Download All About Your ICD

Cardiac Rhythm Therapy // Patient Manual
All About Your ICD
A manual for defibrillator patients
Contents
Introduction.......................................................... 1
Questions and answers about your ICD............. 4
Why do I need an ICD?......................................... 6
I have never had sudden cardiac arrest,
so why do I need an ICD?..................................... 8
What causes these rhythm disorders?............... 9
The heart is a pump, so how can it have
electrical problems?............................................ 9
How does the healthy heart beat?..................... 10
What kinds of tachyarrhythmias
are there?........................................................... 12
What is VF?......................................................... 13
What does VF feel like?...................................... 14
What is VT?......................................................... 14
What does VT feel like?...................................... 16
i
How does the ICD know whether
a rhythm is dangerous?..................................... 16
How does the ICD treat VT and VF?................... 17
Is ATP an effective therapy?............................... 17
What if ATP does not work?............................... 18
How does a doctor know how
much shock I should receive?........................... 18
How does the ICD treat VF?............................... 19
How does electrical energy
reset the heart cells?......................................... 20
How can the ICD get enough energy
to shock the heart back into a
normal rhythm?................................................. 21
What does a shock feel like?............................. 21
How quickly can a person recover
from a high-energy shock?................................ 22
ii
What do the terms “cardioverter” and
“ defibrillator” mean?........................................... 23
How does the ICD know when
to send high-energy and
lower-energy shocks?........................................ 23
Are there other types of arrhythmias?.............. 24
Would an ICD help me if I have
atrial fibrillation?................................................ 27
Why is it important to treat
atrial fibrillation?................................................ 28
Are there other types of
rhythm disorders?.............................................. 28
What causes bradycardia?................................. 30
What does it feel like to
have bradycardia?.............................................. 32
Are there different types
of bradycardia?................................................... 32
iii
Are there different types of
heart block?........................................................ 34
How do I know what kind of
arrhythmias I have?........................................... 35
Will my ICD also act like a pacemaker?........... 36
What does it feel like when the
heart is paced?................................................... 37
Will the pacemaker pace my heart
after a shock?..................................................... 37
Will my arrhythmias ever go away
on their own?...................................................... 38
Why can’t I just take a medicine to
treat my arrhythmia?......................................... 39
Do I still need to take my heart
medications even if I have an ICD?.................... 39
Can a person have an arrhythmia
without any symptoms?..................................... 40
iv
I have never had a dangerous
arrhythmia before. Why does my
doctor want me to get an ICD?.......................... 40
I have survived dangerous
arrhythmias before. Why does my
doctor think I need an ICD?............................... 44
What if my heart condition
changes in the future?....................................... 44
How can the doctor adjust the ICD
once it is implanted in my body?....................... 45
How does the pacemaker part of
my ICD know when to pace and
how fast to pace?................................................ 47
If my heart is beating fast enough on
its own, does the pacemaker still pace?........... 48
Does the pacemaker in my ICD sense
and pace in the upper or lower chambers
of the heart?....................................................... 49
v
Does the ICD shock both the upper
and lower chambers?........................................ 52
How do I know what kind of ICD I have?........... 52
Are there different types of leads?.................... 53
How does the doctor know
whether I need an ICD?..................................... 54
Should I get a second opinion
before getting an ICD?....................................... 54
What is ICD surgery like?................................... 55
How long does ICD surgery take?..................... 56
Is it painful to be awake during
the surgery?........................................................ 56
What will go on during ICD surgery?................ 57
How will they actually perform the
implant surgery?................................................ 58
vi
Is lead testing the same as the
testing the doctors do when they
cause a rhythm disorder?.................................. 61
How long is the recovery time after
ICD surgery?....................................................... 61
What should I do right after surgery?............... 62
What should I do during the
recovery period?................................................. 63
Which activities might I need to give up
now that I have an ICD?..................................... 65
Can I still drive?.................................................. 67
Why would there be any problem
with driving?....................................................... 67
What does it feel like to have an ICD?............... 67
How many shocks can I expect to receive?....... 68
vii
What does it feel like when the
built-in pacemaker paces the heart?................ 69
Where does the ICD get all the energy
to deliver shocks and pacing pulses?............... 69
How long does this battery-operated
device last?......................................................... 70
Is there any warning before the
battery runs out?................................................ 70
What is a replacement?..................................... 71
Why can’t they just replace the battery?........... 71
How often do I need to have checkups?............ 72
Why do I need to go to so many checkups?...... 72
What should I tell my doctor during
my routine checkup?.......................................... 73
What should I tell my family about my ICD?..... 74
Is it safe to be near a microwave oven?............ 74
viii
Can I still use a computer?................................ 75
Can I still use a cell phone?............................... 75
Can I go through airport security or
other checkpoints?............................................. 75
BIOTRONIK Home Monitoring®........................ 77
Resources.......................................................... 80
Websites............................................................. 80
BIOTRONIK...................................................... 80
HRSOnline....................................................... 81
FDA.................................................................. 81
Pacemaker Club............................................. 81
Important information...................................... 84
Contraindications............................................... 84
Risks, warnings and precautions...................... 88
Risks................................................................... 88
ix
Warnings............................................................. 90
Precautions........................................................ 95
Initial Precautions
(First three months after implant)................. 95
Cell phones .................................................... 96
Metal detectors and
security checkpoints...................................... 97
Electromagnetic interference........................ 98
Other healthcare providers.......................... 103
Changes in your health and condition......... 111
Shock therapy............................................... 112
Glossary............................................................ 115
Index................................................................. 132
x
xi
Introduction
This booklet was prepared for you by
BIOTRONIK to help you better understand your
implantable cardioverter-defibrillator, often
referred to as an ICD. The best source of
information for your health questions is your
physician, since every person is unique and
many factors affect your overall health. It is our
goal at BIOTRONIK to give you a good overview
of ICDs and share with you what we have found
to be the general experiences of most patients.
We have divided this booklet into four main
sections:
1. Questions and answers about your ICD
2. BIOTRONIK Home Monitoring®
3. Resources
4. Important information
The section called “Questions and answers
about your ICD” tells you about how these
devices work, why you need an ICD and how it
1
will affect your life. We compiled this
information based on questions that people
frequently ask about their ICDs and how they
work. This is probably the most interesting
portion of the booklet if this is your first ICD and
you do not know what to expect.
Many BIOTRONIK devices offer BIOTRONIK
Home Monitoring®.To learn what this is and how
important it can be in your overall care, refer to
2
this section. If you are not sure whether your
ICD has BIOTRONIK Home Monitoring®, ask
your doctor.
The “Resources” section shares with you some
sources of information that can help you learn
more about ICDs.
The “Important information” section tells you
some of the information that the U.S. Food and
Drug Administration wants you to know about
your device.
Throughout the booklet, we have sometimes
used medical terms. These terms can be long
and confusing, but it is important for you to
know the correct medical words for certain
procedures and conditions. You will notice a
shaded box with these words defined in ordinary
language near where the words appear in the
text. You can also look up these words in
the “Glossary” section at the end of this book.
3
Questions and answers
about your ICD
If you have just learned that you need an ICD
or you have just had your ICD implanted, you
probably have many questions and a lot of
different emotions. Many people who get an ICD
get the news that they need an ICD suddenly,
before they ever realized they had any kind of
heart problem. This can be a confusing time, but
let us look at a few facts you may not have
known about ICDs.
ICDs have been around for decades. They may
seem like modern marvels, but they have
been used to treat millions of people
worldwide since the late 1980s.
Hundreds of thousands of people all around
the globe have an ICD right now. You are
joining a very large group – people with ICDs.
4
While most of the people who get ICDs are
senior citizens, these devices are in people of
all ages – including teenagers and adults.
ICDs have saved thousands of lives by rescuing
people from life-threatening rhythm disorders.
BIOTRONIK has been at work for more than half
a century making implantable devices to treat
heart rhythm disorders, and we have gathered
some of the most common questions to help
you better understand your new ICD.
5
Why do I need an ICD?
You need an ICD because your physician has
determined that you have an electrical problem
in your heart that keeps it from functioning
properly—a problem that could even be lifethreatening. This electrical problem causes or
could cause your heart to beat too rapidly. If
your heart tries to beat very rapidly, it cannot
pump efficiently.
Try this experiment. Open your hand and then
curl it up to make a fist. Think of this as one
heart beat. To pump blood, your heart needs to
relax (so blood fills the heart) and then squeeze
(so that blood pumps out into the body). If you
can open and close your fist one time each
second, that corresponds to a heart rate of
about 60 beats per minute—which is normal.
Now, try to open and close your fist twice per
second. That corresponds to 120 beats per
6
minute. Now try to open and close your fist five
times a second. That corresponds to 300 beats
per minute. You will see that you cannot
completely open and close your fist if you try to
go too fast. The same is true of your heart. If it
tries to beat 300 beats per minute, it cannot
fully fill with blood, and it cannot completely
pump the blood out. In fact, when your heart
beats dangerously fast, it just quivers and stops
pumping blood. This state results in a condition
called sudden cardiac arrest. It sounds like the
heart has stopped, but actually the opposite is
true—the heart is trying to beat too fast.
7
Sudden cardiac arrest (SCA)
A heart rhythm in which the heart is trying
to beat so fast that it merely quivers and
can no longer pump blood effectively.
Sudden cardiac arrest is a dangerous and
life-threatening condition.
I have never had sudden cardiac arrest,
so why do I need an ICD?
An ICD may be implanted even in a person who
has not had sudden cardiac arrest or any other
potentially life-threatening rhythm disorder. If
your doctor determines that you have serious
risk factors for sudden cardiac arrest or other
dangerous rhythms, he or she may recommend
that you get an ICD for your own safety in the
event that one occurs. Some people who
receive an ICD have survived an episode of
8
sudden cardiac arrest already or have had
episodes of other dangerous rhythms.
What causes these rhythm disorders?
There are many things that can cause your
heart to beat in an irregular fashion, including
any or all of these: problems with your heart’s
electrical system, disease and a family history
of rhythm disorders.
The heart is a pump, so how can it have
electrical problems?
Your heart is a pump that depends on small
electrical signals generated by the heart. These
electrical signals travel through certain
conduction pathways within the heart. An
abnormal heart rate is called an arrhythmia.
There are many different kinds of arrhythmias,
and people may have several different
arrhythmias. Any heart rate that is too rapid to
9
be healthful is called a tachyarrhythmia or a
tachycardia. Another type of arrhythmia occurs
when the heart’s rhythm—that is, the sequence
in which it beats—is abnormal.
Arrhythmia
Any type of abnormal heart rhythm and / or
rate. Other terms for this are dysrhythmia
and rhythm disorder.
