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IMPLANTABLE CARDIOVERTER DEFIBRILLATOR

All you need to know

1. What does ICD stand for?

Implantable cardioverter-defibrillator

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.

 

3. What is the cost of an ICD?

The cost of an ICD depends on the model used. It can range from 2lakhs to 4.5lakhs 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 Rs 2,30,000 to Rs 5,00,000 all-inclusive depending on the device you choose.

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

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.

5. What are the types of ICD?

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.

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

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

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.

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 so as to minimize the risk of infection.

9. Who will do my procedure?

Your procedure will be done by one of the 4 consultants in the Cardiac Electrophysiology Unit. They include Dr. David Chase, Dr. John Roshan, Dr. Sirish Chandra Srinath, and Dr. Anand. 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 3 so as to not keep you waiting.

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 doing so. We will wake you up after it is over.

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.

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 so as 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.

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

The electric shock will hurt if one is conscious. 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 failed.

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.

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.

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 in ensuring that there is strict asepsis maintained during the procedure. It is important for patients particularly those with diabetes 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.

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, it is possible for one to 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, it is advisable for him to come for a check-up within a month. If your doctor finds that your shock was inappropriate, then he will change your device programming so as to minimize the chances of this happening again.

18. Are there any restrictions after implanting an ICD?

You cannot do welding. You will need to use your mobile phone on the opposite side ear and keep it in your pant pocket or handbag. You need to keep 6metres away from high tension electric wires and transformers. You will need to avoid being close to gadgets that cause electric vibrations like electric power drills, motorboat engines, physiotherapy involving TENS [transcutaneous electric nerve stimulation], and shortwave diathermy.

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

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

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

You can resume normal activity within 4-6 hours after the procedure. It is advisable that you do not 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.

21. When can I resume driving?

If you had an abnormal heart rhythm, then you will have to wait for 6 months of 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.

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.

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.

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 it is advisable for you to come for a check-up within 1 month of the same.

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