Download Implantable Cardioverter Defibrillator (ICD)

Implantable Cardioverter
Defibrillator (ICD) or
Subcutaneous Implantable
Cardioverter Defibrillator (S-ICD)
Information for patients
This leaflet tells you what to expect after having an ICD or S-ICD
implanted. If you have any queries, please do not hesitate to speak
to one of the doctors or cardiac physiologists caring for you.
Confirming your identity
Before you have a treatment or procedure, our staff will ask you your
name and date of birth and check your ID band. If you don’t have an
ID band we will also ask you to confirm your address.
If we don’t ask these questions, then please ask us to check.
Ensuring your safety is our primary concern.
www.kch.nhs.uk
What is the difference between an ICD and an S-ICD?
An ICD has one or more leads that connect it to the heart, and acts as a pacemaker as well as a
defibrillation.
An S-ICD is a less invasive option for patients that do not need cardiac pacing. It has no leads
that are connected to the heart, but an electrode that is put under the skin.
How does an ICD/S-ICD help my heart?
Your ICD is like a mini computer with a battery and electronic circuits that recognise and
monitor your heart rhythm.
If you heartbeat is too slow, the ICD sends small impulses to give you extra heartbeats if
needed, like a pacemaker. They are not painful and you usually do not notice.
If your heart beats too fast, the ICD sends out faster pacing impulses to slow down the rhythm.
This happens so quickly that you may not notice, but it is also not uncommon to be dizzy,
lightheaded, or get palpitations.
Your ICD will be programmed to give cardioversion shocks to your heart to treat ventricular
tachycardia (an abnormal heart rhythm that causes your heart to beat too fast). It will also give
you defibrillation shocks, if it senses that your heartbeat is so fast that it is life threatening.
These shocks are full energy shocks; you may find them uncomfortable.
Before you leave the clinic, we will set your ICD so that it works best for your heart condition.
The initial settings can and might be modified during follow-up appointments if necessary
Will I feel anything different?
In general, you should not notice the ICD working. If you had a very slow heart rhythm before
the implant, you may notice your heart beating faster now. If you had fast palpitations before
the implant, they might continue as the device does not usually stop the heart from beating
fast. If you continue to have fast palpitations, we usually treat it with medicine.
What do I do if the ICD/S-ICD gives me a shock?
When your heart beats so fast that it becomes life threatening, the device will deliver a full
energy shock to get the heart back to normal rhythm. Patients describe the feeling as being
suddenly kicked or punched into the chest. It can be quite painful for a few seconds, and other
times you won’t feel the shock because you become dizzy. You may notice warning signs such
as palpitations, or it may come on suddenly. If you have any warning signs, sit or lie down or let
someone hold you. No harm will come to anyone who is touching you. After a shock you will
recover quickly. Even you feel well again, you should still contact the clinic to have your device
checked.
If you feel unwell after a shock, or you have several shocks, dial 999 for an ambulance and tell
the paramedics that you have an ICD device and what happened.
Caring for your ICD/S-ICD device
Do I need to stop taking my medication?
This is different for each patient. Your cardiologist will advise you what to do, but with an ICD
device it is normal to continue taking all medication.
What happens when I leave hospital?
For your own safety, you should not drive because the medication you had for the procedure
makes you drowsy. Instead, ask someone to take you home.
During the first 48 hours you may feel some discomfort in the area that has been treated. The
doctor will advise you about what medication you can take for pain relief. If your symptoms
become severe or long-lasting, please tell your GP (home doctor) or cardiac physiologist.
Looking after your wound
• It should take about six weeks for your wound to fully heal. Keep the area clean and dry.
• Stitches (sutures) will dissolve on their own.
•If we used steri-strips and they do not come off on their own within 7-10 days, you can
gently remove them in the shower while they are moist. Do not force them off.
• Do not scratch or rub the wound.
• Do not apply any ointments, creams or lotions on the wound until it is completely healed.
•If the wound rubs on clothing and causes discomfort, cover it with gauze. Change the
dressing every day.
•You can take a shower 48 hours after having an implant: turn your back to the water nozzle
to avoid direct water pressure on the wound. Use this technique for 7-10 days.
•You can have a bath, but keep the wound above water level until the scab is gone
(7-10 days).
If you have any of these symptoms at the wound site, call your doctor immediately, or if out of
hours, go to your local Emergency Department (ED) as these may be signs of infection.
• redness
• soreness
• swelling
• bleeding
• oozing.
Activity guidelines for the first weeks after your procedure
For the first six weeks:
• Walk – it helps you to regain your strength and keep your heart healthy
• Do not lift objects that weigh more than 10 pounds
•Do not do too much in the first weeks. Stop any activity before you get too tired.
•Avoid playing all sports, especially contact sports as this may damage your ICD and leads
•Avoid activities where you push or pull heavy objects, such as mowing the lawn, shovelling
snow or lifting suitcases.
After the start of your recovery (usually after about four weeks), if possible, increase your level
of activity. Speak to your cardiac physiologist about a healthy way of doing this, and to find out
when it is safe to do strenuous activities.
Some patients worry about their heart beating too fast, but it is important for your heart and
your health, to be as active as you can. Most ICD devices can tell the difference between a fast
heartbeat from exercise and a fast heartbeat from dangerous heart rhythms.
