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Defibrillator Implantation

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The image illustrates Defibrillator Implantation.
Image Credit: pennmedicine.org
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Defibrillator Implantation - An Overview

In some people, the electrical system of the heart may develop a short circuit in the pumping chambers( ventricles). This short circuit is termed Ventricular Tachycardia or Ventricular fibrillation. Ventricular Tachycardia (V-tach) is never a good sign. When your heart experiences this arrhythmia, your heart rate exceeds beyond 100bpm, thus putting your life in danger. An Automatic Implantable Cardioverter-Defibrillator (AICD or ICD) becomes necessary to safeguard you from sudden cardiac arrest.

This battery-operated device is implanted in your chest to detect V-tachs and automatically deliver electric shocks to terminate the V-tach and restore your heart rhythm.

The device has a lead or wire and a generator. The lead is placed inside the right ventricle, and the generator is below the left collarbone. The generator’s function is to monitor heart rhythms and deliver defibrillation shocks when they become abnormally fast. ICDs also act like pacemakers by generating electrical impulses to the heart if the rhythm is too slow. The device also tracks and stores data regarding your heart rhythm and the treatments it delivers. Your cardiologist uses this information for further review.

Dr. Karthigesan is the specialist you need for aicd implantation. He is a Cardiac Device Specialist certified by the International Board of Heart Rhythm Examiners, USA. Both his expertise and experience in this field, as well as his compassionate care for patients, are unparalleled. As his patient, you can rest assured you are in good hands.

The image shows the device position after Defibrillator (AICD) Implantation.
A bisection image of the heart with the device after Defibrillator (AICD) Implantation.
Image Credit: mayoclinic.org

Defibrillator (AICD) Implantation: Why it is Necessary

Dr. Karthigesan may recommend an AICD placement if you have the following:

  • Sustained V-tach with fainting spells.
  • Enlarged heart muscle.
  • Genetic heart condition causing long QT syndrome.
  • Rare heart conditions affecting the rhythm.
  • History of coronary artery diseases and heart attacks resulting in a weak heart.

AICD Implantation: Evaluative Tests

Dr. Karthigesan will recommend the following tests before an ICD implantation:

  • Electrocardiography
  • Holter monitoring
  • Event recorder
  • Echocardiography
  • Electrophysiology Study or EP study
Image showing the implanted S-ICD device and S-ICD electrode.
Image Credit: mayoclinic.org
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Defibrillator (AICD) Implantation: 
The Procedure

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Image of an implantable cardioverter defibrillator (ICD).
Image Credit: bhf.org.uk
  • You will be prepared for the procedure, and local anesthesia is administered to the left shoulder region to numb the area where the device will be implanted.
  • The doctor begins by guiding one or multiple insulated wires, known as leads, into your veins near the collarbone using X-rays for precision. These leads are directed towards the heart.
  • One end of the leads are attached to the heart and the others are connected to a device known as the shock generator. This generator is implanted beneath the skin below the collarbone.
  • Once the ICD is properly positioned, it is tested and programmed to accommodate the patient's specific heart rhythm needs. This might involve speeding up the heart after which it is shocked back into a normal rhythm.
  • Typically, the entire procedure to implant an ICD takes a few hours.
Depending on the specific heart rhythm issues, the ICD is programmed in one of two ways:
  • Low-energy pacing: If the ICD is responding to mild changes in heartbeat, you may feel nothing or a painless fluttering in your chest.
  • High-energy shock: For more serious heart rhythm issues, the ICD might deliver a higher energy shock, which can be painful.

AICD Implantation:  Before, During & After Procedure Care

  • Make arrangements to stay at the hospital for one or two nights.
  • Avoid food and drinks for at least eight hours prior to the procedure.
  • Avoid taking blood thinning medication as per Dr. Kathigesan’s advice.
  • The entire procedure will be completed within one hour. An anaesthetist will administer IV sedation to help you stay calm and relaxed. Dr Karthigesan will administer a local anaesthetic below your collarbone.
  • A small bruise of approximately 5-8 centimetres is made.
  • The AICD is then inserted through the bruise  to guide the leads through your vein into your heart, and connect to the device.
  • The bruise is closed and covered with a sterile dressing.
  • You can return home on the next day after your procedure.
  • You will be given medication for relief from the pain and discomfort.
  • You must avoid above-the-shoulder activities like tennis, golf, cycling, swimming, vacuuming, bowling, and heavy lifting.

Defibrillator (AICD) Implantation: The Benefits

  • A sudden cardiac arrest can be prevented more reliably with an ICD than just medication.
  • When your ICD delivers electric shocks, it can be pretty unsettling. However, it indicates that your ICD is working effectively and saving your life. 
  • Your ICD has lithium batteries that can last for at least seven to ten years.
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Defibrillator Implantation:  The Finer Details

A pacemaker is designed only to generate electrical impulses to keep your heart beating normally. An ICD, on the other hand, monitors your heart rhythm and delivers electrical shock to reset the heart during life-threatening fast rhythms.

Apart from avoiding stressful physical activities and driving, you can resume your routine life after ICD implantation. Also, there are no restrictions for handling electronic gadgets.

It is best to get your ICD checked at a device clinic once every six months. Current newer generation devices have remote monitoring or Bluetooth-enabled mobile app facilities for close monitoring of their functions without frequent clinic visits. Apart from routine follow-up visits, you may be asked to visit for a device checkup following a device shock.

Although the risk of mobile phones interfering with ICDs is rare, you should avoid keeping your phone in your breast pocket on the side of the device. You should also use your opposite ear while talking on the phone.

Depending on the usage, most pacemaker and ICD batteries will last 7 to 10 years, after which they will need to be replaced. An outpatient pacemaker generator replacement may require an overnight hospital stay or outpatient surgery.

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