How does the healthy heart beat?
Your heart has four chambers: two upper
chambers (the right atrium and the left atrium)
and two lower chambers (the right ventricle and
the left ventricle). The upper chambers are
much smaller than the lower chambers. The
healthy heartbeat begins with the heart at rest.
It is completely relaxed and blood flows into the
heart. The valves that separate the atria from
the ventricles are open.
10
Lung
Body
Oxygen-enriched blood
Oxygen-depleted blood
Then, the valves between the atria and
ventricles close. Blood continues to flow into the
A healthy heart in the center of the bloodstream
atria. Together the atria contract and the valves
open, squeezing blood into the ventricles. The
valves close and, after a fraction of a second,
6|7
the two large ventricles squeeze at the same
time and the blood is pumped out into the body.
11
A healthy heart rhythm has one atrial beat for
each and every ventricular beat. This is called
one-to-one AV synchrony. Sometimes electrical
problems affect one-to-one AV synchrony or
cause the atria and the ventricles to beat in a
disorganized way.
One-to-one AV synchrony
Also written 1:1 AV synchrony. The healthy
heart rhythm in which there is one atrial
contraction or beat for every ventricular beat.
What kinds of tachyarrhythmias
are there?
There are several kinds of tachyarrhythmias or
tachycardias. If your heart is at risk of beating
too quickly, and this abnormal rhythm starts
from the lower chambers, you have a
ventricular tachyarrhythmia. There are two
12
main types of ventricular tachyarrhythmia:
those that are extremely fast (ventricular
fibrillation or VF) and those that are “slower”
but still very fast (ventricular tachycardia or VT).
Tachycardia
Also called a tachyarrhythmia. Any heart
rate that is too fast for the person’s activity.
What is VF?
Ventricular fibrillation is the most dangerous
heart rhythm and can be life-threatening. It
occurs when the heart tries to beat very rapidly
and can no longer pump effectively. During VF,
the heart may try to beat 300 times a minute or
even faster. This condition is sometimes called
sudden cardiac arrest.
13
Ventricular fibrillation (VF)
A potentially life-threatening arrhythmia
originating in the ventricles in which the
heart tries to beat so quickly that it can no
longer pump effectively. During ventricular
fibrillation, the heart may try to beat
300 beats per minute or faster. Sometimes
called V-fib.
What does VF feel like?
People with VF experience a sudden, usually
unexpected lack of blood flow to the brain that
causes them to feel weak and then pass out. Left
untreated, VF can be fatal in a matter of minutes.
What is VT?
Ventricular tachycardia occurs when a
dangerous heart rhythm originates in the lower
chambers and causes the heart to beat too
14
rapidly. The exact rate of VT depends on your
age and overall health, and even then not all
doctors agree as to the rate range of VT.
Generally speaking, VT can range from more
than 100 beats per minute to up to 200, or even
250, beats per minute.
Ventricular tachycardia (VT)
Sometimes called V-tach. A potentially
dangerous and sometimes life-threatening
arrhythmia originating in the ventricles in
which the heart tries to beat very quickly and
can no longer pump blood effectively.
Ventricular tachycardia can occur at rates of
100 to 250 beats per minute. What defines
ventricular tachycardia is not so much the
rate but that the patient does not tolerate it
well; the rate zones for ventricular tachycardia
vary by age, disease and fitness levels.
15
What does VT feel like?
People with VT usually experience a sense of a
pounding or racing heart and may have other
symptoms, such as being out of breath,
sweating, blurred vision, dizziness and a feeling
of being unwell. Some people with VT faint or
feel like they might faint. VT can last a few
moments or several hours. A person with VT
experiences a very fast heart rate, even if he or
she is resting. VT is a potentially dangerous
arrhythmia and can even be life-threatening.
How does the ICD know whether a
rhythm is dangerous?
The ICD monitors every single beat of your heart
and detects unusual rhythms and high rates. Your
doctor can program how the ICD defines VT and
VF. When it detects such a rhythm, it confirms the
rhythm and then delivers treatment.
16
How does the ICD treat VT and VF?
Your doctor can program your ICD to treat a VT
in different ways. One way is using low-energy
pulses called antitachycardia pacing, or ATP. In
this approach, the device will fire a stream of
rapid but very small electrical pulses at the
heart in an effort to reset it.
Antitachycardia pacing (ATP)
Delivery of a series of rapid, low-voltage
pulses to the heart in an effort to stop an
arrhythmia.
Is ATP an effective therapy?
ATP does not work well for everyone, but it can
be an effective way to stop certain arrhythmias
in some people. The advantage of ATP is that it
uses low energy. Some people experience a
17
fluttering sensation in their chest during ATP,
but many people feel nothing unusual at all.
What if ATP does not work?
If the ICD delivers ATP, it keeps monitoring the
heart. If the ICD detects that the dangerous
arrhythmia is still going on, it will deliver more
therapy, or it will then deliver a shock. In some
cases, the doctor can program the ICD so that
each new therapy is stronger than the one
before, up to the maximum therapy.
How does a doctor know how much
shock I should receive?
Doctors usually set up shocks in terms of joules
or units of energy. The doctor can adjust the
amount of energy in these shocks at the time of
the implant or at follow-up visits. The amount of
shock needed varies and is determined by a
number of factors: the device you have, the
18
condition you have, the medications you take,
and the amount of energy your heart doctor
determines is needed to treat your condition.
Joule (J)
A unit of energy that is commonly used to
describe how much energy is in an ICD shock.
Technically it is the amount of energy needed to
pass an electric current of one ampere through
a resistance of one ohm for one second.
How does the ICD treat VF?
When VF occurs, the ICD delivers its maximum
shock energy. ATP or lower-energy shocks are
not appropriate to treat VF since VF is a
potentially life-threatening condition that must
be stopped as soon as possible. A high-energy
shock can reset the heart rhythm.
19
How does electrical energy reset the
heart cells?
The heart is a muscle made up of highly
specialized cells. These cells respond to
electrical energy. Most of the time, electricity
travels through the heart – that is, electrical
energy stimulates some cells, passes through,
and then stimulates new cells while the
previously stimulated cells recover. An ICD
shock causes all heart cells to be stimulated at
once, essentially “resetting” them to zero. After
a second or two, the heart muscle recovers and
the heart generates a new electrical impulse,
which can now travel through the heart
normally.
20
How can the ICD get enough energy
to shock the heart back into a normal
rhythm?
The ICD contains a battery, as well as some
special components known as capacitors.
The capacitors store a charge. When the ICD
prepares to deliver a shock, it starts to send
electrical energy from the battery to the
capacitors, which hold it until all at once the
device delivers a high-energy shock. Capacitors
can charge in a matter of seconds.
Capacitor
A component within the ICD designed to
hold and release an electrical charge.
What does a shock feel like?
That depends on how bad the rhythm disorder
is and how powerful the shock is. For a “slow”
21
VT and a low-energy shock, you may experience
a thump in your chest. For a high-energy shock,
the sensation may feel more like being kicked in
the chest. If you have a very dangerous rhythm,
you may faint or become unconscious before
the shock is delivered. Some people do not feel
a high-energy shock, but those who do say it is
painful. However, the shock lasts only a fraction
of a second and could save your life.
How quickly can a person recover from
a high-energy shock?
That depends. After you get a shock, you should
find a safe place to sit and rest; contact your
physician and, if needed, summon emergency
medical help. Some people get back to normal
very quickly. Other people may feel uneasy for
hours. If you have trouble recovering from a
shock, talk to your doctor.
22
What do the terms “cardioverter” and
“defibrillator” mean?
Defibrillation refers to electrical energy sent to
the heart to end fibrillation (“de-fibrillate”).
When an ICD sends a shock to stop VF, it acts as
a defibrillator. Cardioversion refers to the use of
lower-energy shocks to “convert” or change the
heart’s rhythm. When an ICD sends a lowerenergy shock to stop VT, it acts as a cardioverter.
Cardioversion
The use of lower-energy shocks to stop
tachyarrhythmias.
How does the ICD know when to send
high-energy and lower-energy shocks?
Your doctor programs your ICD individually for
you so that the device has a definition for VT and
VF. This is usually done by setting specific rate
23
ranges for VT and VF, and possibly other factors
to help define VT and VF. The doctor also
programs how to treat VT and VF (ATP, lowenergy shocks, high-energy shocks). When the
ICD identifies an arrhythmia, it determines what
it is (VT or VF) and then delivers the therapy
your doctor programmed. It also keeps
monitoring your heart rhythm to make sure the
arrhythmia has stopped.
Are there other types of arrhythmias?
Yes, and it is not unusual for a person with an
ICD to have more than one type of arrhythmia.
For example, you may also have
tachyarrhythmias that originate in or near the
atria. These are called atrial tachycardia, atrial
fibrillation and atrial flutter. Atrial fibrillation is
the most serious of these, but it is not lifethreatening. Atrial fibrillation is sometimes
nicknamed A-fib or AF.
24
Atrial fibrillation (also known as A-fib or AF)
A very rapid atrial rate (300 beats per minute
or higher) that causes a loss of 1:1 AV
synchrony. The ventricles try to keep up with
the atria and end up beating too fast as well,
but their rate is erratic. Atrial fibrillation may
stop and start suddenly, or it may be longerlasting—even permanent.
Atrial flutter is often intermittent, that is it may
come and go for no apparent reason. People
with atrial flutter may experience the sensation
of a racing or pounding heart, palpitations,
clamminess, fatigue or a feeling of being unwell.
25
Atrial flutter
A tachycardia that originates in the heart’s
upper chambers, or atria, and causes a
rapid atrial rate. The ventricles, or lower
chambers, try to keep up the atria and also
beat too quickly, but without 1:1 AV synchrony.
This causes the heart to pump inefficiently.
Atrial fibrillation causes the upper chambers of
the heart to beat so fast (300 or 400 beats a
minute) that they cannot actually contract and
relax. They are trying to pump and relax about
5 or 6 times per second. That means instead of
pumping, the atria quiver and blood is not
effectively pumped out. Atrial fibrillation keeps
the heart from pumping blood efficiently and
can cause symptoms of a pounding or racing
heart, fatigue, dizziness, shortness of breath,
palpitations, a feeling of being unwell, and pain or
26
discomfort in the chest. A big concern with
atrial fibrillation is the risk of stroke. Since the
upper chambers do not pump efficiently, blood
collects in the upper chambers where it may
clot. If a clot breaks free, it can cause a stroke.
Would an ICD help me if I have atrial
fibrillation?
