Implantable Cardioverter-Defibrillator (ICD)

Introduction

An implantable cardioverter-defibrillator (ICD) is a small electronic device placed in the chest or abdomen to monitor heart rhythm and deliver electric shocks when life-threatening arrhythmias occur.

When Is an ICD Needed?

An ICD is recommended for patients who are at high risk of sudden cardiac arrest (SCA) due to conditions such as: - Ventricular tachycardia (VT) or ventricular fibrillation (VF). - History of sudden cardiac arrest. - Heart failure with reduced ejection fraction (HFrEF) (EF ≤ 35%). - Genetic conditions (e.g., long QT syndrome, Brugada syndrome, hypertrophic cardiomyopathy).

How Does an ICD Work?

The device continuously monitors the heart rate and rhythm. If it detects a dangerous arrhythmia, it delivers one of the following therapies: 1. Antitachycardia Pacing (ATP) – sends small electrical impulses to stop ventricular tachycardia. 2. Cardioversion – delivers a mild shock to restore normal rhythm. 3. Defibrillation – sends a stronger shock to stop life-threatening arrhythmias like ventricular fibrillation.

ICD Placement Procedure

The ICD is implanted under local anesthesia: 1. A lead (wire) is placed into the heart through a vein. 2. The ICD device is positioned under the skin, usually near the collarbone. 3. The system is tested and programmed before closing the incision.

Potential Risks and Complications

  • Infection at the implantation site.
  • Lead displacement that can affect function.
  • Inappropriate shocks due to device misinterpretation.
  • Battery depletion requiring replacement every 5–10 years.

Life with an ICD

  • Avoid strong electromagnetic fields (e.g., MRI without special conditions).
  • Inform doctors, airport security, and emergency responders about the ICD.
  • Regular follow-ups to check battery life and function.

Conclusion

An ICD can significantly reduce the risk of sudden cardiac death in high-risk patients. It is important for patients with an ICD to follow regular medical check-ups and understand the function of their device.

Source recommendations

1. American Heart Association 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.hrsonline.org/guidance/clinical-resources/2017-ahaacchrs-guideline-management-patients-ventricular-arrhythmias-and-prevention-sudden-cardiac
  4. https://pubmed.ncbi.nlm.nih.gov/29084733/
  5. https://www.sciencedirect.com/science/article/pii/S2405500X22010945

2. 2022 European Society of Cardiology Guidelines for the Management of Patients with Ventricular Arrhythmias and Prevention of Sudden Cardiac Death

  1. https://pubmed.ncbi.nlm.nih.gov/36017572/
  2. https://academic.oup.com/eurheartj/article/43/40/3997/6675633
  3. https://www.escardio.org/Guidelines/Clinical-Practice-Guidelines/Ventricular-Arrhythmias-and-the-Prevention-of-Sudden-Cardiac-Death
  4. https://guardheart.ern-net.eu/wp-content/uploads/sites/4/2023/02/PMID-36017572_ESCGuideline_Zeppenfeld.pdf
  5. https://www.ecrjournal.com/articles/comment-esc-guidelines-2022-management-patients-ventricular-arrhythmias-and-prevention?language_content_entity=en

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