When is a defibrillator necessary

Increased pain, redness, swelling, or bleeding or other drainage from the insertion site. If your device generator feels loose or like it is wiggling in the pocket under the skin. Your doctor may give you other instructions after the procedure, depending on your particular situation. Take the following precautions when you have an ICD implanted. Discuss the following in detail with your doctor, or call the company that made your device:.

If you travel by air, inform security screeners that you have an ICD before going through the metal detector. It may help to say you have a pacemaker — which is true as pacemaker functions are built into ICDs — because security may not know what an ICD is. In general, airport security detectors are safe for pacemakers and ICDs, but the small amount of metal in the device and leads may trigger the alarm.

If you are selected for additional screening, politely remind the screener that the security wand contains a magnet, which may interfere with the programming or function of the ICD pacemaker if it is held over the device for more than a few seconds.

Do not lean on or stand in this equipment. But it is OK to pass quickly through the detection system. Avoid large magnetic fields such as power generation sites and industrial sites, such as automobile junkyards that use large magnets. If an MRI has been recommended for you, contact your doctor. Do not use diathermy the use of heat in physical therapy to treat muscles. Do not use a heating pad directly over your ICD. Avoid transcutaneous electrical nerve stimulation TENS therapy. Talk to your doctor if you are considering this treatment.

Turn off large motors, such as cars or boats, when working on them as they may create a magnetic field. Avoid high-voltage and radar machinery, such as radio or television transmitters, electric arc welders, high-tension wires, radar installations, or smelting furnaces. If you are scheduled for surgery, let the surgeon know well ahead of the operation that you have an ICD.

Also, consult with your cardiologist before the procedure to find out if you need any special preparation. When involved in a physical, recreational, or sporting activity, protect yourself from trauma to the ICD. A blow to the chest near the ICD can affect its functioning. If you are hit in that area, you may want to see your doctor. Cell phones are generally safe to use, but keep them at least 6 inches away from your ICD.

Avoid carrying a cell phone in your breast pocket over your ICD. Always see your doctor when you feel ill after an activity, or when you have questions about beginning a new activity. Always talk to your doctor if you have any questions concerning the use of equipment near your ICD. Health Home Treatments, Tests and Therapies. Why might I need an implantable cardioverter defibrillator?

There may be other reasons for your doctor to recommend an ICD. What are the risks of an implantable cardioverter defibrillator? Possible risks of ICD insertion include: Bleeding from the incision or catheter insertion site Damage to the blood vessel at the catheter insertion site Infection of the incision or catheter site Tearing of the heart muscle Collapsed lung Dislodging of the leads requiring another procedure to reposition the leads If you are pregnant or think that you could be, or are currently breastfeeding, tell your healthcare provider.

If you are allergic to or sensitive to any medicines or latex, tell your healthcare provider. How do I get ready for an implantable cardioverter defibrillator?

Your doctor will explain the procedure to you and ask if you have any questions. If you are pregnant or think that you could be, tell your doctor.

You may get a sedative before the procedure to help you relax. Based on your medical condition, your doctor may request other specific preparation. How is a cardioverter defibrillator implanted? Generally, an ICD insertion follows this process: You will be asked to remove any jewelry or other objects that may interfere with the procedure.

You will be asked to remove your clothing and will be given a gown to wear. You will be asked to empty your bladder before the procedure. You will be placed on your back on the procedure table. The surgical site is cleaned. In some cases, hair may be shaved or clipped. Large electrode pads will be placed on the front and back of the chest. The ICD insertion site will be cleansed with antiseptic soap.

Sterile towels and a sheet will be placed around this area. A local anesthetic will be injected into the skin at the insertion site. For most people, the device will be needed for the rest of their life. There are specific individuals who may get a device for prophylactic purposes, or for some reason the condition resolves. That does not happen very often.

If it can be determined for a fact that the problem has resolved, then occasionally we remove devices. We often use devices in conjunction with medications. We do not look at devices in general as a substitute for medication. On the other hand, no medication can substitute completely for an implanted defibrillator.

