Implantable Cardioverter Defibrillator (ICD)

Introduction

An Implantable Cardioverter Defibrillator (ICD) is a small electronic device that is implanted in patients at risk of sudden cardiac arrest (SCA) due to life-threatening arrhythmias. It continuously monitors the heart’s rhythm and delivers electric shocks if dangerous arrhythmias occur.

Indications for ICD Implantation

ICDs are recommended for patients with: - Previous cardiac arrest due to ventricular fibrillation (VF) or sustained ventricular tachycardia (VT). - Heart failure with reduced ejection fraction (HFrEF) (ejection fraction ≤35%) despite optimal medical therapy. - Certain genetic conditions causing arrhythmias (e.g., Brugada syndrome, Long QT syndrome). - Post-myocardial infarction patients with persistent high-risk arrhythmias.

How an ICD Works

• Monitoring: Continuously tracks the heartbeat.
• Defibrillation: If VF or VT is detected, the ICD delivers a shock to restore a normal rhythm.
• Pacing: Some ICDs also function as pacemakers to prevent slow or irregular heartbeats.

Procedure and Risks

Implantation Process:

• A minor surgical procedure under local anesthesia.
• The device is placed under the skin, typically near the collarbone.
• Leads are inserted into the heart through veins.

Risks:

• Infection at the implant site.
• Lead displacement.
• Inappropriate shocks (though rare with modern devices).

Conclusion

ICDs are life-saving devices for patients with high-risk arrhythmias. If an ICD has been suggested for you, discuss its potential benefits and risks with your cardiologist.

ICD-10 Code

• Z95.810 – Presence of automatic (implantable) cardiac defibrillator.

Source recommendations

1. European Society of Cardiology (ESC) Guidelines on Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death

1. https://www.escardio.org/Guidelines/Clinical-Practice-Guidelines/Ventricular-Arrhythmias-and-the-Prevention-of-Sudden-Cardiac-Death
2. https://academic.oup.com/eurheartj/article/43/40/3997/6675633
3. https://pubmed.ncbi.nlm.nih.gov/36017572/
4. https://www.acc.org/Latest-in-Cardiology/ten-points-to-remember/2022/09/02/14/23/2022-ESC-Guidelines-for-VAs-ESC-2022
5. https://pubmed.ncbi.nlm.nih.gov/26320108/

2. American Heart Association (AHA)/American College of Cardiology (ACC)/Heart Rhythm Society (HRS) 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.ahajournals.org/doi/10.1161/CIR.0000000000001193
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