How to live with an implantable cardiac defibrillator

2024 Author: Samantha Chapman | [email protected]. Last modified: 2023-12-17 09:13

An implantable cardioverter defibrillator (ICD) is a small battery-powered device that is inserted into the body of many people who have survived a heart attack and are at risk of sudden death from ventricular fibrillation or tachycardia. The ICD is often compared to pacemakers, in fact most patients already have one implanted. Learning to live with this device also means understanding its purpose and paying attention to some simple precautions.

Steps

Step 1. Understand how the implantable cardiac defibrillator works

• It is composed of two main elements: the electrodes, which are thin wires connected to the heart and which monitor its rhythm, and the generator which supplies and releases the electrical energy during the shock. Most implantable cardiac defibrillators also function as a pacemaker.

• The electrodes are connected to the heart, to one or both ventricles, and constantly monitor their electrical activity; when they perceive a life-threatening rhythm (arrhythmia), the device intervenes in one of three ways:

  • Cardioversion: Releases a jolt at a precise time during the cardiac cycle to convert the arrhythmia into a normal sinus rhythm (RSN).
  • Defibrillation: it subjects a large part of the heart muscle to an electric shock to depolarize it, "resets" the cells (thus blocking the arrhythmia) and allows the sinoatrial node to re-establish the RSN. This procedure is often represented in the media with a doctor placing electrodes on the patient's chest releasing a jolt that makes him jerk violently.
  • Stimulation: Using a pacemaker built into the ICD delivers short electric shocks to stimulate the heart when the rate slows.

  

  Step 2. Find out about the medical conditions and reasons why you need this device

  • People who have survived cardiac arrest, who suffer from arrhythmia, and are at risk of sudden cardiac death are often candidates for this implant.

  • The two types of arrhythmia that the device is able to treat both originate from the ventricles and are:

    • Ventricular tachycardia (VT): abnormal and rapid heart rhythm (over 100 beats per minute). This phenomenon is treated with cardioversion when the ICD senses the pulse. If nothing is done, the situation could escalate into ventricular fibrillation.
    • Ventricular fibrillation (VF): The heart contracts uncontrollably and quivers instead of pumping blood. This is an extremely dangerous situation because the blood supply to the brain is cut off, depriving it of oxygen. It is treated with defibrillation, but if no action is taken within a few seconds, it is likely to degenerate into asystole (flat electrocardiogram); in this situation, severe brain damage is reported and the patient dies if he does not receive treatment within 5 minutes.
  • Before undergoing the implant, make sure that you fully understand your disease and the reasons why a heart defibrillator of this type is needed. Ask your cardiologist for more information, read brochures, and also talk to other ICD patients.

  

  Step 3. During the first few weeks after the operation, avoid lifting the arm corresponding to the side of the chest where the defibrillator was inserted above your head

  Do this type of movement with the other arm.

  

  Step 4. Prepare for change

  While the lifestyle remains largely unchanged, there are some considerations you need to make. For example, if the ICD has been fitted to the upper chest, you need to change the vehicle's seat belt; if an item of clothing puts pressure on your chest, you don't have to wear it anymore. Make these variations in your routine as you encounter such situations in your daily life.

  

  Step 5. Carry the device card that identifies you as an implantable cardiac defibrillator wearer

  After undergoing the operation, inform your primary care physician, dentist and any other doctors following you.

  Since the device is metallic, it could drive metal detectors and other security systems found in airports and other similar places "crazy"; in this case, show the identification card to the staff and keep it with the other documents to find it easily

  

  Step 6. Whenever possible, stay away from anything that might interfere with the ICD

  These are objects that emit radio waves or magnetic fields. Many times the cardiologist gives patients a booklet listing all the electronic devices they need to pay attention to. Here are some examples:

  • MRI machines (absolutely to be avoided), radio transmission towers and equipment for radio amateurs;
  • Common objects such as cell phones, appliances, microwaves, hairdryers, electric blankets are safe to use as long as they are kept at a distance of at least 15 cm.