What some people are hoping for is when they get a device put in they can come off all of their medications--this is not the case. In fact, devices usually work with medications much better than they work by themselves. For some people we try to treat life-threatening rhythm disturbances with medication first before we place a defibrillator in.

As time has gone by, we have learned more and more about the safety and effectiveness of implanted defibrillators. We have moved toward using devices more than anti-arrhythmic drugs, specifically, to try to lower the risk of an arrhythmia and its consequences. This is because many of the anti-arrhythmic drugs have side effects and some toxicity. But that does not mean that we stop the other drugs used--such as drugs used to lower cholesterol, or drugs to help the heart condition.

For pacemakers, occasionally we do use medication to keep the heart going faster, but that generally is not the best approach. There are some cases when we use medications to prevent fast rhythms in conjunction with a pacemaker or a defibrillator. For biventricular pacemakers, if the heart function improves enough, we can stop some of the medications that appeared to be necessary before. For each person there often is some judgment as to what the right thing is to do.

Based on those guidelines then there is no way you can tell everyone what the right thing is, it requires some judgment. If there is any concern, consider getting another opinion. There are various types of doctors who put in different devices, and there are different kinds of devices requiring different kinds of expertise.

Cardiac electrophysiologists who are board certified through the American Board of Internal Medicine would be considered in most cases qualified to implant most heart rhythm devices. There are other doctors who are not board certified cardiac electrophysiologists but are cardiologists who have a wide range of experience with device implants. Some of them have more experience with one type than another.

Most cardiologists do not have much experience with implantable defibrillators or biventricular pacemaker defibrillators. Nevertheless, for a straight-forward pacemaker implant, they might be very good.

On the other hand one has to recognize that a doctor who is not attuned to the needs of the patient based on their education might be able to place the device but might not understand which would be the right device for the patient.

Other types of doctors implant cardiac devices including, nephrologists, pulmonologists, and others who may be less well trained in the procedure. With respect to experience, certainly experience would help the doctor better understand the risks and benefits and help to minimize the risks of implanting a device.

For a doctor to implant devices safely and effectively, continuous practice doing so is needed. The person who places more devices generally does a better, safer job than the person who replaces an occasional device. There are limits to what is necessary.

In other words, if a doctor were to place 2, devices in a year, that doctor would be unlikely to be any better than the doctor who implants perhaps pacemakers in a year. However, if the doctor only implants two pacemakers in a year, chances are that doctor would not have the type of expertise that you would want to be assured that you are getting the best service.

The American Heart Association and the American College of Cardiology have specific recommendations for the number of devices a doctor needs to place to be considered competent. This also goes for specific types of devices. If a doctor is very good at implanting pacemakers and might implant several hundred pacemakers in a year, they might never implant a biventricular pacemaker or a defibrillator, so they should not be considered qualified to implant every single type of device.

We had one patient who had no chance otherwise to leave the hospital alive. There was no hope for him. We placed the biventricular device, and now he has been fine for over two years. He travels all over the country with his children and grandchildren with no problem whatsoever.

This excellent improvement can and does happen. Generally you do see a marked improvement with the biventricular devices. Are you clear about which benefits and side effects matter most to you? Do you have enough support and advice from others to make a choice? Author: Healthwise Staff. Medical Review: Rakesh K. Rhoads MD - Internal Medicine. This information does not replace the advice of a doctor. Healthwise, Incorporated, disclaims any warranty or liability for your use of this information.

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It looks like your browser does not have JavaScript enabled. Please turn on JavaScript and try again. Important Phone Numbers. Get the facts. Your options Get an ICD. Don't get an ICD. Key points to remember Your doctor may suggest an ICD if you are at risk of having an abnormal heart rhythm that could cause sudden death.

Tests can show if you are at risk. Many medical facts play a role in whether an ICD might help you. For example, the amount of blood your heart pumps ejection fraction helps your doctor decide if an ICD is right for you. Your doctor also will consider other health problems you may have. The ICD also can use painless electrical pulses to fix a heart rate that is too fast or too slow. Your doctor may also advise you to take medicine to reduce your chance of having a deadly abnormal heart rhythm.