Atrial fibrillation can be a challenging
arrhythmia to treat. While your ICD does not
specifically treat atrial fibrillation, it may help
you if you have this condition. BIOTRONIK
devices can monitor the heart and can alert
your doctor if it sees evidence that you have
atrial fibrillation. Your doctor can then adjust
your ICD and prescribe medications to help with
the atrial fibrillation.
27
Why is it important to treat atrial
fibrillation?
Atrial fibrillation is not life-threatening but it
can be dangerous. If you have atrial fibrillation,
your risk of having a stroke increases by a factor
of five. Atrial fibrillation can also cause
uncomfortable symptoms such as shortness of
breath, weakness, dizziness and even fainting.
Atrial fibrillation is what doctors call a
“progressive” disorder, which means that, left
untreated, it tends to get worse over time. For
that reason, it is important to find out if you
have atrial fibrillation so that your doctor can
help you manage it. In many cases, atrial
fibrillation is treated with drugs.
Are there other types of rhythm
disorders?
Yes, your heart can also beat too slowly. Any
type of too-slow heart rate is called a
28
bradyarrhythmia or bradycardia. It is not
unusual for one person to have both too-fast
and too-slow rhythm disorders.
Bradycardia
Any heart rate that is too slow to support
the person’s activity. Another term
for bradycardia is bradyarrhythmia.
People with bradycardia may feel overly tired, be
short of breath, or have other symptoms
because the heart does not beat fast enough to
pump enough blood to meet their needs. People
with bradycardia are often treated with a
pacemaker, which helps pace a too-slow heart
rate. Since many people with tachycardia also
have bradycardia, and because many people
need some pacing support after a shock, all ICDs
from BIOTRONIK have a built-in pacemaker.
29
What causes bradycardia?
To understand bradycardia, you have to know a
little bit about the heart’s natural electrical
system. To know when to pump, your heart
relies on electrical pulses generated by a small
area of tissue called the sinoatrial node
(SA or sinus node).
Sinoatrial node
Also called the sinus node, the sinus, or SA
node. This is an area of highly specialized
tissue on the upper area of the right side of
your heart (the so-called “high right atrium”).
The sinoatrial node generates electrical
pulses and drives the heart rate. In fact, the
sinoatrial node is nicknamed the “heart’s
natural pacemaker.”
30
In the healthy heart, the SA node generates a
small electrical signal that travels across the
upper chambers of the heart (the atria), down
to the center of the heart to the atrioventricular
node or AV node, and then continues down to
the two larger lower chambers of the heart
(the ventricles).
Atrioventricular node
Also called the AV node. Located in about
the middle of the heart, below the upper
chambers and above the lower chambers,
the atrioventricular node is an important
stop on the electrical conduction pathway
through the heart. In the healthy heart, the
atrioventricular node slows the electrical
pulse slightly (fractions of a second) so that
the upper chambers can fully pump and relax
before the lower chambers pump.
31
Sometimes, however, problems can occur in the
heart’s electrical system such as bradycardia.
What does it feel like to have
bradycardia?
People with bradycardia may feel overly tired, be
short of breath, or have other symptoms
because the heart does not beat fast enough to
pump enough blood to meet their needs.
Are there different types of bradycardia?
There are a couple of different ways in which
bradycardia can occur. You might have
bradycardia because your SA node fires too
slowly or does not fire regularly. This is
sometimes called sinus bradycardia because it
is caused by the sinus node (SA node).
32
Sinus bradycardia
A type of too-slow heart rate that occurs
because the SA node does not fire quickly
enough or because it is erratic or unreliable.
Another type of bradycardia occurs when the
electrical pulse traveling through the heart
travels too slowly or is somehow delayed or even
blocked along its pathways through the heart.
This is called heart block. The SA node may
function perfectly well, but the electrical energy
does not travel reliably through the heart.
Heart block
A type of too-slow heart rate that occurs
because the electrical pulses from the
SA node are delayed or even blocked at
the AV node.
33
Are there different types of heart block?
There are three main types of heart block that
are identified by degrees. In first-degree heart
block, the electrical pulse from the SA node is
delayed at the AV node in such a way that you
lose 1:1 AV synchrony, and your heart rate is too
slow. First-degree heart block may be mild and
cause you few or no symptoms. In many cases,
first-degree heart block may be intermittent.
Intermittent
A medical term that describes a condition
that comes and goes. A person with
intermittent AV block experiences it some
of the time, but not continually.
Second-degree heart block is more severe. In
this case, some (but not all) of the impulses from
the SA node are blocked at the AV node. This
34
results in a too-slow heart rate and a loss of AV
synchrony. People with second-degree heart
block may have symptoms that include dizziness,
lightheadedness, shortness of breath and a
feeling of being unwell; they can even faint.
Third-degree heart block is also called
complete heart block. In this case, all of the
electrical impulses from the SA node are
blocked completely at the AV node. The lower
chambers of the heart continue to beat on their
own, but they beat at a much slower rate.
People with third-degree heart block have a
very slow heart rate and a loss of 1:1 AV
synchrony. They can have severe symptoms.
How do I know what kind of arrhythmias
I have?
Ask your doctor about the type of arrhythmia
that you have. It is not unusual for a person with
one arrhythmia to develop another arrhythmia
35
over time or to have more than one kind of
arrhythmia. Your doctor may ask you to undergo
some testing or monitoring to determine the
exact type of arrhythmia that you have.
Will my ICD also act like a pacemaker?
Your ICD includes a built-in pacemaker. If you do
not need a pacemaker, it will remain on standby.
It will keep monitoring your heart, but if your
heart never beats too slowly, it will not pace. If
your natural heart rate ever gets too slow, the
36
pacemaker acts to “fill in the missing beat.” It
does this by delivering a very small amount of
electrical energy – often less than one or two
volts – to the cardiac tissue, causing it to contract.
What does it feel like when the heart
is paced?
You probably will not be able to tell when your
ICD is pacing the heart and when it is on standby.
Will the pacemaker pace my heart after
a shock?
If you ever get a shock from your ICD, your heart
will likely take a few seconds to recover, and
then it will start to beat on its own. The built-in
pacemaker in your ICD will monitor the heart
during this time. If it takes too long for the heart
to recover and start to beat on its own, or if your
heart does not start beating regularly or fast
enough on its own, the pacemaker will pace the
37
heart during this period. Some people need
pacing support after a shock; others do not. In
most cases, this pacing support is only needed
for a short time – usually less than an hour.
Will my arrhythmias ever go away on
their own?
While some health problems can clear up on
their own, it is unlikely that your arrhythmia will
go away. In fact, most arrhythmias become
progressively worse over time. The reason is
that an arrhythmia is caused by some kind of
irregularity in your heart’s electrical system that
cannot repair itself. ICDs and pacemakers can
be the best possible treatment for certain types
of arrhythmias.
38
Why can’t I just take a medicine to treat
my arrhythmia?
While there are some heart drugs that treat
arrhythmias, these drugs are not right for every
patient. They may interact with other drugs you
take and may have certain risks and side
effects. Ask your doctor about the risks and
benefits of drug therapy.
Do I still need to take my heart
medications even if I have an ICD?
That depends. It is not unusual for ICD patients
to continue to take heart medications. These
medications may help the heart in other ways
or may be necessary to allow your heart to work
as efficiently as possible. Some ICD patients
take drugs to help prevent arrhythmias, but rely
on the ICD in case the medications do not work
all of the time. If you have questions about your
medications, talk to your doctor.
39
Can a person have an arrhythmia without
any symptoms?
Yes. The symptoms you experience do not
always match up with your arrhythmia—that is,
you may have severe symptoms and a mild
arrhythmia or mild symptoms with a severe
arrhythmia. Some people have symptoms
caused by their arrhythmia that they attribute to
something else. For example, a person with an
arrhythmia may feel tired and out of breath, but
just think he or she is out of shape.
I have never had a dangerous arrhythmia
before. Why does my doctor want me to
get an ICD?
It is unusual for a person to experience a
dangerous arrhythmia, and some of these
arrhythmias can be fatal. In an effort to save lives,
doctors have studied people with rhythm
disorders and found that there are risk factors
40
for dangerous arrhythmias. These include
having right and left ventricles that do not contract
at the same time (mechanical dyssynchrony),
having heart failure, having a low ejection
fraction, and having certain conditions such as
long QT syndrome. Some people are at very
high risk for a life-threatening arrhythmia even
though they have no symptoms and no history
of arrhythmia. For such people, the ICD is a
preventative treatment. This type of therapy is
sometimes called primary prevention.
Risk factors
Conditions that make it more likely that a
particular disease or rhythm disorder will
occur. For example, smoking is a risk factor
for cancer. Some risk factors cannot be
changed, such as age or family history.
41
Mechanical dyssynchrony
A heart condition in which the right ventricle
and the left ventricle do not contract at the
same time, or in which the lower chambers
of the heart do not contract as a whole.
Mechanical dyssynchrony can cause the
heart to pump less efficiently.
Heart failure (HF)
A syndrome characterized by the heart’s
inability to pump blood efficiently. Heart
failure is a pumping disorder, not an
electrical disorder. It may be mild or severe
and tends to get worse over time.
42
Ejection fraction
The amount of blood, stated as a percentage,
that the heart can pump out in one beat.
No one has an ejection fraction of 100 %.
A normal ejection fraction is approximately
60 % (meaning that in one beat, the heart
pumps out 60 % of the blood it contains).
An ejection fraction below 35 % may be
considered a risk factor for arrhythmias.
Long QT syndrome (LQTS)
A syndrome in which the heart muscle takes
an abnormally long period of time to relax
following a contraction. While this is in itself
not problematic, people with Long QT
Syndrome may develop dangerous
arrhythmias. Long QT Syndrome is hereditary.
43
Primary prevention
An approach to ICD therapy in which a
device is implanted in a patient at high risk
for dangerous arrhythmias even if he or she
has not yet had such an arrhythmia.
I have survived dangerous arrhythmias
before. Why does my doctor think I need
an ICD?
If you have had a dangerous arrhythmia and
survived, you are very fortunate, but you are also
at high risk for having another dangerous
arrhythmia in the future. The ICD will help
protect you should that occur.
What if my heart condition changes in
the future?
Your heart condition may change over time. An
ICD can be individually programmed for you by
44
adjusting dozens of specific settings. If your
condition changes, your doctor can adjust the
ICD to new settings to meet your new needs.
How can the doctor adjust the ICD once
it is implanted in my body?
The clinical team (doctors, nurses) can
communicate with the implanted ICD by using
a special device called a programmer. A
programmer is a computer that uses special
radio waves to share information back and forth
with the implanted ICD.
Programmer
A special computer that a doctor can use to
communicate back and forth with an
implanted ICD. The programmer can obtain
information stored in the ICD and can also
change the settings of the implanted ICD.
