How often does the ICD need to be checked?
The ICD needs to be checked periodically to make sure it is working properly, first in the hospital after the procedure and then by your doctor at his or her office every few months. She or he will let you know how often you need to make an appointment to get the ICD checked.
To check the ICD, the doctor will place a special magnetic wand over the device, which you will not feel. The ICD contains data on your heart rhythm and any pacing or shocks the device delivered so it can be adjusted if necessary. Your doctor can also tell if the battery on the ICD is running low. ICD batteries usually last 5 to 7 years, depending on how many shocks it has to deliver. The battery will not just stop working, but will emit a signal for 6 months before it is due to run out. Your doctor will detect this with the wand during the regular checkups and schedule a procedure to replace your ICD.
How do I know if my ICD is working and what will I feel if it delivers a shock?
Your ICD is constantly monitoring your heart rhythm to make sure it is normal. You will not feel anything during this normal monitoring, but your doctor will be able to check your ICD during your regular follow-up appointments.
Your doctor will program the ICD to respond differently to different heart rhythm problems. You will not typically feel pacing, when the ICD attempts to take over your heart's rhythm with a series of small electrical impulses. Cardioversion, when the ICD delivers a small shock at the same time as your heart beats, can feel like a small "thump" in the chest (like an especially strong heartbeat). If your heartbeat becomes dangerously fast or disorganized, the ICD will deliver a large defibrillation shock. This can be painful, and is described by patients as feeling as if they have been "kicked in the chest." Defibrillation shocks last only a second.
What should I do if I receive a shock?
If you receive a defibrillation shock, you should call your doctor or go to the emergency room. Try to remain calm. If possible, ask someone to stay with you for a little while. Although painful, the ICD may have just saved your life. Follow any instructions that your doctor has given you.
What can go wrong with an implanted ICD?
The most common problem patients with an ICD experience is when the device delivers a shock when it was not needed. As many as 1 in 4 patients with an ICD experience unnecessary shocks.17,18 It is not clear if this is more common in women: some studies have shown that women experience more unneeded shocks, others that this problem is equally common in women and in men.11,13,19-21 If you believe you are receiving unnecessary shocks, let your doctor know: she or he may be able to adjust the ICD so that the shocks do not happen as often while still protecting you. Your doctor will also be able to tell if you have received unnecessary shocks by looking at the data stored on the device.
Even when shocks are given appropriately, the fear of experiencing an ICD shock can affect quality of life for some people. The more shocks someone receives, the more depression and anxiety about the shocks are likely to be an issue.22 Women may experience anxiety about the device more often than men and have more ICD concerns, but they are no more likely to be depressed and just as likely as men to accept the device.23, 24
Despite the stress posed by the prospect of ICD shocks, most studies find that patients with an ICD have a similar quality of life as those who are treated with medication alone.25 In one trial of more than 2500 patients (23% were women) that compared ICD implantation with state-of-the-art medical treatment, ICD patients actually had a better quality of life at 3 months and 1 year, while there were no differences between the two groups after 30 months (no sex-specific data was reported).26
Rarely, an ICD may malfunction to the point that is has to be removed. Between 1990 and 2002, 415,780 patients had ICDs implanted, and 8489 (2%) had to be removed.27
I have been hearing a lot about ICD recalls. Should I be concerned?
The Food and Drug Administration is responsible for making sure that ICD devices are safe for use, and it issues recalls when there is some concern about a device's safety. The term "recall" is used when a medical device is defective or is a risk to a patient's health. There are different levels of recalls depending on how serious the problem is. A recall does not necessarily mean you will have to have the device removed—in some cases, it simply means your doctor will have to monitor your ICD more carefully.
If you hear about an ICD recall, you can find out more on the FDA website at www.recalls.gov. You can also sign up to receive free e-mail alerts about recalls. To find out if a recall affects your device, compare information found on the FDA site to the information on the ICD card you were given or mailed. If they match call your doctor to find out what, if anything, needs to be done.
I have an ICD. What should I watch out for?
