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Living with your
ICD or CRT device
LivingWith
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Living with your
ICD or CRT device
You are now one of a growing group of patients in
the West of Ireland and indeed worldwide, who have
received an ICD or CRT device to aid your heart.
ICD stands for Implantable Cardiac Defibrillator.
This is a small electronic device placed inside the chest to prevent sudden
cardiac arrest due to dangerously fast heart rhythms.
CRT stands for Cardiac Resynchronisation Therapy.
This is a type of pacemaker which also contains an ICD. Its function is to
restore the normal coordinated pumping action of the ventricles.
Both of these devices are placed under the skin inside the chest.
This booklet has been designed to give you a clear understanding
of your new device and how you can live a full and active life
with it in place.
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Contents
How the heart works ..................................................................................................................................... 2
Who is suitable for an ICD/CRT
How an ICD/CRT works
.................................................................................................
4
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5
Checking the device ......................................................................................................................................... 7
Lifestyle considerations with an ICD ..................................................................................... 9
What should I do if I get a shock from my device?
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Frequently asked Questions ............................................................................................................ 13
This booklet was prepared by Paul Nolan, Chief Cardiac Technician
UHG. This Croí publication was supported by an unrestricted
educational grant from sanofi-aventis.
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Aorta
SA
Node
Left
Atrium
Right
Atrium
Left
Ventricle
Right
Ventricle
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How the heart works
The heart is a muscular organ which is made up of four chambers.
The two upper chambers are called the right and left atrium and the
two lower chambers are called the right and left ventricle.
The heart works like a pump, moving blood rich in oxygen and
nutrients around the body.
The heart has a normal rhythm which is called sinus rhythm. This
rhythm starts in an area within the upper chamber (atria) called the
Sino Atrial node or SA node. The SA node sends electrical impulses
from the upper chamber (atria) to the lower chamber (ventricle).
These electrical impulses cause the heart muscle to contract and
pump blood in an orderly and efficient manner.
It is possible for this organised rhythm to go wrong. This is often
termed an arrhythmia. There are many forms of arrhythmia but the
two most common types are explained below.
• If the heart beats too slowly this is called a bradyarrhythmia or
bradycardia. Your ICD or CRT can make sure that your heart
does not beat too slowly.
• If the heart beats too fast this is called a tachyarrhythmia or
tachycardia. There are many types of rhythms your ICD or CRT
device is designed to treat. It treats dangerously fast heart rhythms
that come from the ventricles. These rhythms are known as
ventricular fibrillation (VF) and ventricular tachycardia (VT).
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In ventricular tachycardia (VT), the bottom chambers of the heart
beat rapidly. How a patient will feel while they are in this rhythm can
vary. Some patients will be symptom free or may have mild
symptoms such as dizziness or shortness of breath. Don’t be alarmed
if you experience these symptoms, it does not necessarily mean that
you have VT.
Other patients who experience VT may be quite symptomatic and
may even blackout. If you ever experience a blackout you should
organise to have your device checked by ringing the ICD clinic on
091 542181 or 091 542183.
It is important to note that we can tailor the therapy your device
delivers to match your symptoms.
In ventricular fibrillation (VF), the rhythm of the bottom
chambers of the heart becomes very chaotic and disorganised. This
means that the bottom chambers of the heart do not pump properly
and blood does not travel around the body. A person suffering from
this rhythm will blackout very quickly and will collapse. This is a
serious medical emergency and the only way to treat the problem is
to deliver a shock to the heart muscle which stuns the heart, causing
it to revert back to its normal beating rhythm. An episode of VF is
often referred to as a Cardiac Arrest.
Your device will constantly monitor your heart rhythm and if you
have an episode like this, the device will detect it and treat it, often
before you have blacked out.
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Who is suitable for an ICD/CRT
People require an ICD or CRT for a number of reasons and your
healthcare professional will explain why it is an option for you.
• Previous Cardiac Arrest
Individuals who have already experienced and survived an episode
of dangerous heart rhythms would benefit from an ICD.
• Prophylactic Implant
Prophylactic means ‘just in case’.
ICD’s are implanted in people who are deemed at risk of
developing a dangerous heart rhythm.
• Heart Failure
This is the group of patients who most commonly receive an
ICD/CRT. Heart failure is a term used to describe a condition in
which the heart muscle is weakened and the heart does not pump
as efficiently as possible. An ICD/CRT may benefit some patients
with heart failure as they may be at risk of dangerous arrhythmias.
• Familial or Inherited Syndromes
There are a range of inherited or familial (passed on in a family)
conditions which put people at risk of these dangerous heart
rhythms or what we call sudden cardiac death. These include:
•
•
•
Long QT Syndrome
Brugada
Hypertrophic Obstructive Cardiomyopathy
If you require more information about any of these conditions,
please ask the nursing staff or cardiac technicians and they can
help source this information for you.
