ICD Implant

Heart rhythm disorders can strike suddenly and can be dangerous, as they might increase the risk of sudden cardiac arrest in some patients. Some abnormal heart rhythms are associated with certain signs and symptoms, such as palpitations, dizziness, or even fainting, but some are not and are found only in emergencies. Early treatment is critical for patients with a higher risk of life threatening ventricular arrhythmias.

An implantable cardioverter-defibrillator (ICD) is a tiny electrical device that monitors the heart rhythm. If it detects a dangerous, abnormal fast rhythm originating in the lower heart chambers, it delivers specialised electrical treatment to restore the heart to its normal rhythm, depending on the problem.

The placement of an ICD (implantable cardioverter defibrillator) is performed by cardiac electrophysiologists and cardiologists at Gleneagles Hospitals using specialised imaging and monitoring techniques. The specialists examine the patient's condition prior to surgery, taking into account factors such as his/her medical history, cardiac health, and other relevant factors.

An Implantable Cardioverter Defibrillator (ICD) is a miniaturised, battery-powered electronic device placed under the skin in the area just below the collarbone. It is connected to the heart through insulated wires called leads.

This device continuously monitors the electrical activity of the heart. If a potentially fatal ventricular arrhythmia is detected, the ICD will deliver appropriate therapy to restore normal heart rhythm.

As per the abnormality observed, the ICD can:

• Send low-energy electrical pulses to fix fast heart rate problems
• Deliver anti-tachycardia pacing (ATP) to stop some abnormal rhythms
• Send high-energy shocks to restore a normal heartbeat

Today's ICDs can even record heart rhythms, thereby providing doctors with information about the recorded events for further adjustments. Even though an ICD does not treat any heart condition, its importance lies in preventing sudden cardiac arrest in patients.

An ICD is not required for every person with a heart condition. It should be recommended only after careful assessment, when the advantages outweigh the disadvantages.

The doctors would normally consider implanting the ICD in those patients who:

• Have survived sudden cardiac arrest caused by ventricular arrhythmias
• Have suffered from sustained ventricular tachycardia
• Have experienced heart failure with poor pumping function
• Have genetic cardiac rhythm disorders resulting in sudden cardiac death
• Have high-risk cardiomyopathies with ventricular arrhythmias
• Have structural heart diseases, associated with increased risks of sudden cardiac arrest

This depends on a variety of factors, including:

• Type of heart disease
• Functioning of the heart and its ejection fraction
• Cardiac history
• Current state of health
• Results of imaging and cardiac studies

At Gleneagles Hospitals, all cases would be individually assessed to determine whether implanting an ICD is the best solution.

Before the ICD is inserted, the patient undergoes a comprehensive cardiac evaluation to determine whether the procedure is appropriate and safe for them. These include the following:

• Detailed patient history and physical assessment
• Electrocardiogram (ECG)
• Echocardiography to check heart functionality
• Blood work
• Chest X-ray if required
• 24-hour Holter monitoring in some cases
• Cardiac magnetic resonance imaging or any other imaging studies, depending on need

Doctors also consider current medications, cardiac interventions, and the presence of other medical conditions. This extensive evaluation enables healthcare providers to determine which patients are best suited for receiving an ICD.

Even though implantation of an ICD provides many benefits to patients, there are certain cases where it should not be performed. The procedure should not be done on patients who have:

• Active infections that need to be treated first
• Severe illnesses where the benefits from the treatment would be small
• Certain types of reversible reasons for their abnormal heart rhythms
• Diseases that put them at high risk of complications during the procedure

Some people may need further tests and treatments before they get their ICD.

Preparation

Prior to the procedure, a final clinical evaluation and blood tests are carried out on the patient. A review of medications, allergies, and prior cardiac procedures is conducted by healthcare professionals.

The patient is normally told not to eat or drink for a few hours before the procedure. Some drugs may need to be adjusted based on the cardiologist's advice. Local anaesthesia with sedation is used for the procedure.

During the Procedure

The insertion of the ICD is done in a special cardiac catheterisation lab or an electrophysiology room under constant monitoring.

