Introduction to ICD in Cardiology

Introduction

An Implantable Cardioverter Defibrillator (ICD) is a device designed to monitor and correct life-threatening heart rhythm abnormalities, particularly ventricular tachycardia (VT) and ventricular fibrillation (VF) , which can lead to sudden cardiac arrest.

How Does an ICD Work?

The ICD is implanted under the skin, usually below the collarbone. It continuously monitors the heart's activity and, if it detects a dangerous arrhythmia, it delivers treatments such as: - Anti-tachycardia pacing (ATP): Small, painless electrical impulses to stop an abnormal rhythm. - Cardioversion: A mild electric shock to restore normal rhythm. - Defibrillation: A stronger shock to stop potentially fatal arrhythmias.

Who Needs an ICD?

ICDs are recommended for individuals at high risk of sudden cardiac death due to conditions such as: - Previous cardiac arrest or life-threatening arrhythmias - Severe heart failure with reduced ejection fraction (EF ≤35%) - Hypertrophic cardiomyopathy with arrhythmic risk - Certain genetic conditions predisposing to sudden cardiac death (e.g., Long QT Syndrome, Brugada Syndrome)

Risks and Benefits

Benefits:

  • Life-saving potential by preventing sudden cardiac arrest.
  • Evidence-based therapy backed by numerous clinical trials.
  • Improved quality of life for high-risk patients.

Risks:

  • Inappropriate shocks due to false detections.
  • Infection or complications related to implantation.
  • Battery depletion requiring replacement every 5-10 years.

ICD and Daily Life

Patients with an ICD can generally return to normal activities but should: - Avoid strong electromagnetic fields. - Inform healthcare providers about the ICD before medical procedures. - Have regular follow-up visits for ICD function monitoring.

Conclusion

ICDs play a crucial role in preventing sudden cardiac death in high-risk patients. If you or a loved one has been recommended an ICD, discussing the benefits and potential risks with a specialist is essential.

Source recommendations

1. American College of Cardiology/American Heart Association/Heart Rhythm Society Guidelines for Management of Patients with Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death

  1. https://www.ahajournals.org/doi/10.1161/CIR.0000000000000549
  2. https://pubmed.ncbi.nlm.nih.gov/29097320/
  3. https://www.heartrhythmjournal.com/article/S1547-5271(17)31249-3/fulltext
  4. https://pubmed.ncbi.nlm.nih.gov/29084733/
  5. https://www.hrsonline.org/guidance/clinical-resources/2017-ahaacchrs-guideline-management-patients-ventricular-arrhythmias-and-prevention-sudden-cardiac

2. European Society of Cardiology Guidelines for Management of Patients with Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death

  1. https://academic.oup.com/eurheartj/article/43/40/3997/6675633
  2. https://pubmed.ncbi.nlm.nih.gov/36017572/
  3. https://www.escardio.org/Guidelines/Clinical-Practice-Guidelines/Ventricular-Arrhythmias-and-the-Prevention-of-Sudden-Cardiac-Death
  4. https://pubmed.ncbi.nlm.nih.gov/26320108/
  5. https://www.ahajournals.org/doi/10.1161/CIR.0000000000000549

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