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Heart Rhythm Problems: Should I Get an Implantable Cardioverter-Defibrillator (ICD)?
You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.
Heart Rhythm Problems: Should I Get an Implantable Cardioverter-Defibrillator (ICD)?
Get the facts
- Get an ICD.
- Don't get an ICD.
This decision aid focuses on whether to get an ICD (implantable cardioverter-defibrillation) when you do NOT have heart failure. The ICD decision for heart failure patients raises some different issues.
Key points to remember
- An ICD constantly checks your heart rate and rhythm. It is designed to fix a dangerous abnormal heart rhythm and prevent sudden death.
- Your doctor may suggest an ICD if you are at risk of having an abnormal heart rhythm that could cause sudden death.
- Your doctor also will consider other health problems you may have to see how high your risk is for a deadly heart rhythm and whether an ICD could prevent it.
- The shock from an ICD hurts briefly. It’s been described as feeling like a punch in the chest. But the shock is a sign that the ICD is doing its job to keep your heart beating. The ICD also can use electrical pulses to fix a heart rate that is too fast or too slow, but you usually do not feel those pulses.
- Even with an ICD, you may still need to take medicine to help prevent a deadly abnormal heart rhythm.
An ICD is a battery-powered device that can fix an abnormal heart rate or rhythm and prevent sudden death. The ICD is placed inside the chest. It's attached to one or two wires (called leads) that go into the heart through a vein.
An ICD is always checking your heart rate and rhythm. If the ICD detects a life-threatening rapid heart rhythm, it tries to slow the rhythm to get it back to normal. If the dangerous rhythm does not stop, the ICD sends an electric shock to the heart to restore a normal rhythm. The device then goes back to its watchful mode.
An ICD also can fix a heart rate that is too fast or too slow. It does so without using a shock. It can send out electrical pulses to speed up a heart rate that is too slow. Or it can slow down a fast heart rate by matching the pace and bringing the heart rate back to normal.
Whether you get pulses or a shock depends on the type of problem that you have and how the doctor programs the ICD for you.
Your doctor will put the ICD in your chest during minor surgery. You will not have open-chest surgery. You probably will have local anesthesia. This means that you will be awake but feel no pain. You also will likely have medicine to make you feel relaxed and sleepy.
Your doctor makes a small cut (incision) in your upper chest. He or she puts one or two leads (wires) in a vein and threads them to the heart. Then your doctor connects the leads to the ICD. Your doctor programs the ICD and then puts it in your chest and closes the incision.
In some cases, the doctor may be able to put the ICD in another place in the chest so that you don't have a scar on your upper chest. This would allow you to wear clothing with a lower neckline and still keep the scar covered.
Most people spend the night in the hospital, just to make sure that the device is working and that there are no problems from the surgery.
You may be able to see a little bump under the skin where the ICD is placed.
The shock from an ICD hurts briefly. It’s been described as feeling like a punch in the chest. But the shock is a sign that the ICD is doing its job to keep your heart beating. You won't feel any pain if the ICD uses electrical pulses to fix a heart rate that is too fast or too slow.
There’s no way to know how often a shock might occur. It might never happen.
It's possible that the ICD could shock your heart when it shouldn't. If that were to happen, you would have pain. The shock could make you fall out of bed, and that could injure you.
In rare cases, the shock could cause the heart to quiver, or flutter, and stop pumping blood. This is called ventricular fibrillation (say "ven-TRICK-yuh-ler fib-ruh-LAY-shun"), which can be deadly. If this happened, the ICD would shock your heart again to stop the fluttering.
Many people say that they have a good quality of life with an ICD. But shocks—and the fear of shocks—can make some people worry too much. They may be afraid all the time that the ICD might shock them. This worry can reduce a person's quality of life.
- ICDs can help lower the risk of sudden death from dangerous heart rhythms. In studies, ICDs lowered the number of people who died because of a heart problem from 16 out of 100 people to 7 out of 100 people.1
- ICDs might also help lower the risk of death from causes other than sudden cardiac death. In studies of people with dangerous heart rhythms, ICDs lowered the number of people who died from any reason from 30 out of 100 to 21 out of 100.1
There are several risks to getting an ICD. But the risks are different for each person. The risk for problems associated with the implant procedure might be higher for people who are age 80 or older.
