It sends electrical signals to start or regulate a slow heartbeat. It's most often placed in the chest just under the collarbone. A pacemaker may be used if the heart's natural pacemaker the SA node is not working properly causing a slow heart rate or rhythm, or if the electrical pathways are blocked.
Another type of pacemaker is called a biventricular pacemaker. It's used for ventricles that don't contract at the same time. This can make heart failure worse. A biventricular pacemaker paces both ventricles at the same time. This increases the amount of blood pumped by the heart.
This treatment is called cardiac resynchronization therapy CRT. In some cases, a newer type of system called a leadless pacemaker may be used. This device is implanted within the heart itself. It does not use leads to stimulate the heart. An implantable cardioverter defibrillator ICD looks similar to a pacemaker, though slightly larger.
It works very much like a pacemaker. But the ICD can send an energy shock that resets an abnormal heartbeat back to normal. Many devices combine a pacemaker and ICD in one unit for people who need both functions. After the shock is delivered, a "back-up" pacing mode is available if needed for a short while. This is a fast-pacing impulse sent to correct the rhythm.
This can be used instead of shocking the heart in some cases. Instead, this device is implanted in the left axillary region. Ann ICD lead is tunneled under the skin over the sternum. It can deliver energy shocks to treat life-threatening heart rhythms. Not only is the ICD programmed to pace your heart if it falls below a lower programmable rate, but more importantly, it is capable of delivering an electrical defibrillation shock if your heart rate is too fast and you are suffering from ventricular tachycardia or fibrillation.
Single-chamber systems always refer to presence of one right ventricular ICD shocking coil lead; a dual-chamber system refers to the addition of a right atrial pacemaker lead that can sense the atrial electrical activity. For those patients with a history of sick-sinus syndrome or bradycardia originating from the atria top chambers of the heart , they typically benefit from implantation of this second lead that can monitor their atrial and sinus node rate.
Your cardiologist will make the final recommendation based on your clinical situation. Programming of your ICD system is a painless and easy procedure.
Newer generation of devices are now allowing wireless communication for ease of use. However, this is limited to several feet, still necessitating an office visit with your physician. Figure 5. ICD systems have been proven to prolong survival in a select population. The role of antiarrhythmic medication to suppress ventricular tachyarrhythmias in this population as a primary treatment regimen is limited, given it has no survival benefit.
However, antiarrhythmics are useful to reduce the burden of ventricular tachyarrhythmias in patients with recurrent ICD shocks. ICDs are not always necessary for patients with ventricular tachycardia and a reversible or treatable cause, including a myocardial infarction, coronary blockage, or medications.
In general, an ICD insertion is a safe procedure. However, as with any surgical procedure there is a risk of complications. You will be given an identification card by your device company; it is recommended that you keep this card with you, especially when you travel to the airport or visit a medical provider. Your physician will see you again typically 6 weeks after your ICD implantation to examine the incision site and to confirm device programming. Thereafter, expect to follow-up every months to monitor the device function and the battery life.
Most ICD batteries last years. You may be startled and anxious after receiving an ICD shock, but this should be tempered by the knowledge that your ICD has done its job to protect you from life-threatening tachyarrhythmias. Local support groups are available for patients with ICDs and a history of therapeutic shocks. You should always have your device implantation card available, along with a plan of action if you were to receive a shock.
This plan can be discussed with you and your physician, to limit your anxiety at the time of shock. You will be given specific instructions about what to do the first time your ICD delivers a shock. For example, you may be told to dial or go to the nearest emergency room in the event of a shock from the ICD. Calming yourself with slow deep breaths can be helpful if you are anxious after a shock. Ask your doctor when you will be able to return to work.
The nature of your job, your overall health, and your progress will determine how soon you may return to work. After implantation, your ICD will require regular evaluation called an interrogation to evaluate its function and battery status, and to check for any significant events stored by the device.
Your doctor will tell you when and how this is done. A home monitor may be provided to you that can communicate with your ICD wirelessly. Information about ICD function can then be related to your doctor over the internet. 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.
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