and may vary with different systems – but the risk builds with increased radiation. The implanted ICD should be shielded from radiation as much as possible. It may need to be relocated if it lies directly in the targeted radiation field.​

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19. Do I have an increased risk of lightning killing me because I have an ICD?

No, the risk of dying from lightning is the same as that of anyone else.

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20. When can I resume normal activity after the procedure?

You can resume normal activity within 4-6 hours after the procedure. You shouldn't repeatedly lift your arm above shoulder level on the side of the procedure for 6 weeks after the procedure. This will help your wound to heal and prevent the lead from getting dislodged.

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21. When can I resume driving?

If you had an abnormal heart rhythm, then you will have to wait for 6 months for no such life-threatening rhythms to resume driving. If you have not had any sudden cardiac death-like event or any abnormal rhythm, then you can start driving 6 weeks after the procedure.

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22. Can my doctors monitor my heart rhythm through the ICD from far away?

Yes, it is possible to monitor your heart rhythm through a remote monitoring device. This device is the size of a mobile phone and it can continuously transmit your heart rhythm to the hospital where it can be monitored. This remote transmitting device needs to be purchased separately and costs approximately Rs. 60,000 to Rs. 1,00,000 depending on the company and the ICD device model.

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Remote monitoring is useful for those who are living in remote places, whose children are abroad, and who don’t have any ready immediate access to Cardiac Superspeciality care. It is particularly helpful if one feels he got a shock from the device. Through remote monitoring, the doctor can tell him if he got a shock and if it was appropriate or inappropriate. However, the doctor cannot change or modify the device setting remotely and the patient will have to come to a hospital that has the facilities to do so.

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23. When should I come for my next check-up after the ICD is implanted?

You ideally need to come 6 weeks to 3 months after your procedure, for us to make sure that the device is properly fixed and functioning to our satisfaction.

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24. How frequently do I need to have my machine checked?

You need to have a yearly check-up after the ICD is implanted. If you experienced a shock, then you should come for a check-up within 1 month of the same.