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How an ICD device works
The ICD consists of a generator (box) and a lead
or leads. This is implanted under the skin, in the
upper area of the chest close to the shoulder.
The leads are passed through the veins into the chambers of the
heart where they make contact with the muscle. The leads ensure
that the ICD can detect every heart beat and thus decides if a rhythm
is dangerously fast.
Once an ICD has been implanted it will monitor your heart rhythm
and will continue to do so for every minute of every day for the
coming years.
How does the device treat the heart
Your ICD is continually monitoring your heart rhythm and will detect
if you have a fast rhythm. An ICD looks firstly at how fast the rhythm
is and the duration of the rhythm. The device will decide if the
rhythm is coming from the ventricles and needs to be treated. All this
happens in a couple of seconds.
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If the device recognises an episode of ventricular tachycardia it may
treat it in two ways.
One way is to pace the heart slightly faster than the abnormal
rhythm which will often stop this rhythm. This is a painless therapy
and many people are unaware that they have had an episode treated
by the device. The other is to deliver a shock. If the device recognises
an episode of ventricular fibrillation (VF), it will deliver a shock to
restore your heart rhythm to normal. This is the only way to treat VF.
How a shock feels
This is different for everyone. It is commonly described as a swift
thump or blow to the chest. Some people will blackout before they
get the shock, if this happens it is important to get your device
checked as soon as possible.
Whilst a shock is not pleasant, remember it is a lifesaving therapy.
How a CRT device works
The CRT also consists of a generator and three leads going into the
heart. Most CRT devices function as an ICD, so all the points
regarding ICD apply to the CRT.
The CRT device paces both the left and right side of the heart in an
effort to make the pumping action of the weakened heart more
efficient. Not all patients are suitable for this type of device.
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Checking the device
The ICD/Pacing Clinic
Your ICD or CRT device will be monitored by the team of Cardiac
Technicians in the hospital. We keep a close eye on your device to
ensure it is functioning correctly and that the leads and battery are
behaving as they should be.
A ‘wand’ is simply placed on the skin over your ICD which reads back
information to the computer. These checks can take as little as ten
minutes or may take up to half an hour depending on how much
information there is to look at.
On some occasions we may need a doctor to see you and you should
allow for some delay if this is needed.
Generally your device is checked the day after the implant and the
technician who checks your device will go through some important
information with you. You will be given a European ID Card which
you should keep with you at all times. This is in case you get taken
into another hospital.
Generally the device will then be checked after eight weeks and again
at three monthly intervals.
It is possible to check some devices from your own home with a
special appliance. If you have this type of device or you are suitable
for it, one of the technicians will discuss the details with you. The
eight week check will still be done in the clinic.
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Living with your
ICD
It is common to feel nervous and anxious when you first go home.
Once the wound has healed and your doctor gives you the go ahead,
you can return to the activities you enjoyed before you got your ICD.
• Your GP will remove your stitches approximately ten days after
you have had your ICD inserted.
• It is particularly important in the first few weeks to keep an eye on
the implant site. If there are any signs of redness and swelling or
infection contact the ICD clinic for advice.
• Before your eight week check up you are advised not to perform
any vigorous tasks and to avoid stretching your arms. These
activities include swimming, lifting and dragging, golf, vigorous
exercise or contact sport.
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• The early weeks are important as the implant is settling into the
muscle and the wound is healing.
• Once you have had your eight week check up, you can return to
the activities you enjoyed before you got your ICD. The ICD
should give you the confidence of knowing that your heart
rhythm is being constantly monitored by your device. This may
even prompt you to increase your level of activity or take up new
activities. The vast majority of activities are safe even though you
have an ICD.
Lifestyle considerations with an ICD
• Using domestic appliances such as microwave ovens, televisions,
computers, etc. will not interfere with your device.
• There is a small chance that mobile or cordless phones could
interfere with your device, for this reason we recommend that you
use your phone on the opposite side to your device and
that you do not keep your phone in a shirt or jacket pocket
over the device.
• Do not try to repair electrical equipment.
• Some electrical devices may interfere with your device such as
security pillars at shop doors. This is low risk, but to avoid
interference walk through at a normal pace and avoid standing in
the doorway. Do not lean against the security pillars.
• Do not carry heavy bags over your shoulder on the device side.
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Returning to work
Your doctor will advise you when you can return to work.
Depending on your work environment there may be certain things
that could potentially interfere with your device.
Power tools can be used but we would advise that you keep them at
an arm’s-length distance from your device to minimise the chance of
any interference. We would also recommend that you don’t use any
feature which locks the power tool in the ‘on’ position. This is so you
can quickly turn the power tool off if you start to feel unwell.
