ICDs

Summary

This video helps the patient better understand why he or she may need an ICD and explains what an ICD does. It covers the steps leading to surgery and what the patient can expect before being discharged. Recovery guidelines, temporary restrictions, and incision care in the first few weeks following discharge are reviewed. The video gives patients safety guidelines for living a full life with an ICD.

Details

Introduction

This program is designed to help relieve some concerns you may have about the ICD and the procedure to implant it. It will also review guidelines for living with an ICD so you can enjoy a healthy, productive life.

Understanding Your Heart

• The heart is one of the body's most vital organs:
  • It is a muscle that continuously pumps blood carrying oxygen and nutrients throughout the body.
  • The heart is divided into four chambers that contract in a steady rhythm.
    • First, the upper two chambers of the heart, called the atria, contract.
    • Then the two lower chambers of the heart, called the ventricles, contract.
  • The heart’s contractions are controlled by electrical impulses that travel through the heart at a steady rhythm.
• Sometimes the heart's normal rhythm is disrupted:
  • Electrical signals can move through the heart in rapid and disorganized patterns called arrhythmias.
  • These abnormal rhythms, specifically the ones which occur in the ventricles, can cause the heart to beat faster and less effectively.
  • This weakens the heart's pumping ability.
  • Cause symptoms such as:
    • Dizzy spells
    • Fatigue
    • Shortness of breath
    • Fainting
  • Life threatening rhythms called Ventricular Tachycardia and Ventricular Fibrillation can occur.
  • Causes of arrhythmias, include:
    • Another heart related condition
    • A heart attack
    • Heart damage
    • Genetic factors

Understanding Your ICD

• An ICD is an electronic device implanted in the body to restore the heart's natural rhythm:
  • It has two parts:
    • The main component, the pulse generator, contains a computer chip and battery.
    • Connected to it are thin wires called leads.
  • The pulse generator is implanted in the chest, below the collarbone.
  • The leads are then threaded through a vein and attached to the walls of the heart's chambers. Leads may be attached to one or two chambers of your heart.
  • When the pulse generator senses an abnormally fast heart rhythm, it sends an electrical impulse through the leads that shocks the heart and restores its' normal rhythm.
• An ICD can produce several types of impulses:
  • Some fast rhythms may be corrected with a low energy impulse.
  • To correct other, faster heart rhythms, a stronger impulse can be produced.
  • An ICD produces electrical impulses only when it senses an irregular heart rhythm.
    • Your doctor will set the ICD to a desired heart rate.
    • If an irregular rhythm occurs, the ICD detects that rhythm and delivers a shock.
  • Most ICDs can also deliver impulses, when the heart rate becomes too slow, so it can pump at a normal, pre-determined pace.

What To Expect The Day Of Surgery

• Pre-operative guidelines:
  • Your doctor will provide specific instructions regarding eating and drinking prior to your procedure.
  • Talk to your doctor about any medications you are taking. It may be recommended that you stop taking certain ones, like aspirin, which can thin the blood, several hours or days in advance.
• When you arrive at the hospital you will:
  • Dress in a hospital gown.
  • Be asked to remove any jewelry or accessories such as contact lenses or dentures. These will be given to a family member for safe keeping.
• There are risks associated with implanting an ICD:
  • Including:
    • Infection
    • Severe bleeding
    • A collapsed lung
    • A heart attack
  • Be sure to discuss any risks or concerns you may have with your healthcare team.
  • Before the procedure, you will be required to sign a consent form.
• ICDs are implanted on either the left or right side of the chest. You will have input as to where it will be best suited for you.
• Preparation for the procedure:
  • You will be given medications to help relax you.
  • Your chest will be shaved, cleaned, and prepared near the collarbone, where the incision will be made.
  • An IV will be inserted to provide medications, anesthesia, and vital fluids during your procedure.
  • Electrodes will be attached to monitor your heart rhythm and the leads of the ICD will be tested to make sure they sense your heart signals clearly.
• The Procedure:
  • An incision about three to four inches long will be made near your collarbone in order to form a pocket just under the skin to house the pulse generator.
  • The pacing lead will be threaded through a vein and into your heart.
  • X-ray monitors will guide your physician through the procedure.
  • If a second lead is used, the doctor will repeat the process.
  • Leads will be tested for sensing and stimulation, and then sewn into the small pocket under the skin.
  • Once the leads are connected, the system is checked to make sure it is working properly.