- You could get an infection where the ICD is placed. This happens about 1 to 2 times out of 100. So there is no infection about 98 to 99 times out of 100.2
- The leads that attach to the heart may break or stop working right. This can happen between 2 and 15 times out of 100 after 5 years of having the ICD. So it doesn't happen about 85 to 98 times out of 100.3 But the risk of a lead breaking or not working right appears to increase over time. One long-term study found that, after 10 years, 20 out of 100 leads had problems. This means that 80 out of 100 leads didn't have problems.4 If a lead does break or doesn't work anymore, you will need surgery. The surgery would be more complex than that needed to replace an ICD battery.
- Serious bleeding could occur after placement of the ICD. This happens from 1 to 6 times out of 100. Serious bleeding doesn't happen 94 to 99 times out of 100.1
- A lung could collapse (pneumothorax) from a buildup of air in the space between the lung and the chest wall. This happens less than 1 time out of 100. This doesn't happen 99 times out of 100.1, 5
The ICD could shock the heart when it shouldn't. There is no way to know if or when this could happen. It might never happen.
There also is a chance that a manufacturer may recall an ICD for a problem. If this were to happen, you might need surgery to take out the ICD and leads.
You will need regular checkups with your doctor to make sure that the ICD is working.
It's important to keep taking any medicines your doctor has prescribed. You'll also need to follow a healthy lifestyle. This includes eating heart-healthy foods, getting regular exercise, and not smoking.
If the ICD gives you a lot of shocks, your doctor may prescribe the rhythm-control medicine amiodarone. This medicine helps prevent abnormal heart rhythms and may keep the ICD from sending shocks too often. Your doctor also could suggest catheter ablation to lower the number of times the ICD shocks you. Catheter ablation can lower the chance of some abnormal heart rhythms, such as atrial fibrillation or ventricular tachycardia. These rhythms can cause the ICD to shock you.
An ICD runs on a battery that lasts from 5 to 8 years. To have the battery replaced, you will need minor surgery.
If you get an ICD, you have to be careful not to get too close to some devices with strong magnetic or electrical fields. These include MRI machines, battery-powered cordless power tools, and CB or ham radios. But most everyday appliances are safe.
Your doctor may advise you to get an ICD if you have had a dangerous abnormal heart rhythm, or if you are at risk for having one.
Compare your options
What is usually involved?
What are the benefits?
What are the risks and side effects?
- You will have minor surgery to have the ICD put in. Your doctor will numb the area with local anesthesia.
- You probably will spend the night in the hospital, just to make sure that there are no problems.
- You will need to have minor surgery to replace the battery after 5 to 8 years.
- You keep taking your heart medicine and following a healthy lifestyle.
- An ICD can prevent sudden death from an abnormal heart rhythm.
- An ICD can also fix a heart rate that is too fast or too slow without using a shock.
- You may have peace of mind that a dangerous heart rhythm could be fixed right away.
- Problems can happen during or soon after the procedure to place the ICD. Examples include a lead tearing the heart or a lung collapsing.
- The manufacturer could recall an ICD for a problem. If this were to happen, you might need surgery to take out the ICD and leads.
- The shock from an ICD hurts briefly.
- If the ICD gives you too many shocks, you also may need to take a rhythm-control medicine or have catheter ablation.
- You follow a healthy lifestyle.
- In some cases, you may be able to have catheter ablation to fix an abnormal heart rhythm.
- You may take a rhythm-control medicine to prevent abnormal heart rhythms.
- You avoid the risks of surgery.
- You won't worry about when the ICD might shock you.
- You could have an abnormal heart rhythm that could cause sudden death.
Personal stories about considering an ICD
These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.
My doctor said there's a good chance I could get a really bad heart rhythm that could make my heart stop. We talked about an ICD. I'm a little nervous about getting shocked. But if it could save my life, it's worth it, so I'm going to get one.
Cassius, age 62
I've had a couple of episodes of palpitations from a really fast heart rate. But I'm taking medicine, and it seems to be working. I'm not ready to get an ICD.
