CIN - ** UNIQUE ASSESSMENT APP by Dr. Neeraj Bhalla **


AICD implants

What Is An Icd?

An ICD is a device that is implanted inside your body to treat VT/VF (give link of Arrhythimia) and thereby prevent Sudden Cardiac Arrest (SCA).

It works automatically by constantly monitoring your heart rate and detecting VT or VF episodes as soon as they begin. When an ICD detects an episode of VT or VF it immediately delivers therapy in the form of low energy electrical pulses or electric shocks to terminate the arrhythmias before they can harm the patient.

The ICD is a part of a system that has two main components – the ICD itself and the leads. The ICD is made of titanium metal and contains a battery, a microprocessor (a small computer) and electronic circuitry.

The leads are insulated wires that are threaded through a vein from the ICD to the inside of your heart. They serve to carry electrical signals from the heart to the ICD enabling the ICD to constantly monitor your heart rate and identify VT / VF episodes when they occur. The leads also serve to carry electrical impulses and shocks from the ICD to the heart to terminate VT/VF.

Today’s ICDs are capable of providing four types of therapies that can be performed by your doctor:

•  Antitachycardia Pacing: In this type of therapy the ICD sends out bursts of low energy electrical pulses at a rate faster than the patient’s VT. For up to 95 % of VT’s, these rapid pulses are sufficient to terminate the VT. Most patients do not even feel these low energy pulses.

•  Cardioversion Shock: If antitachycardia pacing does not stop the VT, the ICD can be programmed to deliver stronger electrical impulses called cardioversion shocks. These shocks may be programmed from low energy to high energy, as needed. Patients often describe the cardioversion shock as a thump on the chest and associate it with some discomfort.

•  Defibrillation: If the ICD detects VF, it will send a high-energy shock to the heart to restore the heart to its natural rhythm. Some people lose consciousness when their heart goes into VF, so they are not aware of receiving the shock. Others who are awake during a defibrillation shock describe it as a “strong kick in the chest” that “passes very quickly”. Most of the time the realization that the shock has saved their life more than compensates for the discomfort patients feel from it.

•  Bradycardia Pacing: If the ICD detects a very slow heart rate (bradycardia), it will pace the heart with electrical stimuli and prevent it from beating too slowly.

How Effective Are Icds?

The ICD was invented more than two decades ago with the specific purpose of automatically detecting and terminating life-threatening arrhythmias that cause Sudden Cardiac Arrest (SCA). Today, they are considered the most effective therapy available for the treatment of patients who are at high-risk for SCA due to VT/VF. The electrical therapies provided by ICD are up to 99% effective in terminating VT and VF.

Clear proof of the superiority of ICDs in preventing SCA over the currently available medicines for arrhythmia management has emerged from a number of clinical trials. Based on these trials, expert committees across the world have recommended ICD therapy in preference to other therapies in patients who are at high-risk of suffering from SCA due to VT/VF. On an average, patients who receive ICD therapy are likely to live significantly longer than those who are managed solely with medications.

Approximately 200,000 ICDs are being implanted per year worldwide (2004) and the number of implants is growing at a rapid rate.

How Is An Icd Implanted?

The ICD implant operation is not an open-heart surgical procedure. In fact, it is a relatively simple procedure that is performed under local anaesthesia and usually takes about 2 hours.

The ICD is usually implanted under the skin, in the left (and rarely in the right) chest area, just below the collar bone. The ICD leads are inserted into one of the veins located in the chest area that lead into the heart. The leads are pushed through these veins until they enter the heart and make contact with the heart tissue. The other end of the leads is inserted into the ICD.

Once the leads have been placed and connected to the ICD, the ICD system’s function is tested to ensure that it can effectively detect and terminate dangerous ventricular arrhythmias.

Patients are usually discharged from the hospital within 2 to 5 days after the ICD is implanted.

What Type Of Lifestyles Do Icd Patients Typically Lead?

Upon the advice of their physician, ICD patients can lead normal lifestyles which include:

•  Pursuing hobbies or recreational activities
•  Returning to their jobs
•  Resuming strenuous activity
•  Resuming sexual activity
•  Travelling

Depending on the patient’s condition, the doctor may recommend avoiding situations where a few seconds of unconsciousness due to a rapid heart rhythm could be dangerous to the patient or others. Such activities may include driving, swimming, working with heavy machinery etc.

Patients with ICDs can safely operate both home and office electrical appliances.

ICD patients must strictly adhere to the routine follow-up schedule established by their doctor. In addition, when a patient feels symptoms or receives a shock, the patient must contact his or her physician.

How Can I Learn More About Icd Therapy?

Your doctor is best suited to answer questions about your ICD therapy.



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