45
Communicating with the device is a simple and
painless procedure. With the programmer, your
clinician can get information stored in the ICD
and also change how the device is set. For
example, it is possible to change the rate
“zones” for defining ventricular tachycardia and
ventricular fibrillation.
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How does the pacemaker part of my
ICD know when to pace and how fast
to pace?
The ICD consists of a pulse generator (running
on a battery) plus one or more wires called
leads. The lead is plugged into the pulse
generator at one end and the other end is
maneuvered into the heart. Once inside the
heart, an electrode on the end of the lead picks
up signals from the heart. This allows the ICD’s
pacemaker to “know” what your heart is doing
in a process called sensing.
Sensing
The ability of a pacemaker to pick up
electrical signals from within the heart
and interpret them – that is, to know how
rapidly the heart is beating.
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The pacemaker senses your heart’s activity, so
when your heart is beating properly, the
pacemaker is on standby and does nothing but
observe. However, if the pacemaker senses that
your heart has not beat when it is time for it to
beat, it will fire a small electrical pulse that will
cause the heart muscle to contract. This is
pacing. All pacemakers sense and pace.
Pacing
The ability of a pacemaker system to
generate and deliver a small electrical output
pulse to the heart that causes it to beat.
If my heart is beating fast enough on its
own, does the pacemaker still pace?
No. The pacemaker senses 100 % of the time,
but it only paces when necessary.
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Does the pacemaker in my ICD sense
and pace in the upper or lower
chambers of the heart?
That depends on what kind of ICD you have. A
single-chamber ICD includes a pulse generator
plus one wire or lead that is attached to the
inside of the right ventricle.
Single-chamber ICD
An ICD with one wire or lead attached to the
inside of the heart so that it can pace and
sense in the right ventricle. The “singlechamber” designation refers to the ICD’s
built-in pacemaker. If the ICD delivers a
shock, it uses the same lead and will shock
the right ventricle.
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Lead
Also called pacing wire, defibrillation wire or
wire. A thin, flexible, insulated wire with one
or more electrodes at the end. One end of the
lead is plugged into the ICD, and the other
end (with the electrode) is attached to the
inside of the heart. Electrical pulses from the
device travel via the lead into the heart to
pace; electrical energy from the heart travels
via the lead into the device to sense.
50
A dual-chamber ICD is a pulse generator plus
two leads, one of which is secured to the inside
of the right ventricle (lower chamber) and the
other to the inside of the right atrium (upper
chamber). A dual-chamber ICD shocks only the
right ventricle, but it can pace and sense in both
the right atrium and right ventricle.
Dual-chamber ICD
An ICD with a built-in pacemaker and at
least two leads that paces and senses in the
atrium (via a lead in the right atrium) and
paces and senses in the ventricle (via a lead
in the right ventricle). If a dual-chamber ICD
delivers a shock, it uses the right ventricular
lead to shock the right ventricle.
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Does the ICD shock both the upper and
lower chambers?
The ICD is designed to deliver a shock only
through the right ventricular lead to the right
ventricle. The shock energy is strong enough to
defibrillate the whole heart.
How do I know what kind of ICD I have?
Ask your doctor whether you have a singlechamber or a dual-chamber ICD. The decision
52
about what kind of device you get is based on
your arrhythmias. There are many factors that
might affect this decision, so discuss this with
your doctor.
Are there different types of leads?
Yes, there are many types of leads. For example,
the right ventricular lead in an ICD system is a
defibrillation lead, capable of delivering a large
amount of electrical energy.
Some leads are specifically designed to pace
only; this type of lead might be used in the right
atrium with an ICD. Some leads have a small
amount of steroid medication at the tip to help
them function better in the first weeks after
implant surgery. Leads may also vary in the
insulation material they use or the type of
electrodes they have. Your physician will pick
the leads that are best suited for you.
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How does the doctor know whether
I need an ICD?
The doctor will base the conclusion on your
overall health, your medical history and the
results of tests. Some of these tests may involve
procedures to observe your heart’s rate and
rhythm. Every patient is unique, so your doctor
will base his or her decision on the factors
specific to you. If an ICD is recommended, your
doctor can answer your questions and schedule
your surgery.
Should I get a second opinion before
getting an ICD?
If you ever feel that you need more information
or if you are unsure about your doctor’s
recommendations, it is wise to consult another
specialist for a second opinion. Your physician
will not be offended if you want a second opinion.
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What is ICD surgery like?
In ICD surgery, the physician will implant the
device in your body. For most people, the ICD is
implanted in the upper chest below the
collarbone, but in some cases, the doctor may
decide it is better to implant the device in the
abdomen. The doctor will make a small cut in a
nearby vein and then advance the lead(s) gently
through the vein. This is done using a device
called a fluoroscope, which is like a video X-ray.
Once the lead is inside the heart, it is attached
and plugged into the ICD. The area where the
ICD is implanted is sewn up. This procedure is
often done under local anesthetic. You will be
given some medication to relax you, and your
chest area will be numbed, but you will be
awake during the procedure.
55
Fluoroscope
A device that allows for real-time X-rays to
be taken, creating a sort of X-ray movie. A
fluoroscope is used during ICD implantation
so the physician can observe the lead
advancing through the vein and into the heart.
How long does ICD surgery take?
While that depends on your particular case,
it generally lasts about one to two hours.
Is it painful to be awake during the
surgery?
You will be given some medication to numb the
area where the ICD is implanted. If you do feel
pain or even discomfort, tell the clinical team at
once. They can adjust your medication so that
you are not in any pain or discomfort, although
you may feel some pressure at times. You will
56
be draped so you cannot see what the clinicians
are doing. However, you will likely be aware of
what is going on around you.
What will go on during ICD surgery?
You may be surprised that several clinicians are
in the room. There is one doctor who performs
the surgery, but another physician may be
present to assist. There will likely be at least one
nurse in the room. A technician may be present
to operate some of the monitors and technical
equipment. During the procedure, these
clinicians talk to each other, and you may hear
some loud voices around you. Do not be
alarmed; this is very normal. During the
operation, they may call out numbers or other
information to each other. They may also
occasionally talk to you to check that you are
comfortable. In some cases, your device will be
tested during the implant. The doctor will apply
57
some electrical energy to your heart to cause a
rhythm disorder, then the device will be tested to
see if it can identify and stop the rhythm
disorder and change your heart rhythm back to
normal. You may be given some extra medicine,
and the clinical team will tell you what to expect.
How will they actually perform the
implant surgery?
The physician will make an incision in your
upper chest to create a pocket where the ICD is
placed. For most people, this is in the upper
chest below the collarbone, but in some cases,
the doctor will make the pocket in the abdomen.
58
Pocket
Also called the ICD pocket. A small area
that the physician forms in the upper chest
(or sometimes abdomen) that is just large
enough to hold the implanted device.
This pocket is typically formed above the
muscle, and it is only large enough to contain
the device. Once the pocket is formed, the
clinicians will drench it in antibiotics to prevent
infection. Meanwhile, the physician will make a
small incision in a nearby vein. Through this tiny
cut he or she will insert the ICD lead. The lead
is temporarily stiffened for this procedure by the
insertion of a very thin wire called a stylet. Using
a fluoroscope, or video X-ray machine, the
physician will gently advance the lead with stylet
through the vein and into the heart.
59
When the lead is in the proper place, as seen on
the fluoroscope, the physician will then attach it
to the inside of the heart. The lead may attach
using small protrusions called tines; it may
attach with a corkscrew-type mechanism. Once
the lead is attached in the heart, the other end is
plugged into a special device used for testing.
The physician will test the lead to make sure that
it paces and senses properly. It is sometimes
necessary for the clinical team to detach the lead
and reposition it to get it to work better. This is
not unusual. Once the clinical team has the lead
in the best possible position, the lead is
unplugged from the test device, plugged into the
ICD and tested again. After making sure it is
working properly, the ICD is placed into the
pocket, and the pocket is sewn closed.
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Is lead testing the same as the
testing the doctors do when they
cause a rhythm disorder?
No. All ICDs will have at least one lead, and this
lead will be checked to make sure it can pace
and sense and that it is attached properly in the
heart. In some cases, the doctor will also want to
test whether the device can stop a rhythm
disorder. This is a different kind of test. It is not
always necessary to do this test for all patients.
When it is done, it is to make sure that the device
can identify a dangerous rhythm disorder, stop it,
and change the heart rhythm back to normal.
How long is the recovery time after ICD
surgery?
The recovery time depends on your overall health,
your condition, the type of procedure you had and
your age. While some ICDs are implanted on an
outpatient basis, many people stay one or two
61
nights in the hospital. When you are discharged
from the hospital, you will be given specific
instructions about how to care for yourself.
What should I do right after surgery?
In the first days after your ICD surgery, you may
find the implant site to be tender and slightly
swollen. The clinical team will advise you how to
62
keep the implant site clean and dry. If you notice
any redness or extreme soreness at the implant
site, contact your doctor immediately or go to
the emergency room, as these are possible
signs of infection. You may soon feel some of
your arrhythmia symptoms have lessened or
are gone. In the first few days after surgery,
avoid all strenuous activity and exercise, and do
not lift your arms over your head. Moving your
arms can place a strain on the implanted
lead(s). In a few weeks, the leads will be firmly
attached inside the heart, but in the first weeks
after surgery, strenuous activity may move the
leads out of their proper place.
What should I do during the recovery
period?
You will likely need a few weeks, possibly even a
few months, to fully recover from ICD surgery.
You should feel better and better with each
63
passing week. During this time there are a few
recommendations to speed your healing:
Do not wear clothing that binds or is tight over
the implant site.
Avoid touching the ICD site as much as
possible.
Do not lift or carry heavy objects, and do not
carry anything heavy on your shoulder (such
as a heavy bag, purse or backpack).
Avoid strenuous exercise and “big” or twisting
motions. This would include, for example,
activities such as swinging a golf club or
baseball bat, picking up a child and gardening.
Do not raise your arms up over your head for
the first few weeks after surgery.
Your doctor will tell you when you can resume
your normal activities and which activities you
might have to modify or give up.
64
Which activities might I need to give up
now that I have an ICD?
Your doctor will give you specific advice about
what you can and cannot do as an ICD patient.
In general, people who have an ICD can do most
of what they used to do – and may even find that
they have more energy and feel better so that
they can resume doing things that they had
previously given up. That being said, if you have
an ICD, you should avoid participating in sports
that might cause you to suffer a blow to the
chest, such as football or boxing. Do not fire a
rifle with the gun butt directly over the implant
site. You will likely be able to resume most
regular activities, such as:
Returning to work
Traveling
65
Playing sports (with the exception of
contact sports, during which the implant site
could be hit)
Bathing, swimming and showering
Normal sexual activity
Moderate exercise, as your overall health
permits
If you find that any particular activity makes you
feel worse, tell your doctor at once.
