Heart Rhythm Problems: Should I Get an Implantable Cardioverter-Defibrillator (ICD)?

An ICD is a battery-powered device that can fix an abnormal heart rate or rhythm and prevent sudden death. The ICD is placed under the skin of your chest. It's attached to one or two wires (called leads). For one type of ICD, these leads go into the heart through a vein. For another type, the lead is placed under the skin so it lies near your heart.

An ICD is always checking your heart rate and rhythm. If the ICD detects a life-threatening rapid heart rhythm, it may try to slow the rhythm back to normal using electrical pulses. 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.

Some ICDs also can fix a heart rate that is too slow. The ICD does so without using a shock. It can send out electrical pulses to speed up a heart rate that is too slow.

Whether you get pulses or a shock depends on the type of ICD, the type of heart problem that you have, and the way 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.

The doctor will make an incision (cut) in the skin just below your collarbone or at the side of your chest. The doctor will put the ICD leads through the cut. For one type of ICD, your doctor puts one or two leads in a large blood vessel and threads them into the heart. For another type, the lead may be placed under the skin through a small cut in the middle of your chest. Then your doctor connects the leads to the ICD. Your doctor puts the ICD under the skin of your chest and closes the cut. Your doctor also programs the ICD.

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.

An ICD can help lower the risk of sudden death from a dangerous heart rhythm.

How well an ICD may work for you depends on several things. These include whether you have already survived a life-threatening heart rhythm. Your doctor can help you understand how well an ICD might help you.

There are several risks to getting an ICD. But the risks are different for each person. The risks also depend on the type of ICD that you get. Your doctor can help you understand what your risks are from an ICD.

During the procedure. Problems can happen during or soon after the procedure to implant an ICD. Here are some examples.

• You may have pain or bruising.
• Serious bleeding could occur after placement of the ICD.
• A lung could collapse (pneumothorax) from a buildup of air in the space between the lung and the chest wall.

After the procedure. Problems can also happen months or years after the ICD is implanted. These problems are related to the device or the leads.

• The leads that attach to the heart may break or stop working right. If a lead does break or does not work anymore, you would need surgery. The surgery would be more complex than that needed to replace an ICD battery.
• You could get an infection where the ICD is placed.
• 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. Your doctor will program your ICD to lower the risk of one of these shocks.
• 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.
• The idea of living with an ICD and getting shocked worries some people. For some people, getting a shock can cause anxiety and depression.

After the ICD is implanted, you will not drive for a short time. Depending on the reason you got the ICD, you may not be able to drive for one week to a few months. If you get a shock from the ICD, your doctor may ask that you don't drive for a short time.

You'll need to take steps to safely use electric devices. Some electric devices have a strong electromagnetic field. This field can keep your ICD from working right for a short time. Check with your doctor about what you need to avoid and what you need to keep a short distance away from your ICD. Many household and office electronics do not affect your ICD.

You will need regular monitoring and checkups with your doctor to make sure that the ICD is working well and that the programming is right for you.

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.

An ICD runs on a battery that can last several years. If the battery gets low, you can decide whether or not to have minor surgery to replace the ICD.

Talk with your doctor about the possibility of turning off the ICD at the end of life. Many people consider turning off the ICD when their health goals change from living longer to getting the most comfort possible at the end of life. Turning off your ICD is legal. It isn't considered suicide. The decision to leave on or turn off your ICD is a medical decision that you make based on your values.

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.

Your personal feelings are just as important as the medical facts. Talk with your doctor about what matters most to you.

You and your doctor will decide whether an ICD is right for you.