We would recommend that you keep your device a minimum of
arm’s-length distance from any type of engine, including car
engines.
Arc Welding can cause serious interference with your device and
you should never arc weld. You should also remain at least 10
metres away from anyone who is doing this task.
Travel
There is no reason why you cannot travel with your ICD and enjoy
your holidays. However, you should carry your ID card with you. This
is particularly important when abroad.
When you are passing through the security check at the airport, show
your ID card to the security staff at the earliest opportunity. They are
trained to look after individuals with an ICD and will not send you
through the large security system as this may temporarily interfere
with your device.
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Driving
If you have never had a history of a dangerous heart rhythm and have
received a prophylactic device, then you may return to driving once
the stitches are removed.
If you have a history of dangerous rhythms then there may be some
driving restrictions. This will be discussed with you by your
Cardiologist and you should follow his or her recommendation, not
only for your safety but also for the safety of your passengers and
other road users.
The date on which you can resume driving will be entered on the
back of this booklet.
If you end up receiving an appropriate shock from your device then
your cardiologist may instruct you to refrain from driving for a period
of time. This may be up to six months.
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What should I do if I get a shock
from my device?
If you get a shock from your device:
• Look for a place to sit or lie down comfortably
• Ask someone to stay close at hand in case you start to feel unwell
• Rest for approximately 15 minutes
If you get:One shock – but NONE of the following symptoms
• Chest pain
• Breathlessness
• Dizziness
• Palpitations
Contact the ICD clinic on 091 542181 or 091 542183
between 9am and 5pm.
If you get:One shock – and ANY of the following symptoms
• Chest pain
• Breathlessness
• Dizziness
• Palpitations
Attend your nearest hospital’s Emergency
Department/Casualty as soon as possible
If you get:More than one shock in 24 hours
(this does not happen to many patients)
Attend your nearest hospital’s Emergency
Department/Casualty as soon as possible
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Frequently asked questions
Is a Cardiac Arrest the same as a Heart Attack?
A cardiac arrest occurs when the bottom
chambers of the heart become chaotic and do
not pump blood around the body. A heart attack
is different.
A heart attack occurs when one of the blood vessels which supplies the
muscle to the heart, called the coronary arteries becomes blocked.
An ICD will not prevent or treat a heart attack.
In simple terms a cardiac arrest is a ‘wiring problem’ (like a short
circuit) and a heart attack is a ‘plumbing problem’ (like a blocked pipe).
Will I be able to feel the device?
The devices are small, they fit into the palm of your hand and are very
light. Whilst you may be aware of it at first, many patients tell us that
they forget the device is there after a couple of weeks.
Is the device visible?
Again, initially you will probably be conscious of the device. Generally
the device is not noticeable and cannot be seen under clothing.
Do I still need to take my medications?
Absolutely, your medications have a very important job to do. The ICD
does one job and the medications do another.
What does a shock feel like?
Every patient has a different sensation from a shock so it is difficult to
describe, most people describe the feeling as a hard thump in the
chest.
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Can I give a shock to anyone else?
No! Even if someone else is touching you at the exact moment you
get a shock, (e.g. if they are holding hands or even hugging), no
electricity will pass.
How long does the device last for?
This varies depending on how often the device is used and other
factors. On average, devices last between 4 and 8 years. Some
patients may need a new device slightly sooner, while some may get
longer use from their device.
How is my device replaced?
It is replaced in a similar manner to the original implant. However, in
the majority of cases the old lead is used so the procedure is simpler.
Do I need to attend for a device check-up if I haven’t had a shock?
Yes, we carry out important checks on the lead and the battery to
make sure the device is operating correctly. The device also stores a
lot of information for us which can be helpful in managing your heart
condition.
What about undergoing medical procedures?
If you are having any medical or dental procedures done you should
inform the doctor or dentist that you have an ICD inserted. They can
then liaise with us with regard to any precautions that may be
necessary.
Is it safe to become pregnant with an ICD
Yes, many ICD patients have normal pregnancies and go on to have
very healthy children. However, if you are planning to get pregnant
you should discuss this with your doctor in the context of your heart
condition.
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When is it ok to have sex again?
Once your wound is healed you can become sexually active again.
Sometimes people worry that their heart rate may go too high and
cause the ICD to fire a shock – this is very unlikely to happen. Also
remember it is not possible for you to pass on a shock to another
person.
Remember we are here to answer any other questions you
may have, please do not hesitate to call us in the ICD clinic on
(091) 542181 or (091) 542183
Useful numbers
Ambulance
ICD Clinic UCHG
Coronary Care UCHG
112
................. (091) 542181, (091) 542183
................. (091) 544260
.................
You can resume driving:
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