First, a small cut will be made below the collarbone, and the leads will be inserted into the heart using imaging guidance called fluoroscopy. When they are properly placed, the ICD generator will be connected to the leads and implanted under the skin.

Finally, the ICD is tested for its proper functioning, and the incision is closed. This process may take from one to three hours.

Immediately After

After completion of the procedure, the patients are observed in the recovery unit, where heart rate, blood pressure, and ICD functioning will be evaluated. The physician may order a chest X-ray to determine whether the leads have been positioned correctly or if any complication, such as a pneumothorax, has developed. Additionally, the device is programmed to meet the patient's needs.

The majority of patients spend only one night in the hospital; however, the duration depends on the patient's condition. At discharge, instructions will be provided on wound care, limitations, drugs, and next visits.

Recovery after ICD implantation is generally straightforward, although it varies from one patient to another. Mild discomfort, swelling, or bruising around the incision site is common during the first few days and usually improves gradually. Patients are typically advised to avoid lifting the arm on the side of the implant above shoulder level or carrying heavy objects for several weeks while the leads heal and secure themselves in place.

Most people can gradually return to their daily activities based on their doctor's advice. However, strenuous exercise and contact sports should be avoided until complete healing has occurred.

Regular follow-up visits are essential after implantation. During these appointments, specialists check the battery status, assess lead function, review any recorded heart rhythm events, and adjust the device settings if required. Patients are also educated about living safely with an ICD, including precautions regarding certain electrical devices, medical procedures, and travel.

ICD placement is safe in most patients who are candidates for the procedure. But like all invasive procedures, there are risks. They include:

• Bleeding/bruising at the implant site
• Infection
• Incision pain/swelling
• Lead dislocation
• Pneumothorax (air leak from around the lung) - rarely occurring

These problems are rare and can typically be handled well if noticed promptly. Some of the long-term factors to consider are:

• Device or lead wear and tear or malfunction over time
• Exhaustion of battery power, leading to the replacement of the ICD generator after a few years
• Inappropriate shock, which occurs occasionally due to benign heart rhythm or sensor problems
• In some instances, relocation or replacement of leads might be required

Regular follow-up appointments are essential after ICD implantation. These visits involve testing the ICD battery, assessing lead performance, reviewing any detected episodes of heart rhythm, and making necessary setting adjustments. The regular checkup enables early detection of any problems and ensures the device is functioning properly.

With advances in cardiac care over the years, there has been an increase in the use of ICDs in highly selected patients at high risk of developing ventricular arrhythmias.

The main reasons behind this are:

• Reduced risk of sudden cardiac death due to ventricular arrhythmias
• Monitoring of the heart's rhythm
• Treatment of any ventricular arrhythmia automatically
• High-risk patients receive long-term protection
• Highly selected people improve their quality of life

ICDs nowadays have become smaller and more reliable, and are designed to store data.

• Expert Cardiologists and Cardiac Electrophysiologists: ICDs are implanted by cardiologists and cardiac electrophysiologists, who are experts in diagnosing and treating complex heart rhythm disorders.
• Comprehensive Heart Evaluation: Each patient receives a comprehensive evaluation through various tests that help determine whether ICD implantation is the best option for them.
• Advanced Technology: At Gleneagles Hospitals, imaging techniques, electrophysiology labs, and the latest-gen ICDs are used to assist with precise implantation and effective functioning of ICDs.
• Tailored Treatment Plans: The treatment plan is customised to the specific heart problem and the patient's general health.
• Follow-Up Care: Post-implantation, patients are evaluated periodically to monitor the proper functioning of the device throughout its life cycle.

An implantable cardioverter-defibrillator (ICD) is an important treatment option for patients at increased risk of life-threatening ventricular arrhythmias and sudden cardiac death. By continuously monitoring the heart rhythm and delivering prompt therapy when required, the device provides long-term protection against serious rhythm disturbances. Not all patients with heart problems need an ICD, but proper assessment can determine which patients can benefit from it.

ICD implantation at Gleneagles Hospitals is carried out under the guidance of highly qualified cardiologists, with diagnostic and follow-up treatments provided. Each step of the process is carefully planned to ensure the patient's safety.