66
Can I still drive?
Some areas may have laws or regulations about
whether a person with an ICD can still drive.
Ask your doctor about driving and the laws in
your area.
Why would there be any problem with
driving?
You have an ICD because you are at risk for a
dangerous rhythm disorder. The concern is that
you might have such a rhythm disorder and
suffer symptoms or have a shock while driving.
Your doctor can help determine if and when you
can resume driving.
What does it feel like to have an ICD?
At first, you may be very aware of the device,
and you may want to touch the implant site.
After a few weeks, you will get used to this. If
your device treats a dangerous heart rhythm,
67
you may feel it. If the device delivers
antitachycardia pacing (ATP), you may not feel
anything, or you may feel a sort of fluttering in
your chest. If the device delivers a shock, what
you experience will depend on your rhythm
disorder and how much electricity the shock
sends to the heart. Shocks can be painful, but
they last only a fraction of a second. Some
people with dangerous rhythm disorders are
unconscious when the shock is delivered and do
not feel it.
How many shocks can I expect to
receive?
That depends. Some people with an ICD never
get a shock. Some people will receive several
shocks a year. If you get frequent shocks, your
doctor may prescribe some medications that
can help reduce the number of arrhythmias you
experience. These medications do not
68
guarantee that you will never have any rhythm
disorders, but they may make them less
frequent. Your doctor may be able to adjust the
device to reduce the number of shocks you get.
What does it feel like when the built-in
pacemaker paces the heart?
The pacemaker part of your ICD only works if
and when you need it. The pacemaker uses very
low amounts of electricity – often less than one
or two volts – so you do not feel it at all.
Where does the ICD get all the energy to
deliver shocks and pacing pulses?
Your ICD is battery-powered. In fact, the battery
takes up most of the space inside an ICD. This
is a very special, long-life battery that is
designed to alert the physician when it is
running low.
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How long does this battery-operated
device last?
How long the battery lasts depends in part on
how many treatments (ATP and shocks) you
need, how often the pacemaker portion of the
ICD has to pace, and how much electricity it uses
doing these things. Even if you get a couple of
high-energy shocks per year and the pacemaker
paces 100 % of the time with a high output
setting, your ICD should last a couple of years or
more. It may last far longer than that. When you
go for your checkup, your heart doctor can
estimate how much longer your device will last.
Is there any warning before the battery
runs out?
Yes. ICD batteries are different from car
batteries or other batteries that deplete
suddenly. An ICD battery signals when it is
nearing depletion, but still runs for many
70
months at full capacity. Your heart doctor will
alert you when the battery is nearing depletion,
but you will still likely have weeks or even
months to schedule a replacement.
What is a replacement?
When the battery wears out, the entire device is
removed and a new ICD is inserted in place of
the old one. This involves a new surgical
procedure, but it is usually faster and easier
than the original procedure. In most cases, the
lead(s) stays in place. It is just unplugged from
the old ICD and then plugged into the new ICD.
Why can’t they just replace the battery?
Your ICD is hermetically sealed to prevent fluids
in your body from entering the device and
interfering with the circuits. There is no way to
open it up and remove the battery. For that
reason, the entire ICD is removed and replaced.
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How often do I need to have checkups?
Most ICD patients need to see their doctor from
two to four times a year. How often the doctor
wants to see you depends on many factors.
During most visits, the doctor or nurse will
examine you, ask you some questions, and then
check your device using a special computer
called a programmer that can communicate with
the implanted ICD. This is completely painless.
Why do I need to go to so many
checkups?
It is important for the clinical team to monitor
your device. Each time you come in for a
checkup, they will see how much energy is left
in the battery. They can also check to make sure
that the leads are working properly and that the
device is doing what it is supposed to do. While
many of these visits will be routine, it is
important to know that your device is always
72
working properly. An ICD may one day be
needed to save your life; you want to make sure
it is in good working order.
What should I tell my doctor during my
routine checkup?
Report to your physician any unusual symptoms
such as redness at the implant site, difficulty
breathing, swelling of legs or hands, chest pain,
dizziness, lightheadedness, shortness of breath,
fainting spells, persistent hiccups or abnormal
heart rates (such as a very slow, very fast or
abnormal pulse). Also tell your doctor about any
changes in your health, new medications you
are taking, and medications you have
discontinued.
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What should I tell my family about my
ICD?
Chances are that unless you tell others that you
have an ICD, they will never know. Most people
with ICDs live normal, active lives. While your
medical privacy is important, you should
consider that in the event of an emergency,
those around you should be able to inform the
medical team that you have an ICD. They should
also know what to do in the event you have a
shock. For that reason, we recommend that you
share this information with your family and
those close to you.
Is it safe to be near a microwave oven?
Yes. Normal household appliances in good
condition will not interfere with your ICD.
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Can I still use a computer?
Yes. A computer or tablet computer will not
interfere with your ICD.
Can I still use a cell phone?
In general, most cell phones in good condition
are safe around ICDs. It is recommended that
you do not place the phone over the implanted
ICD (even if the phone is turned off) and that you
hold the phone on the side of the body opposite
your ICD.
Can I go through airport security or
other checkpoints?
There are so many different types of security
systems in use today that it is difficult to make
any general recommendation. Instead, we
recommend that you present your BIOTRONIK
ID card to the security personnel, request a pat-
75
down and follow their instructions. Whether or
not you can go through security machinery, you
should have no problem traveling. Airport and
other personnel are trained to assist people
with ICDs so that they can safely clear security
checkpoints.
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BIOTRONIK Home Monitoring®
BIOTRONIK Home Monitoring® is an
important feature of some BIOTRONIK
pacemakers and ICDs. Ask your doctor if you
have it, and if so, which features apply to you.
You may have a special type of ICD with a
separate transmitter device. Together, your ICD
and the transmitter can share information with
your doctor about your heart and your device
and how they are working together. In simple
terms, the ICD communicates automatically to
the transmitter, and the transmitter then sends
information to a secure computer server that
your doctor can access. This happens without
any special action on your part. It is painless. In
fact, you will not even be aware that it is
happening.
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BIOTRONIK Home Monitoring® has changed
ICD therapy. With Home Monitoring, your ICD
can report directly to the doctor about any
unusual heart rhythms you have experienced, or
if the device battery is low, or if the lead is not
functioning properly. If your ICD ever delivers
ATP or a shock to treat a dangerous arrhythmia,
BIOTRONIK Home Monitoring® will
automatically alert your doctor.
78
In some cases, the ICD can detect and identify a
problem before you even know it is there. But
most of the time, BIOTRONIK Home Monitoring®
just confirms to your doctor’s office that
everything is working fine.
BIOTRONIK Home Monitoring® system provides
you with an automatic connection to your
physician, even as you go about your ordinary daily
activities. Your heart doctor will help explain how
to take advantage of the Home Monitoring system.
Please note that the transmitter is NOT an
emergency system. It is for monitoring only.
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Resources
You may want to learn more about your ICD or
want to meet other people who have ICDs to
share experiences. There are a number of
resources that may be helpful to you.
Websites
Please note that websites change frequently,
and the ways to access patient information may
change with time. Visit the sites, and seek the
sections designated for patients.
With the exception of the BIOTRONIK site,
BIOTRONIK is not responsible for the content of
the sites referenced, but has examined them at
the time of printing and found them to be of
potential interest to you.
BIOTRONIK
BIOTRONIK maintains a large website with high
quality information for patients about its products
and pacing in general. Visit biotronik.com and
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click on the tab marked “Patients.” You will find
information about the heart, heart disease, ICD
therapy and cardiac pacing.
HRSOnline
The Heart Rhythm Society is a large nonprofit
organization for clinicians who specialize in
pacemakers and ICDs. Visit them online at
HRSonline.org. Locate the tab marked “Patient
Resources.” There is information about the
heart, electrical problems with the heart, ICDs
and pacemakers.
FDA
The U.S. Food and Drug Administration (FDA)
has an extensive website that contains a
significant amount of consumer information.
FDA information is more likely to be topical
and based on new research, new products or
potential product problems. Visit them at
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FDA.gov and then select “Medical Devices.”
Look for resources for consumers.
Pacemaker Club
The Pacemaker Club is an organization run by
individuals who have pacemakers or ICDs. It
operates as a message board where people with
pacemakers or ICDs can share experiences, ask
questions and find support and encouragement.
It is important to know that the Pacemaker Club
is not run by medical experts or monitored by
physicians. This site should not be taken as a
source for medical or health information, but it
is a great way to connect informally with other
people who have pacemakers or ICDs. Visit
them at the pacemakerclub.com. You’ll need to
register to participate, but registration is free.
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Support Groups
Some hospitals hold regular support group
meetings for people with pacemakers or ICDs.
Ask your heart doctor if there are such
meetings in your community or contact local
hospitals. These groups bring together patients
and their loved ones to share experiences and
offer encouragement. They may also periodically
offer educational sessions or guest speakers.
83
Important information
Contraindications
In the United States, the law requires this
manual to describe the contraindications for
the device.
Contraindication
A condition or situation in which it may not
be appropriate for you to have this device.
84
This ICD is contraindicated:
If your anatomy does not allow it to be
properly placed.
f you have a mechanical heart valve.
If you have other implanted medical devices
that are not compatible with this ICD.
If you have a heart rhythm known as constant
or recurring ventricular tachycardia or
ventricular fibrillation.
If your only heart rhythm disorder is a
too-slow heart rate or a heart rhythm
problem that originates in the heart’s
upper chambers (atria).
If the dangerous heart rhythms you have
are considered temporary or reversible.
85
Your heart rhythm might be considered
temporary or reversible if it occurs because of
some condition or event and it is expected that
when you heal, your heart rhythm will go back to
normal. These kinds of temporary or reversible
dangerous heart rhythms may happen:
Right after a heart attack.
If you take too much of certain medications.
After nearly drowning or being electrocuted.
If you have an electrolyte imbalance.
If you have sepsis (infection).
If certain areas of your body are starved
for oxygen.
86
Heart attack
Also called a myocardial infarction. A medical
event that occurs when one or more of the
arteries that supplies the heart muscle with
oxygen is clogged or blocked. This results in a
portion of the heart muscle being starved for
oxygen. This tissue dies. Depending on how
much tissue dies, the heart attack may be
major or minor. It is not unusual for people
to have dangerous abnormal heart rhythms
immediately after a heart attack.
