Implantable Defibrillators Save Lives
More than a quarter million Americans trust their lives to an implantable cardioverter defibrillator (ICD), a small, pager-sized device that continually monitors their heart rate, ever ready to deliver a jolt of electricity. Research shows millions more could benefit.
“It’s like having a built-in paramedic with me every place I go,” says Joe Higgins of Oregon about his ICD. “Knowing it’s there is a tremendous comfort. I know I don’t have to worry about sudden death. I expect the machine to do the job.”
Higgins, 69, has a long history of heart disease. He received an ICD six years ago after passing out due to an irregular heart rhythm.
Rachel Smith of North Carolina received her first ICD 10 years ago after experiencing sudden cardiac arrest at age 33.
Most people with ICDs, like Smith and Higgins, have survived a cardiac arrest or suffer from irregular heart rates that increase their risk of sudden death. But now, an additional four million Americans may be eligible for the life-saving devices.
“Anybody with a damaged heart can be at risk [for sudden cardiac arrest],” said L. Bing Liem, DO, FACC, Associate Professor at Stanford University.
In July 2002, the US Food and Drug Administration (FDA) expanded the conditions it deems appropriate for ICD use. In the past, electrical testing was needed to prove an increased risk for abnormal heart rhythms. Now patients with a history of heart attack and depressed heart function may be candidates without enduring the invasive testing. ICDs are also prescribed for persons with moderately severe heart failure who have not previously experienced a heart attack or loss of consciousness, but may be at risk for future life-threatening arrhythmia.
What Does an ICD Do?
An ICD monitors the heart rate. If it detects a dangerous rhythm, it sends a shock of electricity to return the heartbeat to a normal pattern. Most units also function as pacemakers. Some include special features to strengthen the heartbeat.
An ICD is placed under the skin near the collarbone. Wires from the device are attached to the heart during the short procedure.
“The procedure is very straightforward and simple,” says Dr. Liem. “[Vice President] Dick Cheney went home the same afternoon. There’s no significant time for recovery.”
Patients typically resume their normal activities. They must avoid areas with high electromagnetic fields, such as found inside a power-generating plant. Microwave ovens, cellular phones, and household appliances pose no danger. The devices typically need to be replaced every 4-8 years.
“An ICD needs careful consideration,” said Lisa Salberg, 34. The New Jersey woman has hypertrophic cardiomyopathy, a genetic condition that increases her risk of sudden cardiac death. She received an ICD five years ago and trusts it more than her own heart. “It is going to be part of your life from here on out. Make sure all your questions are answered before the implant.”
Adjusting to the Technology
It takes most people time to psychologically adjust to the device. Anxiety is common.
“The first couple of months I was very aware,” said Salberg. Her device has not gone off.
“I don’t do anything that’s going to get my heart rate way up there where I’m going to test the boundaries of the device,” she said. “But I have a normal life and don’t let it get in the way.”
Higgins’ ICD has jolted his heart twice. After the first shock, while walking up a steep grade, his doctor adjusted the device’s parameters. A second shock occurred four years later.
“It felt like the kick of a mule in my chest,” Higgins said. “I don’t limit my activities at all. It might go off. I’ve had two experiences. But it’s an instantaneous thing, and it goes away. I’m fine afterward.”
Higgins has walked 5-6 miles during a relay race. He scuba dives, walks four miles daily, exercises with weights, and does push-ups and sit-ups.
“Before scuba diving, I called Medtronic (the manufacturer) to find out whether my ICD was capable of taking depths,” Higgins said. He also contacted the company before traveling abroad to obtain a list of the medical facilities familiar with ICDs.
Smith has not been so lucky. She has felt the kick 57 times. She exercises regularly and at first blamed that activity for triggering the ICD to deliver its jolt. But then shocks occurred while watching television, in a restaurant, and during a speaking engagement.
“It got to the point I was afraid to go out of the house,” Smith said. “I had to push through that by connecting with other people, going to support groups. Taking a step at a time, you do it.”
Smith has worked through her anger, anxiety, and depression. She described it as a grieving process for her former self. Some people seek help with emotional aspects from a mental health counselor. Even with the multiple shocks, Smith knows her ICD has saved her life and has no regrets.
“Without this defibrillator, I wouldn’t be where I am today,” she concluded. “It’s given me some of the best years of my life.”
American Heart Association
Heart Rhythm Society
US Food and Drug Administration
Heart and Stroke Foundation of Canada
Heart Healthy Kit: Public Health Agency of Canada
American Heart Association website. Available at: http://www.americanheart.org.
Goldberger Z, Lampert R. Implantable cardioverter-defibrillators: expanding indications and technologies. JAMA. 2006 Feb 15;295(7):809-18.
North American Society of Pacing and Electrophysiology. Available at http://www.hrsonline.org/. Accessed July 16, 2008.
US Food and Drug Administration website. Available at: http://www.fda.gov.
Last reviewed July 2008 by Craig Clark, DO, FACC, FAHA, FASE
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