Federico, age 66
I just got some test results back that show there's a chance I could get a heart problem that causes my heart to stop. I have absolutely no symptoms, and the idea of an ICD scares me. But the idea of having my heart stop scares me more. I'm going to get an ICD.
Cherie, age 70
My doctor told me that my heart problem might be fixed if we destroy some heart tissue that is causing it. The procedure is called ablation. It might correct the problem, so I don't need to have an ICD. I'm going to try that. If it doesn't work, then I'll talk to my doctor about getting an ICD.
Martin, age 66
What matters most to you?
Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.
Reasons to get an ICD
Reasons not to get an ICD
I want to do everything I can to prevent a deadly heart rhythm.
I would rather use only medicine to lower my chance of a deadly heart rhythm.
I'm not worried that the ICD might shock me.
I would worry all the time that the ICD might shock me.
I don't mind having a device inside my body.
I don't like the idea of having a device inside my body.
I'm not worried about the small risks of surgery.
I'm concerned that something could go wrong with the surgery.
My other important reasons:
My other important reasons:
Where are you leaning now?
Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.
Getting an ICD
NOT getting an ICD
What else do you need to make your decision?
Check the facts
I need to have an ICD if I have heart problems.
- True Sorry, that's not right. Not everyone with heart problems needs an ICD. Your doctor may suggest an ICD if you are at risk of having an abnormal heart rhythm that could cause sudden death.
- False You're right. Not everyone with heart problems needs an ICD. Your doctor may suggest an ICD if you are at risk of having an abnormal heart rhythm that could cause sudden death.
- I'm not sure It may help to go back and read "Get the Facts." Not everyone with heart problems needs an ICD.
I'll feel a painful shock if an ICD fixes a heart rhythm that could cause sudden death.
- True You're right. The shock from an ICD hurts briefly. But the shock is a sign that a possibly deadly heart rhythm has been fixed. An ICD also can use painless pulses to fix a fast or slow heart rhythm.
- False Sorry, that's not right. The shock from an ICD hurts briefly. But the shock is a sign that a possibly deadly heart rhythm has been fixed. An ICD also can use painless pulses to fix a fast or slow heart rate.
- I'm not sure It may help to go back and read "Get the Facts." The shock from an ICD hurts briefly. But the shock is a sign that a possibly deadly heart rhythm has been fixed.
I might need surgery again someday if the ICD breaks or if it needs a new battery.
- True That's right. The ICD or the wires that attach to it could break. If that happens, you might need surgery to fix the problem. You also will need surgery to replace the battery, which lasts 5 to 8 years.
- False Sorry, that's not right. The ICD or the wires that attach to it could break. If that happens, you might need surgery to fix the problem. You also will need surgery to replace the battery, which lasts 5 to 8 years.
- I'm not sure It may help to go back and read "Get the Facts." If the ICD or the wires that attach to it broke, you might need surgery to fix the problem. You also will need surgery to replace the battery.
Decide what's next
Do you understand the options available to you?
Are you clear about which benefits and side effects matter most to you?
Do you have enough support and advice from others to make a choice?
How sure do you feel right now about your decision?
Use the following space to list questions, concerns, and next steps.
Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.
|Primary Medical Reviewer||E. Gregory Thompson, MD - Internal Medicine|
|Specialist Medical Reviewer||Rakesh K. Pai, MD, FACC - Cardiology, Electrophysiology|
- McKelvie R (2010). Heart failure, search date May 2009. Online version of BMJ Clinical Evidence: http://www.clinicalevidence.com.
- Ezekowitz JA, et al. (2003). Implantable cardioverter defibrillators in primary and secondary prevention: A systematic review of randomized, controlled trials. Annals of Internal Medicine, 138(6): 445–452.
- Eckstein JE, et al. (2008). Necessity for surgical revision of defibrillator leads implanted long-term. Circulation, 117(21): 2727–2733.
- Kleemann T, et al. (2007). Annual rate of transvenous defibrillation lead defects in implantable cardioverter-defibrillators over a period of >10 years. Circulation, 115(19): 2474–2480.
- Reynolds MR, et al. (2006). The frequency and incremental cost of major complications among medicare beneficiaries receiving implantable cardioverter-defibrillators. Journal of the American College of Cardiology, 47(12): 2493–2497.
Last Updated:June 2, 2011