Sepsis
A severe condition characterized by a
whole-body infection.
There are certain types of ICD wires, also called
leads, that may be contraindicated if you cannot
87
tolerate a small dose of steroid medication. In
such cases, you may be able to have an ICD, but
it must use a different type of ICD lead.
Risks, warnings and precautions
As with any medical device, there are certain
risks and safety concerns associated with
having an ICD.
Risks
The following lists some rare but possible
adverse events associated with an ICD.
Adverse events
Sometimes called “side effects,” these are
negative occurrences and / or symptoms
that may be associated with the ICD.
These adverse events may be unpleasant,
uncomfortable or painful. Some of these risks
88
may require you to undergo surgery again to replace,
remedy or remove the ICD system. Your physician
can explain these risks to you in more detail and
may be able to take steps to minimize these risks. If
you experience any of these adverse events or other
unusual problems that may or may not be related to
the ICD, please tell your physician at once.
Bleeding around the heart
Damage to the heart
Collection of air or gas in the chest cavity, also
known as “pneumothorax”
Death if the ICD is not able to shock or pace
properly
ICD moving from its original location and/or
protruding through the skin
Infection
Problems with the ICD lead, including dislodgement
89
Blood clots
Blocked blood vessels
Rejection of the ICD by the body
Muscle or nerve stimulation that may
cause hiccups
Fluid accumulation around the ICD
Faster heart rates
Unnecessary shocks
Vein closure
Some of these conditions may occur without you
being aware of them. For that reason, you should
see your heart doctor for all regular checkups.
Warnings
Warnings advise you about certain situations
that can put you at serious risk and may
damage your health. There are some important
warnings for people with ICDs.
90
Strong magnetic fields can interfere with your
ICD. This includes industrial magnets, heavy
industrial equipment and certain amusement
park rides. If you know you are near a strong
magnet, move away from the magnetic field
as soon as you can. The ICD is designed to
withhold treatment when in a strong magnetic
field, so your ICD may not deliver the therapy
you need if you are around strong magnets.
Some ICD patients (but not all) may also
experience dizziness, lightheadedness or a
feeling of being unwell when they are in a
magnetic field.
Magnetic resonance imaging (MRI) can
interfere with the ICD, damage the device
and / or wire(s) and may harm you. Avoid MRI
procedures. If an MRI is ever recommended,
tell the clinical team that you have an ICD.
Always carry your BIOTRONIK identification
91
(ID) card with you in case you cannot speak for
yourself.
This warning does not apply to BIOTRONIK
ProMRI® systems.
Some devices may be approved as safe for
certain kinds of MRI procedures. If yours is one
of these, your patient ID card from BIOTRONIK
will have a MR symbol on it.
Magnetic resonance imaging (MRI)
A procedure to painlessly take a
picture of the soft tissue in the body
using magnetic waves.
92
ICD function testing may be required as part of
your ICD surgery to test the system. Your
doctor will electrically cause your heart rhythm
to become fast and irregular and then use the
device to detect and treat the rhythm to bring
your heart back to normal. The purpose of the
test, which is safely conducted by the clinical
team in the hospital, is to be sure that your
device is able to identify dangerous heart
rhythms and treat them effectively. The ICD
93
function test is usually only performed when
the device is implanted, but it may be
necessary to test the device more than once.
ICD function testing
The use of the newly implanted ICD to
identify and treat a potentially dangerous
heart rhythm that the doctor provokes in the
hospital setting. This test makes sure the
device can detect dangerous heart rhythms
and treat them quickly and effectively.
During an ICD function test, you may experience
discomfort and pain. Although rare, in some
cases the ICD will not be able to treat the
dangerous heart rhythm provoked by the doctor.
If this happens, the clinical team may use an
external defibrillator to bring your heart rhythm
back to normal. External defibrillation can be
94
painful. ICD function testing can give your
doctor important information so he or she can
program your device to work effectively for you.
Some very sick patients have died as a result of
ICD function testing, although this is extremely
unusual. If ICD function testing is necessary, it
is carried out in the hospital by a clinical team
to make it as safe as possible for you.
Precautions
Precautions are advice to you to protect you
from minor injury and to keep your ICD in good
working condition.
Initial precautions
(First three months after implant)
Right after the implantation procedure takes
place, avoid making sudden and/or very large
movements or doing strenuous activities. Avoid
lifting or carrying heavy objects. These kinds of
95
vigorous activities can delay healing of the
implant site or even cause your wound to reopen.
Vigorous movement can also put stress on the
leads. Avoid wearing tight clothes or anything
that might put pressure on the implant site. Take
care that nothing bumps or hits the implant site.
Cell phones
You may use a cell phone with an ICD providing
you take some simple precautions.
96
Keep the phone at least 6 inches (15 cm) away
from the ICD at all times, even when the phone
is turned off.
Hold the phone to the ear opposite the ICD. For
example, if your ICD is implanted on your left
side, hold your cell phone to your right ear.
Do not put the phone over the ICD or carry it in
a breast pocket so it is over the ICD, even if the
phone is turned off.
Metal detectors and security checkpoints
Avoid both walk-through and handheld metal
detectors. If you need to pass through a security
checkpoint (at the airport or a courthouse, for
example), tell the security personnel that you have
an ICD and show your BIOTRONIK ID card. Security
professionals are trained to check people with
implanted devices without the use of the metal
detector. Depending on the policies in that setting,
you may need to perform a pat-down search.
97
Electromagnetic interference
People with ICDs should try to avoid
electromagnetic disturbance which may
cause electromagnetic interference (EMI).
Electromagnetic interference (EMI)
Electronic disturbances are invisible signals,
sometimes called “static” or “noise” that can
interfere with certain medical devices, including
ICDs. Power tools, heavy machinery, theft
detection systems and security systems may all
produce electromagnetic emissions, which can
create electromagnetic disturbances. These
disturbances may result in electromagnetic
interference (EMI).
Your ICD was designed with special filters to keep
out and reduce unwanted electromagnetic
disturbances which may cause EMI. However,
there are many types of devices and sources of
98
electromagnetic disturbance in the world today, so
complete protection from EMI is not possible. If
your ICD senses EMI, it may “think” that these
signals are coming from your heart and cause your
ICD to respond inappropriately. For example, the
EMI may cause your ICD to deliver unnecessary
therapy, which can be painful and may even start a
dangerous heart rhythm. On the other hand, EMI
can also cause your ICD to withhold therapy you
might need, which puts you at risk during a
dangerous heart rhythm. For these reasons,
people with ICDs should try to avoid sources of
electromagnetic disturbance as much as possible.
EMI may interfere with the ICD, but it does not
damage it permanently. If an ICD is sensing
EMI, some (but not all) people may have
symptoms such as feeling lightheaded, dizzy or
unwell. If this occurs – or if you know you are
near a source of electromagnetic disturbance,
even if you do not have symptoms – move out of
99
the area. This should allow the ICD to go back
to normal operation.
Most household appliances (including
microwave ovens) are safe to operate around
ICDs. Appliances in good working order will not
interfere with your ICD. Electrical tools, power
tools or other electrical devices may interfere
with your ICD if they are not properly shielded
or not in good repair. If these affect your ICD,
turn them off or move away from them.
100
Many stores use theft detection systems and
sometimes this equipment can affect your ICD. If
you know you are passing through a theft detection
system, simply walk through it at a normal pace.
This should not interfere with your device. Some
stores conceal these theft detection systems,
which may be located anywhere within the store. If
you think that a theft detection system is affecting
your device, move out of the area quickly. It may be
necessary for you to leave the store.
Some equipment is known to produce
electromagnetic disturbance that may cause EMI
and should be avoided or used with caution.
This includes:
Electric welding equipment
Electric melting furnaces
Radio and TV transmitters, including
commercial stations
101
Radar transmitters
Power plants
High-voltage lines
Walkie-talkies and other two-way
communication systems, including
emergency vehicle two-way radios
Microwave transmitters, TV satellite dishes
Paging transmitters
Satellite towers
Electrical starting systems of gasoline engines,
if not properly shielded
Electrical tools and power tools
Electrical appliances not in good working condition
Some amusement park rides, such as
bumper cars
102
Other healthcare providers
Always tell other healthcare professionals that
you have an ICD (this includes doctors, dentists,
X-ray technicians, nurses and emergency room
staff). Carry your BIOTRONIK ID card with you at
all times. Some people with ICDs wear a special
medical alert bracelet; while this is not
required, it may communicate this information
for you if you ever need emergency medical care
and cannot speak for yourself.
If you ever need surgery, make sure the clinical
team knows about your ICD. High doses of
radiation or X-rays can damage the device, so
everyone caring for you must know about your
ICD. If you need surgery, your heart doctor may be
consulted to take the necessary steps with your
ICD to protect you and the device. Since some
types of procedures can cause the ICD to deliver
therapy you do not need or to withhold therapy
103
you do need, it is important that your heart
doctor be able to discuss your case with the
other physicians. In most cases, your ICD will
be turned off for the duration of the procedure.
After the operation, the ICD will be turned back
on. This step is completely painless and usually
takes only a few minutes.
Once you have an ICD, there are certain
procedures and operations that may possibly
harm you or the device. Tell the clinical team
that you have an ICD, and they can help to
evaluate the risks and benefits and discuss
them with you. There may be protective steps to
help make the procedure safe for you and/or
protect the ICD system from possible damage. If
you undergo any type of procedure, your doctor
should test the ICD before and after the
procedure to make sure it is working properly.
Some procedures can damage the ICD system.
104
This damage may not be detected right after the
procedure, but could cause a malfunction or
device failure in the future.
The following are some procedures that should
be avoided if you have an ICD. In some cases, it
may be possible for you to undergo the
procedure with special steps taken. If you might
need to undergo any of these procedures,
discuss the possible risks and your safety with
your physician.
Diathermy
Diathermy
Heat produced by electricity and used on
tissue in the body, usually as a form of physical
or occupational therapy and in surgery.
105
Diathermy may cause heating of the ICD, leads
or implant site. If diathermy must be used, it
should be used as far from your ICD as possible.
Transcutaneous electrical nerve
stimulation
Transcutaneous electrical nerve
stimulation (TENS)
The use of electrical energy to stimulate
muscles. The energy is produced by a
TENS device and is carried by wires through
electrodes stuck onto the skin.
TENS devices are often used to treat pain. They
are not implanted in the body and can be easily
removed or turned off.
106
Magnetic resonance imaging (MRI),
see page 91-92.
Electrical cautery
Electrical cautery
The use of heat from an electrical
device to seal a wound or remove tissue.
Electrical cautery is usually performed during
surgery.