Recovering From Your Procedure

• How you will feel:
  • Drowsy and tired
  • The incision site will feel tender and sore.
  • If you feel pain, alert your nurse in order to receive pain medication.
• Discharge:
  • It is typical to be up and about within a day, and go home within one to three days.
  • Your health care team will test the ICD once again to make sure it continues to be in good working order.
  • Your health care team will review individual discharge instructions with you, which may include:
    • Incision care
    • Medications
    • Physical activity
    • A schedule to follow for regular check-ups
    • Someone will be required to pick you up and drive you home

Recovering At Home

• Take things slowly in the beginning, especially during the first one to two weeks.
• Temporary Restrictions:
  • You should not lift heavy objects.
  • Limit movements of the arm closest to your incision.
  • Do not participate in rough contact sports such as wrestling and football.
  • Avoid driving, swimming, boating and climbing ladders.
• Safe Activities:
  • You will be able to return to most activities after a short period of time, as soon as you feel up to it, or as your doctor directs, including:
    • Exercise
    • Work
    • Sexual activity
• Incision Care:
  • Keep the area clean and dry:
    • Do not use soap and water on your incision for at least 2 days after arriving home.
    • Do not apply any lotion or powder until the incision has healed completely.
  • Report to your physician any signs of soreness, swelling, or redness near your incision.

Living With Your ICD

• ICD Therapy:
  • An ICD can produce a variety of electrical impulses:
    • Some impulses are so mild you probably won't even notice them, except for some pounding in the chest for a short period of time.
    • Stronger shocks may feel like a swift thump or blow to the chest, but last only a fraction of a second.
  • When your ICD delivers therapy, remain calm:
    • The ICD is working to correct dangerous heart rhythms.
    • Sit or lie down when you feel the therapy.
    • Discomfort associated with shock therapy typically lasts for a short period of time.
  • Alert your healthcare team immediately if:
    • You are experiencing what appear to be random shocks.
    • You receive two or more shocks in a 24 hour period.
    • If you experience severe palpitations, dizziness, or fainting.
• Lifestyle Adjustments:
  • An ID card with information about your heart rhythms and your particular device will be issued after your ICD is implanted. Always carry it with you.
  • Make sure all your healthcare providers are aware that you have an ICD. Medic alert bracelets indicating that you have an ICD are also an option.
  • You may use common household appliances in good working order, such as: microwave ovens, tvs, computers, and hair dryers.
  • Some devices may interfere with your ICD and should be used carefully, or even avoided:
    • When using a cell phone, be sure to hold the phone on the opposite side of your ICD device.
    • Avoid standing near large motors or industrial equipment or other electromechanical equipment.
    • Some medical equipment may affect its function. Once again, make sure your healthcare providers are aware that you have an ICD.
    • Your health care team can provide you with detailed information on what is safe and what is not safe.
• You may find adjusting to life with an ICD a little difficult at first:
  • You may experience feelings of sadness or depression.
  • If these feelings persist, contact your healthcare team.
• Checkups & Maintenance:
  • ICD checkups tell the doctor if your ICD is working properly, how often it has delivered therapy, and how much energy is left in the battery.
  • ICDs can be expected to last three to six years:
    • When the battery gets weak, the pulse generator needs to be replaced.
    • The lead wires usually are not changed, just tested to make sure they are working properly.

Conclusion

It may take a little time adjusting to an ICD, but gradually you will return to an active, healthy life. In fact, the biggest change may be finding yourself being more active, and able to do more than ever before.