Internal Cardiac Defibrillator (ICD)

Introduction

An Internal Cardiac Defibrillator (ICD) is a medical device implanted in patients at risk of life-threatening arrhythmias, such as ventricular tachycardia or ventricular fibrillation. The device continuously monitors the heart's rhythm and delivers electrical shocks if necessary to restore a normal heartbeat.

How Does an ICD Work?

  1. Monitoring: The ICD constantly tracks the heart's rhythm.
  2. Detection of Abnormal Rhythms: It identifies dangerous arrhythmias.
  3. Shock Delivery: If needed, the device sends an electrical pulse to correct the rhythm.
  4. Pacing Ability: Some ICDs can also act as pacemakers if the heart beats too slowly.

Indications for ICD Implantation

Patients may need an ICD if they have:

  • Survived sudden cardiac arrest.
  • A history of ventricular arrhythmias.
  • Heart conditions such as cardiomyopathy or low ejection fraction (EF < 35%).
  • A genetic predisposition to arrhythmias (e.g., Long QT syndrome, Brugada syndrome).

Risks and Considerations

While ICDs are life-saving devices, they come with potential risks:

  • Infection at the implantation site.
  • Inappropriate shocks.
  • Lead displacement or device malfunction.
  • Psychological impact, including anxiety and depression.

Living With an ICD

  • Regular follow-ups with a cardiologist are necessary.
  • Avoid strong electromagnetic fields (e.g., MRI without special precautions).
  • Some restrictions on intense physical activity may apply.

Conclusion

An ICD can be a crucial intervention for patients at risk of life-threatening arrhythmias. Despite some risks, it significantly improves survival rates and quality of life when appropriately used.

Source recommendations

1. American Heart Association Guidelines on ICD

  1. https://www.heart.org/en/health-topics/arrhythmia/prevention--treatment-of-arrhythmia/implantable-cardioverter-defibrillator-icd
  2. https://www.ahajournals.org/doi/10.1161/CIR.0000000000000549
  3. https://www.heart.org/en/health-topics/arrhythmia/prevention--treatment-of-arrhythmia/living-with-your-implantable-cardioverter-defibrillator-icd
  4. https://www.ahajournals.org/doi/10.1161/CIR.0000000000001063
  5. https://professional.heart.org/en/science-news/-/media/832EA0F4E73948848612F228F7FA2D35.ashx

2. European Society of Cardiology Guidelines on Sudden Cardiac Death

  1. https://academic.oup.com/eurheartj/article/43/40/3997/6675633
  2. https://www.escardio.org/Guidelines/Clinical-Practice-Guidelines/Ventricular-Arrhythmias-and-the-Prevention-of-Sudden-Cardiac-Death
  3. https://pubmed.ncbi.nlm.nih.gov/36017572/
  4. https://www.ahajournals.org/doi/10.1161/CIR.0000000000000549
  5. https://pubmed.ncbi.nlm.nih.gov/29191938/

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