Because strong electrical and magnetic fields can affect the function of your ICD, you should take precautions to avoid them:
- Avoid getting too close to areas or machines that emit strong electric or magnetic fields (for example, stereo speakers)
- Most everyday appliances like microwaves are safe, but you should avoid prolonged close exposure
- If you are unsure whether a machine is safe, keep at least 6 inches between your ICD and the machine
- The 6-inch rule also applies to portable electronic devices such as cell phones and iPods; use the ear opposite your ICD to talk on the phone, and don't store devices in your breast or jacket pocket
- Airport metal detectors are safe, but the handheld metal detector wands should NOT be held near the ICD
- Be sure to tell doctors or medical technicians about your ICD before having any tests
- X-rays and CT scans are safe
- MRIs are NOT SAFE because they contain a strong magnetic field
Write down any specific safety questions that occur to you so you can ask your doctor.
Do I still need to take my heart rhythm drugs after I get an ICD?
Although most women with heart failure who have an implanted ICD do not require heart rhythm drugs, your doctor may keep you on some medications, such as amiodarone, sotalol, or dofeditilide, even after you have an ICD. These drugs can prevent heart rhythm disturbances that could cause you to receive an ICD shock.
- Lloyd-Jones D, Adams R, Carnethon M, et al. Heart disease and stroke statistics--2009 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation. Jan 27 2009;119(3):e21-181.
- Narang R, Cleland JG, Erhardt L, et al. Mode of death in chronic heart failure. A request and proposition for more accurate classification. Eur Heart J. Sep 1996;17(9):1390-1403.
- Kannel WB, Wilson PW, D'Agostino RB, Cobb J. Sudden coronary death in women. Am Heart J. Aug 1998;136(2):205-212.
- Hunt SA, Abraham WT, Chin MH, et al. 2009 Focused update incorporated into the ACC/AHA 2005 Guidelines for the Diagnosis and Management of Heart Failure in Adults A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines Developed in Collaboration With the International Society for Heart and Lung Transplantation. J Am Coll Cardiol. Apr 14 2009;53(15):e1-e90.
- Hohnloser SH, Kuck KH, Dorian P, et al. Prophylactic use of an implantable cardioverter-defibrillator after acute myocardial infarction. N Engl J Med. Dec 9 2004;351(24):2481-2488.
- Bardy GH, Lee KL, Mark DB, et al. Amiodarone or an implantable cardioverter-defibrillator for congestive heart failure. N Engl J Med. Jan 20 2005;352(3):225-237.
- Moss AJ, Zareba W, Hall WJ, et al. Prophylactic implantation of a defibrillator in patients with myocardial infarction and reduced ejection fraction. N Engl J Med. Mar 21 2002;346(12):877-883.
- Connolly SJ, Hallstrom AP, Cappato R, et al. Meta-analysis of the implantable cardioverter defibrillator secondary prevention trials. AVID, CASH and CIDS studies. Antiarrhythmics vs Implantable Defibrillator study. Cardiac Arrest Study Hamburg . Canadian Implantable Defibrillator Study. Eur Heart J. Dec 2000;21(24):2071-2078.
- Zipes DP, Camm AJ, Borggrefe M, et al. ACC/AHA/ESC 2006 guidelines for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: a report of the American College of Cardiology/American Heart Association Task Force and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Develop Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death). J Am Coll Cardiol. Sep 5 2006;48(5):e247-346.
- Middlekauff HR, Stevenson WG, Stevenson LW, Saxon LA. Syncope in advanced heart failure: high risk of sudden death regardless of origin of syncope. J Am Coll Cardiol. Jan 1993;21(1):110-116.
- Russo AM, Day JD, Stolen K, et al. Implantable Cardioverter Defibrillators: Do Women Fare Worse Than Men? Gender Comparison in the INTRINSIC RV Trial. J Cardiovasc Electrophysiol. May 12 2009.