107
External defibrillation
Defibrillation
The use of large amounts of electrical energy
to “shock” the heart out of cardiac arrest and
restore its normal rate and rhythm.
External defibrillation
Defibrillation that is given through paddles
applied to the chest (“external” to the body).
In an emergency situation, first responders may
deliver external defibrillation by placing large
paddles on the chest and sending electrical
energy to change your heart rhythm from a
dangerous rhythm to a more normal one. During
external defibrillation, very large amounts of
energy will be sent through the skin to your
heart. External defibrillation can be effective in
restoring a normal heart rhythm, but in rare
108
cases, the electrical energy could damage your
device. After external defibrillation, the amount
of energy your device needs to pace your heart
may increase for a short time or permanently. If
external defibrillation is required, the medical
team should place the defibrillator paddles in a
way to affect your implanted device as little as
possible. If you ever receive external
defibrillation, alert your heart doctor at once so
that your ICD can be checked.
Radiation therapy
There are different types of radiation treatments
used in medicine. An X-ray is a type of radiation
therapy, and so are devices that send
concentrated radiation energy to specific areas
of the body (called “radiotherapy”). It may be
possible for a person with an ICD to undergo
radiation therapy, but your heart doctor should
be consulted.
109
Lithotripsy
Lithotripsy
A procedure during which sound waves
are used to break up kidney stones.
Lithotripsy may damage the ICD or interfere
with its function. If your doctor decides you may
undergo lithotripsy, the procedure should be
performed as far from the ICD as possible.
Cardiac ablation
Cardiac Ablation
A surgical procedure during which very tiny
sections of cardiac tissue are destroyed, either
by surgically cutting them out or destroying
them with heat energy or freezing cold.
110
Cardiac ablation is often performed using a
catheter and a very small incision. Although it
may be considered minor surgery, it may
damage the ICD. Cardiac ablation using heat
or radiofrequency energy may overheat the
implanted ICD lead. This can damage the lead,
possibly damage the ICD, and could even harm
you. If cardiac ablation is necessary, your heart
doctor should be consulted to make sure proper
precautions are taken. It may be possible to
perform the ablation far from the ICD lead; the
ICD should be turned off during the ablation.
Changes in your health and condition
Your health and physical condition are always
changing. Changes in your overall health and
fitness, the drugs you take and illnesses you
might have may all affect your ICD. For these
reasons, you should see your ICD doctor
regularly and tell him or her about your current
111
health and all of the drugs you are
taking – including those prescribed by other
clinicians. You should also tell your heart doctor
about any over-the-counter drugs, vitamins and
supplements you are taking, since these may
also affect your heart. Some drugs can have an
effect on your heart that may change the way
your ICD should be programmed.
Shock therapy
Your ICD is designed to deliver a large amount
of electrical energy (shock) to your heart to help
change a dangerous rhythm into a normal one.
This is not a common occurrence; some
patients never get a shock, and others may
receive only a few shocks during their entire
lifetimes. Some people feel symptoms before
they are shocked, but others do not. If you ever
get a shock or think you might have had a
shock, call your doctor immediately.
112
If you received a shock and did not actually need
it, your doctor may need to make some
adjustments to your ICD. This is a simple,
painless procedure, and it may help prevent
inappropriate shocks in the future.
If you got a shock because you had a dangerous
heart rhythm, your doctor may want to better
assess your condition. This can sometimes be
done using BIOTRONIK Home Monitoring® so
that you do not have to come into the clinic. On
the other hand, your doctor may want to see you
in person to evaluate your condition.
It is possible that you may get more than one
shock. Your ICD will continue to deliver therapy
if it detects that the dangerous rhythm is still
going on. In such cases, you should seek
emergency medical help.
It may be a good idea for you and your family
and friends to develop a “shock plan.” Discuss
113
what should happen in the event that your ICD
delivers a shock.
A shock plan might include:
Finding a quiet place where you can safely
rest.
Contacting your doctor (have his or her phone
number handy).
Being able to get to the nearest emergency
room in the event that your doctor asks you to
go there.
Being prepared to seek emergency medical
help in the event your ICD delivers more than
one shock.
114
Glossary
Adverse events
Sometimes called “side effects,” these are
negative occurrences and/or symptoms that
may be associated with a particular form of
treatment, such as your ICD.
Antitachycardia pacing
Delivery of a series of rapid, low-voltage pulses
to the heart in an effort to stop an arrhythmia.
Abbreviated ATP.
Arrhythmia
Any type of abnormal heart rhythm and / or rate.
Other terms for this are dysrhythmia and
rhythm disorder.
Atria (singular: atrium)
The two upper chambers of the heart.
115
Atrial fibrillation, also known as A-fib or AF
A very rapid atrial rate (300 beats per minute or
higher) that causes a loss of one-to-one AV
synchrony. The ventricles try to keep up with the
atria and end up beating too fast as well, but
their rate is erratic. Atrial fibrillation may stop
and start suddenly, or it may be longer
lasting – even permanent.
Atrial flutter
A tachycardia (too-fast heart rate) that
originates in the heart’s upper chambers (atria)
and causes a rapid atrial rate. The lower
chambers (ventricles) try to keep up with the
atria and also beat too quickly, but without oneto-one AV synchrony. This causes the heart to
pump inefficiently.
116
Atrioventricular node (AV node)
A specialized area of cardiac tissue located in
about the middle of the heart (below the upper
chambers and above the lower chamber) that is
an important part of the electrical conduction
pathway through the heart. In the healthy heart,
the atrioventricular node slows the electrical
pulse slightly (fractions of a second) so that the
upper chambers can fully pump and relax
before the lower chambers pump.
Atrioventricular synchrony (AV synchrony)
The healthy heart rhythm in which there is one
atrial contraction or beat for every ventricular
beat – often called one-to-one atrioventricular
synchrony.
117
Bradycardia
Any heart rate that is too slow to support the
person’s activity. Braydcardia is a type of
arrhythmia. This is sometimes called
bradyarrhythmia.
Capacitor
A component within the ICD designed to hold
and release an electrical charge.
Cardiac ablation
A surgical procedure in which very tiny sections
of cardiac tissue are destroyed, either by
surgically cutting them out or destroying them
with heat energy or freezing cold.
Cardioversion
The use of lower-energy shocks to stop
tachyarrhythmias and restore the heart to a
normal rhythm.
118
Contraindication
A condition or situation in which it may not
be appropriate for you to have a particular
treatment or medical device.
Defibrillation
The use of high-energy shocks to “shock” the
heart out of cardiac arrest and restore the heart
to its normal rate and rhythm.
Diathermy
Heat produced by electricity and used on tissue
in the body, typically during a surgical procedure.
Dual-chamber ICD
An ICD that paces and senses in the atrium (via
a lead in the right atrium) and paces and senses
in the ventricle (via a lead in the right ventricle).
A dual-chamber ICD delivers a shock only to the
right ventricle.
119
Ejection fraction (EF)
The amount of blood, stated as a percentage,
that the heart can pump out in one beat. No one
has an ejection fraction of 100 %. A normal
ejection fraction is approximately 60 % (meaning
that in one beat, the heart pumps out 60 % of the
blood it contains). An ejection fraction below 30 %
may be considered a risk factor for arrhythmias.
Electrical cautery
The use of heat from an electrical device to seal
a wound or remove tissue, typically during a
surgical procedure.
Electromagnetic interference (EMI)
Electronic disturbances are invisible signals,
sometimes called “static” or “noise” that can
interfere with certain medical devices, including
ICDs. Power tools, heavy machinery, theft
detection systems and security systems may all
produce electromagnetic emissions, which can
120
create electromagnetic disturbances. These
disturbances may result in electromagnetic
interference (EMI).
External defibrillation
The use of large amounts of energy, administered
via paddles applied to the chest (“external” to the
body), to “shock” the heart out of cardiac arrest
and restore its normal rate and rhythm.
Fluoroscope
A device that allows for real-time X-rays to be
taken, creating a sort of X-ray movie. A
fluoroscope is used during ICD implantation so
the physician can observe the lead advancing
through the vein and into the heart.
Heart attack, also known as a myocardial
infarction or MI.
A medical event that occurs when one or more of
the veins that supplies the heart muscle with
121
oxygen is clogged or blocked. This starves a
portion of the heart muscle of oxygen so that this
tissue dies. Depending on how much tissue dies,
the heart attack may be major or minor. It is not
unusual for people to have dangerous abnormal
heart rhythms immediately after a heart attack.
Heart block
Any type of too-slow heart rate that occurs
because the electrical pulses from the sinus
node (SA node) are delayed or even blocked at
the AV node.
Heart failure (HF)
A syndrome characterized by the heart’s
inability to pump blood efficiently. Heart failure
is a pumping disorder, not an electrical disorder.
It may be mild or severe, and it tends to get
worse over time. People with heart failure are at
risk for dangerous arrhythmias.
122
ICD
A commonly used abbreviation for implantable
cardioverter-defibrillator.
ICD function testing
The use of the newly implanted ICD to identify and
treat a potentially dangerous heart rhythm that the
doctor provokes in the hospital setting. This test
makes sure the device can detect dangerous heart
rhythms and treat them quickly and effectively.
Implantable cardioverter-defibrillator (ICD)
An electronic device implanted in the body that
can cardiovert or defibrillate the heart in an
emergency. These devices have a built-in
pacemaker to pace the heart, as well.
Iithotripsy
A procedure during which sound waves are
used to break up kidney stones.
123
Intermittent
A medical term that describes a condition that
comes and goes. An intermittent arrhythmia is one
that occurs at times but not continuously. An
intermittent arrhythmia can still be very dangerous.
Joule (J)
A unit of energy commonly used to describe how
much energy is in an ICD shock. Technically, it is
the amount of energy needed to pass an electric
current of one ampere through a resistance of
one ohm for one second.
Lead
A thin, flexible, insulated wire with one or more
electrodes at the end. One end of the lead is
plugged into the ICD and the other end (with the
electrode) is attached to the inside of the heart.
Electrical energy from the ICD travels via the lead
into the heart to pace; electrical energy from the
heart travels via the lead into the ICD to sense.
124
Long QT Syndrome (LQTS)
A syndrome in which the heart muscle takes an
abnormally long period of time to relax following
a contraction. People with Long QT Syndrome
are at high risk for dangerous arrhythmias.
Long QT Syndrome is hereditary.
Magnetic resonance imaging (MRI)
A procedure to painlessly take a picture of soft
tissue in the body using magnetic waves.
Mechanical dyssynchrony
A heart condition in which the right ventricle
and the left ventricle do not contract at the
same time or in which the lower chambers of
the heart do not contract as a whole.