How can heart failure affect heart rhythm? How can an ICD help? How is the ICD placed? You may be able to see a little bump under the skin where the ICD is placed. How does it feel to get a shock from an ICD? There's no way to know how often a shock might occur. It might never happen.

Who might want an ICD? Your doctor will look at whether: You're taking medicine to treat heart failure and to prevent abnormal heart rhythms. You're expected to live more than 1 year. Your ejection fraction is lower than normal.

You have passed out from previous abnormal heart rhythms. You have had a heart attack. This means that you have some trouble doing everyday activities because of your heart failure symptoms. Who might not want an ICD? You have frequent abnormal heart rhythms ventricular tachycardia that can't be controlled with medicines. An ICD would shock you repeatedly. You have class IV heart failure and heart transplant surgery is not an option.

People who have class IV heart failure can't do any physical activity without symptoms. An ICD probably wouldn't help you live longer. You have an abnormal heart rhythm that can be fixed with catheter ablation. This is a procedure that destroys some heart tissue where the abnormal rhythm starts. What are the benefits of an ICD? ICDs can help lower the risk of dying suddenly from a heart problem.

In studies, ICDs lowered the number of people who died because of a heart problem from about 16 out of people to about 7 out of people. In studies, ICDs lowered the number of people who died from any reason from about 30 out of to about 20 out of What are the risks of an ICD? Serious bleeding could occur after placement of the ICD. This happens from 1 to 6 times out of Serious bleeding doesn't happen 94 to 99 times out of But a pneumothorax can be treated and people recover well.

This happens less than 1 time out of This doesn't happen 99 times out of Serious problems don't happen 99 times out of Pain, bleeding, or bruising soon after the procedure. The leads that attach to the heart may break or stop working right. This can happen between 2 and 15 times out of after 5 years of having the ICD. So it does not happen about 85 to 98 times out of One long-term study found that, after 10 years, 20 out of leads had problems. This also means that 80 out of leads didn't have problems.

The surgery would be more complex than that needed to replace an ICD battery. You could get an infection where the ICD is placed. This happens about 1 to 2 times out of So there is no infection about 98 to 99 times out of There is no way to know if or when this could happen.

In studies, these shocks happened to 3 to 21 out of people over 1 to 5 years. This means that these shocks didn't happen in 79 to 97 people out of There also is a chance that a manufacturer may recall an ICD for a problem. If this were to happen, you might need surgery to take out the ICD and leads. What follow-up do you need after getting an ICD?

Compare your options. You probably will spend the night in the hospital, just to make sure that there are no problems. You would need to have minor surgery to replace the battery after 5 to 8 years. You keep taking your heart failure medicine and following a healthy lifestyle.

An ICD may lower the risk of sudden death in some people who have heart failure. An ICD can fix a heart rate that is too fast or too slow without using a shock. You may have peace of mind that a dangerous heart rhythm could be fixed right away. Problems can happen during or soon after the procedure to place the ICD. Examples include a lead tearing the heart or a lung collapsing. The manufacturer could recall an ICD for a problem. If the ICD gives you too many shocks, you also may need to take a rhythm-control medicine or have catheter ablation.

You may take a rhythm-control medicine to prevent abnormal heart rhythms. You avoid the risks of surgery. You won't worry about when the ICD might shock you.

You could have an abnormal heart rhythm that could cause sudden death. Personal stories about getting an ICD for heart failure These stories are based on information gathered from health professionals and consumers. What matters most to you? I want to do everything I can to prevent a deadly heart rhythm. I'm not worried that the ICD might shock me.

I would worry all the time that the ICD might shock me. I don't mind having a device inside my body. I don't like the idea of having a device inside my body. I'm not worried about the small risks of surgery. I'm concerned that something could go wrong with the surgery. I'm not concerned that the ICD or the leads could break.

My other important reasons: My other important reasons:. Where are you leaning now? What else do you need to make your decision? Check the facts. True Sorry, that's not right. Not everyone who has heart failure needs an ICD. Your doctor may suggest an ICD if you are at risk of having an abnormal heart rhythm that could cause sudden death.

False You're right.