  

  Step 7. Avoid aggressive sports that involve constant physical contact

  These include football, wrestling and boxing. Stay alert and watch out for any balls that may hit the implant site; this means taking precautions even when you are assisting as a spectator and there is a real possibility that the ball will leave the pitch and reach the stands.

  

  Step 8. Avoid driving especially in the first months after surgery

  You may suddenly become unconscious or flinch due to the intervention of the device and lose control of the vehicle.

  

  Step 9. React calmly when you feel the electric shock

  30-50% of patients can detect ICD intervention during the first year after implantation. Although you are likely to be unconscious before the shock, many people often describe it as a painful blow to the chest. If the device activates with a shock, promptly call the cardiologist.

  • It is vital to be organized when dealing with the shocks of an implantable cardiac defibrillator. Be aware that they can happen and it's important to know if you need to go to the emergency room or just make an appointment with your doctor to reassure yourself about the effects of shock. You should discuss with your doctor or cardiologist what you need to do after device surgery and carry out exercises so that when the time comes, your response is spontaneous and natural.
  • Always keep your ICD identification card and medical information with you or on hand, prepare a list of the medications you are taking and the contact details of the cardiologist; in this way, you feel reassured and make it easier for the people who help you in case of need.
  • Educate family and friends about what to do when you are subjected to a defibrillator shock; explain to them what they need to monitor and how they can help you. Having a support group on hand can make a huge difference in staying positive after shock episodes.
  • Practice deep breathing and relaxation techniques to stay calm when the ICD activates; a state of excessive arousal (panic, shallow breathing, and so on) can make your mood unnecessarily worse. Some people recommend daily meditation to maintain awareness of their reactions to stressful situations.
  • Talk to a psychologist. It is normal to experience anxiety or depression, fear and worry about the shaking of the device. These psychological repercussions are often associated with the uncertainty of when the shock will occur and what will happen next (including the fear of dying). These fears slowly subside as you get used to the implant, but it's important to talk to people who can reassure you.
  • For many patients it is better to have an ICD than not to have it; if and when the shock activates, know that it is at least a "reminder" to remind you that you have the best care available. Examine your personal values, the advantages and disadvantages of the defibrillator when considering surgery.

  

  Step 10. An ICD is a good solution at a certain stage in life, but health conditions change over the years (due to the progression of heart or other organ disease), making the device less beneficial

  Discuss these possibilities with your doctor before undergoing the implant.

  

  Step 11. Show up regularly for follow-up appointments with your cardiologist

  It is essential that the device is checked in a timely manner. During visits, you are subjected to an electrocardiogram to examine the electrical activity of the heart; depending on the type of disease, tests are conducted every 4-6 months or even once a year. These times are also good times to ask your doctor your questions or explain your concerns.

  Advice

  • Make sure family members are able to perform CPR and that they call 911. If you do not regain consciousness after a shock, you should intervene with CPR and call the emergency services.
  • Since the implantable cardiac defibrillator is a life-saving device, remember that you have the right to have it deactivated; remember to mention this when discussing your living will with your doctor and family.
  • When the device is activated with a shock, people around you are not at risk. Often the defibrillator activates more than once or the patient may perceive an abnormal heart rate and expect its intervention. It is quite safe to hold the person's hand to comfort him in these moments; if you are pregnant, know that this behavior does not affect the health of the baby.
  • The implant area is covered with a sterile dressing immediately after surgery; after a few days it is removed and you can feel the device under your skin.

  Warnings

  • The cardiologist typically prescribes antiarrhythmic drugs to control irregular heart rate. Implanting a heart defibrillator is not a substitute for the action of these medicines and you should continue to take them.
  • If you have experienced several shocks in a short time, call your doctor right away. Since the device is designed to stop the arrhythmia after a single shock, the need for multiple interventions of the defibrillator may indicate it is malfunctioning.