Mechanical dyssynchrony can cause the heart
to pump less efficiently. Some – but not
all – people with heart failure have mechanical
dyssynchrony.
125
One-to-one AV synchrony
The healthy heart rhythm in which there is one
atrial contraction or beat for every ventricular beat.
Pacing
The ability of the ICD’s built-in pacemaker to
generate and deliver a small electrical output
pulse to the heart, causing it to beat.
Pocket
A small area in the body, usually the upper
chest, that the physician forms to hold the
implanted ICD. Also called the ICD pocket.
Primary prevention
An approach to ICD therapy where an ICD is
implanted in a patient at high risk for dangerous
arrhythmias even if he or she has not yet had
such an arrhythmia.
126
Programmer
A special computer that a doctor can use to
communicate back and forth with an implanted
ICD. The programmer can obtain information
stored in the ICD and can change the settings of
the implanted ICD.
Risk factor
Any condition that makes it more likely that a
particular disease or rhythm disorder will occur.
For example, smoking is a risk factor for cancer.
Some risk factors cannot be changed, such as
age or family history.
Sensing
The ability of a pacemaker to pick up electrical
signals from within the heart and interpret
them – that is, to know how rapidly the heart is
beating.
127
Sepsis
A severe condition characterized by a wholebody infection.
Single-chamber ICD
An ICD with one wire (or lead) attached to the
inside of the right ventricle so that it can pace
and sense in the ventricle. The “singlechamber” designation refers to the ICD’s builtin pacemaker.
Sinoatrial node, also known as the SA node
An area of highly specialized tissue on the upper
right side of the heart (the “high right atrium”).
The sinoatrial node generates electrical pulses
and drives the heart rate. In fact, the sinoatrial
node is nicknamed the “heart’s natural
pacemaker.” Sometimes called the sinus node
or just the sinus.
128
Sinus bradycardia
Any type of too-slow heart rate that occurs
because the SA node (sinus node) does not fire
quickly enough or because it is erratic or
unreliable.
Sudden cardiac arrest (SCA)
A heart rhythm in which the heart is trying to
beat so fast that it merely quivers and can no
longer pump blood effectively. Sudden cardiac
arrest, sometimes called sudden cardiac death,
is a dangerous and life-threatening condition.
Tachycardia
Any heart rate that is too fast for the person’s
activity. Also called tachyarrhythmia.
129
Transcutaneous electrical nerve stimulation
(TENS).
The use of electrical energy to stimulate
muscles. The energy is produced by a small
device and is carried by wires through
electrodes stuck onto the skin.
Ventricles
The two lower chambers of the heart.
Ventricular fibrillation, also known as V-fib or VF
A potentially life-threatening arrhythmia
originating in the ventricles in which the heart
tries to beat so quickly that it can no longer
pump effectively. During ventricular fibrillation,
the heart may try to beat 300 beats per minute
or faster.
130
Ventricular tachycardia, also known as
V-tach or VT
A potentially dangerous and sometimes lifethreatening arrhythmia originating in the
ventricles in which the heart tries to beat very
quickly and can no longer pump blood
effectively. Ventricular tachycardia can occur at
rates of 100 to 250 beats per minute. What
defines ventricular tachycardia is not so much
the rate, but that the patient does not tolerate it
well; the rate zones for ventricular tachycardia
vary by age, disease and fitness levels.
131
Index
A
Ablation............................................................111
Antitachycardia pacing........................17, 68, 115
Arrhythmia........................... 9, 10, 14, 15, 16, 17,
18, 24, 27, 35, 36, 38, 39, 40, 41, 43, 44, 53, 63, 68
Atrial fibrillation................ 24, 25, 26, 27, 28, 116
Atrial flutter................................... 24, 25, 26, 116
Atrial tachycardia..............................................24
Atrioventricular synchrony.............................117
Atrium...................... 10, 30, 51, 53, 115, 119, 128
AV node............................ 31, 33, 34, 35, 117, 122
AV synchrony.............................................35, 117
B
Bathing..............................................................66
Battery........................... 21, 47, 69, 70, 71, 72, 78
132
BIOTRONIK.............1, 2, 5, 27, 29, 77, 80, 92, 143
BIOTRONIK Home Monitoring®........... 1, 2, 3, 78,
79, 113
BIOTRONIK ID Card.............................75, 97, 103
Blood clot...........................................................90
Bradycardia............................. 29, 30, 32, 33, 118
C
Capacitor...................................................21, 118
Cardiac ablation..............................110, 111, 118
Cardiac arrest..........................................119, 121
Cardioversion.............................................23, 118
Cell phones............................................75, 96, 97
Chest pain..........................................................73
Complete heart block........................................35
Computer................................. 45, 72, 75, 77, 127
133
Conduction pathway..............................9, 31, 117
Contraindications......................................84, 119
D
Defibrillation.......................... 23, 50, 53, 108, 119
Diathermy........................................105, 106, 119
Difficulty breathing............................................73
Dizziness.............................. 16, 26, 28, 35, 73, 91
Driving................................................................67
Dual-chamber ICD..............................51, 52, 119
E
Ejection fraction..................................41, 43, 120
Electrical cautery....................................107, 120
Electromagnetic interference...................98, 120
EMI............................................... 98, 99, 101, 120
Exercise.................................................63, 64, 66
134
External defibrillation............... 94, 108, 109, 121
F
Fainting........................................................28, 73
Fatigue.........................................................25, 26
FDA....................................................................81
First-degree heart block...................................34
Fluoroscope............................. 55, 56, 59, 60, 121
Follow-up...........................................................18
G
Guns...................................................................65
135
H
Heart.................4, 6, 7, 8, 9, 10, 12, 13, 14, 15,16,
17, 18, 19, 20, 21, 23, 25, 26, 27, 28, 29, 30, 31, 32,
33, 34, 35, 36, 37, 38, 39, 42, 43, 44, 47, 48, 49, 50,
52, 54, 55, 56, 58, 59, 60, 61, 63, 68, 69, 70, 71, 73,
77, 79, 81, 83, 85, 87, 89, 90, 93, 99, 103, 104, 108,
109, 111, 112, 115, 116, 117, 118, 119, 120, 121,
122, 123, 124, 125, 126, 127, 128, 129, 130, 131
Heart attack................................. 86, 87, 121, 122
Heart block.................................... 33, 34, 35, 122
Heart failure................................ 41, 42, 122, 125
Heart rhythm.......................... 5, 8, 10, 12, 13, 14,
19, 24, 58, 61, 67, 78, 85, 86, 87, 93, 94, 99, 108,
113, 115, 117, 122, 123, 126, 129
Heart Rhythm Society.......................................81
Hiccups........................................................73, 90
HRSOnline.........................................................81
I
ICD function test............................ 93, 94, 95, 123
ID card............................................ 75, 92, 97, 103
Implantable cardioverter-defibrillator.......1, 123
Implant surgery...........................................53, 58
Incision.................................................58, 59, 111
Infection............................. 59, 63, 86, 87, 89, 128
L
Lead.............................. 47, 49, 50, 51, 52, 53, 55,
56, 59, 60, 61, 63, 71, 72, 78, 87, 88, 89, 96, 106,
111, 119, 121, 124, 128
Lightheadedness...................................35, 73, 91
Lithotripsy........................................................110
Long QT Syndrome..............................41, 43, 125
137
M
Magnetic field....................................................91
Magnetic resonance imaging..... 91, 92, 107, 125
Magnets.............................................................91
Mechanical dyssynchrony...................41, 42, 125
Metal detectors.................................................97
Microwave oven.........................................74, 100
MRI............................................... 91, 92, 107, 125
Myocardial infarction.................................87, 121
N
Natural pacemaker...................................30, 128
O
One-to-One (1:1) AV Synchrony...........12, 25, 26,
34, 35, 116, 126
138
P
Pacemaker......................... 29, 36, 37, 38, 47, 48,
49, 51, 69, 70, 77, 81, 82, 83, 123, 126, 127, 128
Pacemaker Club................................................82
Pacing...............29, 37, 38, 48, 50, 69, 80, 81, 126
Power tools..............................................100, 102
Precautions................................... 88, 95, 96, 111
Primary prevention..............................41, 44, 126
Programmer.................................. 45, 46, 72, 127
Pulse generator....................................47, 49, 51
R
Radiation..................................................103, 109
Radio waves.......................................................45
Replacement.....................................................71
Risk factors...................................... 8, 40, 41, 127
139
Risks...................................... 39, 88, 89, 104, 105
S
SA node.........30, 31, 32, 33, 34, 35, 122, 128, 129
Second-degree heart block..............................34
Sepsis..................................................86, 87, 128
Sexual activity....................................................66
Shock........................................ 18, 19, 20, 21, 22,
23, 24, 29, 37, 38, 49, 51, 52, 67, 68, 69, 70, 74, 78,
89, 90, 108, 112, 113, 114, 118, 119, 121, 124
Shock plan...............................................113, 114
Showering..........................................................66
Single-chamber ICD.................................49, 128
Sinoatrial node..........................................30, 128
Sinus node................................... 30, 32, 128, 129
140
Sports..........................................................65, 66
Stroke...........................................................27, 28
Sudden cardiac arrest................... 7, 8, 9, 13, 129
Support group...................................................83
Symptoms....................................... 16, 26, 28, 29,
32, 34, 35, 40, 41, 63, 67, 73, 88, 99, 112, 115
T
Tachyarrhythmia....... 10, 12, 13, 23, 24, 118, 129
Tachycardia................ 10, 12, 13, 26, 29, 116, 129
Theft detection system....................................101
Third-degree heart block..................................35
Transcutaneous electrical nerve stimulation
(TENS)......................................................106, 130
Transmitter.................................. 77, 79, 101, 102
141
V
Ventricle........................ 10, 11, 12, 14, 15, 25, 26,
31, 41, 42, 49, 51, 52, 116, 119, 125, 128, 130, 131
Ventricular fibrillation............. 13, 14, 46, 85, 130
Ventricular tachyarrhythmia.......................12, 13
Ventricular tachycardia..... 13, 14, 15, 46, 85, 131
W
Warnings......................................................88, 90
X
X-ray............................... 55, 56, 59, 103, 109, 121
142
All About Your ICD
A manual for defibrillator patients
© BIOTRONIK SE & Co. KG
All rights reserved. Specifications
are subject to modification,
revision and improvement.
M4179-A 09/15
© 2015 BIOTRONIK, Inc. All rights reserved.
MN053r1 9/22/2015
BIOTRONIK, Inc.
6024 Jean Road
Lake Oswego, OR 97035, USA
Technical Services:
1-800-284-6689
Home Monitoring Help Line:
1-800-889-9066
www.biotronik.com