- Pires LA, Sethuraman B, Guduguntla VD, Todd KM, Yamasaki H, Ravi S. Outcome of women versus men with ventricular tachyarrhythmias treated with the implantable cardioverter defibrillator. J Cardiovasc Electrophysiol. Jun 2002;13(6):563-568.
- Zareba W, Moss AJ, Jackson Hall W, et al. Clinical course and implantable cardioverter defibrillator therapy in postinfarction women with severe left ventricular dysfunction. J Cardiovasc Electrophysiol. Dec 2005;16(12):1265-1270.
- El-Chami MF, Hanna IR, Bush H, Langberg JJ. Impact of race and gender on cardiac device implantations. Heart Rhythm. Nov 2007;4(11):1420-1426.
- Hernandez AF, Fonarow GC, Liang L, et al. Sex and racial differences in the use of implantable cardioverter-defibrillators among patients hospitalized with heart failure. JAMA. Oct 3 2007;298(13):1525-1532.
- Peterson PN, Daugherty SL, Wang Y, et al. Gender differences in procedure-related adverse events in patients receiving implantable cardioverter-defibrillator therapy. Circulation. Mar 3 2009;119(8):1078-1084.
- Rosenqvist M, Beyer T, Block M, den Dulk K, Minten J, Lindemans F. Adverse events with transvenous implantable cardioverter-defibrillators: a prospective multicenter study. European 7219 Jewel ICD investigators. Circulation. Aug 18 1998;98(7):663-670.
- Wood MA, Stambler BS, Damiano RJ, Greenway P, Ellenbogen KA. Lessons learned from data logging in a multicenter clinical trial using a late-generation implantable cardioverter-defibrillator. The Guardian ATP 4210 Multicenter Investigators Group. J Am Coll Cardiol. Dec 1994;24(7):1692-1699.
- Davis DR, Tang AS, Lemery R, Green MS, Gollob MH, Birnie DH. Influence of gender on ICD implantation for primary and secondary prevention of sudden cardiac death. Europace. Dec 2006;8(12):1054-1056.
- Lampert R, McPherson CA, Clancy JF, Caulin-Glaser TL, Rosenfeld LE, Batsford WP. Gender differences in ventricular arrhythmia recurrence in patients with coronary artery disease and implantable cardioverter-defibrillators. J Am Coll Cardiol. Jun 16 2004;43(12):2293-2299.
- Dolack GL. Clinical predictors of implantable cardioverter-defibrillator shocks (results of the CASCADE trial). Cardiac Arrest in Seattle, Conventional versus Amiodarone Drug Evaluation. Am J Cardiol. Feb 1 1994;73(4):237-241.
- Jacq F, Foulldrin G, Savoure A, et al. A comparison of anxiety, depression and quality of life between device shock and nonshock groups in implantable cardioverter defibrillator recipients. Gen Hosp Psychiatry. May-Jun 2009;31(3):266-273.
- Spindler H, Johansen JB, Andersen K, Mortensen P, Pedersen SS. Gender differences in anxiety and concerns about the cardioverter defibrillator. Pacing Clin Electrophysiol. May 2009;32(5):614-621.
- Bilge AK, Ozben B, Demircan S, Cinar M, Yilmaz E, Adalet K. Depression and anxiety status of patients with implantable cardioverter defibrillator and precipitating factors. Pacing Clin Electrophysiol. Jun 2006;29(6):619-626.
- Schron EB, Exner DV, Yao Q, et al. Quality of Life in the Antiarrhythmics Versus Implantable Defibrillators Trial: Impact of Therapy and Influence of Adverse Symptoms and Defibrillator Shocks. Circulation. February 5, 2002 2002;105(5):589-594.
- Mark DB, Anstrom KJ, Sun JL, et al. Quality of Life with Defibrillator Therapy or Amiodarone in Heart Failure. N Engl J Med. September 4, 2008 2008;359(10):999-1008.
- Maisel WH, Moynahan M, Zuckerman BD, et al. Pacemaker and ICD generator malfunctions: analysis of Food and Drug Administration annual reports. JAMA. Apr 26 2006;295(16):1901-1906.