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Implantable cardioverter defibrillators (ICDs)
Ventricular tachycardia (VT) and ventricular fibrillation (VF) are the two heart rhythms responsible for most sudden cardiac deaths in the United States. Implantable cardioverter defibrillators (ICDs) are used in people who survive a life-threatening heart rhythm or are at high risk of developing one. An ICD is a small electronic device implanted in your body to monitor your heart rhythm at all times. It acts as a pacemaker for slow heart rates; when fast rhythms occur, it treats the rhythm by delivering the appropriate type of electrical therapy needed: rapid-pacing, low-energy shock or high-energy shock. The two kinds of shocks may be used in combination.
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About the size of a stopwatch, an ICD pulse generator is a small metal case containing a battery, a microprocessor, and electrical circuits. It is implanted in the upper chest. The ICD system also includes one or more insulated wires (called "leads"), electrodes, and patches. Most implantations are done using local anesthesia. You may also receive a sedative. The leads are inserted into a vein under your collarbone and passed to your heart using X-ray equipment to follow the progress. Then the lead is positioned and tested before being connected to the ICD. It must be tested to be sure it works properly; the heart is shocked to create a fast rhythm, which is then detected and converted by the ICD. During this test, you will receive general anesthesia. You won't feel the fast rhythm or the shock. You may have further testing of the ICD to program or adjust it to your specific needs.
Eventually the ICD battery will wear down and the generator will need to be replaced. The battery will be checked at each follow-up visit. Usually the replacement will be done as an outpatient procedure.
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