Arm movements
After a few weeks, tissue will grow around the lead(s). This helps to keep them in place.
In the first six weeks try to avoid lifting the arm that is on the same side as your ICD. Do not
lift it above shoulder level or stretch it out behind your back until you have had your first
outpatient check.
Once you have had your first device check and everything is ok, you can return to activities that
are normal for you.
When you touch the skin that covers the ICD, you might feel some lumps. These lumps are the
leads that are attached to the box; they are curled up beside the box under the skin.
Do not try to move the box or leads. If they continue to bother you, please tell your
physiologist.
Driving
The Driving and Vehicle Licensing Agency (DVLA) has guidelines that regulate the safety of
patients with a pacemaker, and whether or not it is safe for them to drive. For more details, visit
the DVLA site and search for “pacemakers”. ICD implants have a temporary driving ban of one
to six months.
Restrictions depend on why you have had your ICD fitted. It is important that you discuss this
with your cardiac physiologist or doctor at your device clinic. They will explain this in more
detail.
You must tell the DVLA that you have had a ICD implanted. We strongly recommend that you
tell your insurance company.
Equipment that might affect your ICD
If your ICD is near electrical equipment, it may temporarily affect its settings.
Most household equipment, such as toasters, microwaves, blenders, TVs, VCRs, radios, CD
players, hairdryers and shavers should be safe. If you are not sure, please check with your device
clinic for advice.
Mobile phones
To avoid interference, do not carry an active phone near the device, but hold it on the opposite
side. Do not keep your mobile phone in a coat or shirt pocket over your ICD.
Shop doorway security systems
Walking through the system at a normal pace is fine, but do not stay in the area.
Arc welding
You should avoid this if possible. There are exceptions, but please ask the device clinic for more
information.
Magnets
Do not carry magnets or put a magnet over your chest. Avoid carrying stereo or hi-fi speakers
as they contain strong magnets.
Medical equipment and hospital treatments
Most hospital equipment will not cause any problems. However, we advise you to tell medical
and dental staff that you have a CRT device, and to take your device ID card with you. We will
give you an ID card at your first follow up appointment after surgery.
If you go into hospital for any investigations or operations that are not about your pacemaker,
you may find it useful to contact your implant centre for advice before you go.
X-rays, CT scans and mammograms
Avoid MRI (magnetic resonance imaging) machines. Some electrical nerve and muscle
stimulators (TENS machines) may interfere with CRT devices, depending on their how they are
applied. Contact your device clinic for more advice.
Operations
If you have an operation, you must tell your surgeon and anaesthetist that you have an ICD
device implant. It may be necessary to temporarily switch off (deactivate) the shock therapies
during the operation.
Sexual activity
It is very common to be concerned about resuming sexual activity, especially if you have an ICD.
But you can be sure that the device will not cause any harm to your partner, even if the device
shocks during intercourse.
Travel
Walking through an airport metal detector archway does not harm your ICD. However the
device’s metal casing may set off the airport security alarm, so we advise you to show security
your identification card beforehand.
Follow-up appointments
Device clinic visits
Your ICD should be checked regularly. Your first device check will be about six weeks after
surgery.
The clinic offers remote monitoring (monitoring your heart and implanted device while you
are at home) but you will be seen at least once a year and may be asked to come into the clinic
more often if necessary.
At your visit, we will examine your ICD for settings, battery life and leads. If your condition has
altered, we may make changes to your ICD’s settings.
We will give you an ID card for your ICD. You should carry this with you at all times in case you
need medical attention.
Changing your ICD
An ICD battery usually lasts five to seven years.
Every time you visit the device clinic, we will check your battery. Cardiac physiologists will
tell you when you need a new ICD box. They will let you know in plenty of time, and make
arrangements at a time that is convenient to you, so that you won’t have a low battery.
When you have your box changed, you will be admitted to hospital for a procedure similar
to when you had your first ICD device fitted. You will not usually need new leads put in.
Who can I contact with queries and concerns?
Changing appointments
You can phone 020 3299 8165, Monday to Friday, 9am – 10am, or go to our Change of
appointment form online at www.kch.nhs.uk
Where can I find more information?
Arrhythmia Alliance
www.heartrhythmcharity.org.uk
British Heart Foundation
www.bhf.org.uk
Care provided by students
We provide clinical training where our students get practical experience by treating patients.
Please tell your doctor or cardiac physiologist if you do not want students to be involved in
your care. Your treatment will not be affected by your decision.
PALS
The Patient Advice and Liaison Service (PALS) is a service that offers support, information and
assistance to patients, relatives and visitors. They can also provide help and advice if you have a
concern or complaint that staff have not been able to resolve for you.
PALS at King’s College Hospital
Denmark Hill
London
SE5 9RS
Tel:
Email: 020 3299 3601
[email protected]
You can also contact us by using our online form at www.kch.nhs.uk/contact/pals
PALS at Princess Royal University Hospital
Farnborough Common
Orpington
Kent
BR6 8ND
Tel: Email: 01689 863252
[email protected]
If you would like the information in this leaflet in a different language or format, please
contact PALS on 020 3299 1844.
www.kch.nhs.uk
PL706.1 July 2015
Review date July 2018
Corporate Comms: 1106