| SURGERIES OF THE HEART |
Implantable Cardioverter Defibrillators (ICD)
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OTHER NAMES OF THE PROCEDURE
Automatic Cardioverter Defribrillator Implantation,Automatic Implantable Cardioverter Defribrillator (AICD)
Automatic Cardioverter Defribrillator Implantation is the surgical insertion of an implantable cardioverter defibrillator (ICD). An ICD is a small battery-operated device that is implanted in the chest and continuously monitors the heart’s rhythm. These days, implantable defibrillators combine the function of a pacemaker with the function of an external defibrillator. The mechanism monitors the heart’s rate and rhythm. If the heart slows or speeds up too much, the pacemaker element provides pacing to restore a normal heart rate. If the heart begins to beat in a disorganized fashion, the device provides a shock to restore normal rhythm.
REASONS FOR THE PROCEDURE
An ICD is inserted when the lower chambers of the heart (ventricles) are at risk for rhythm disturbances, specifically beating too slowly ( bradycardia ), too rapidly (ventricular tachycardia), or in an unsynchronized fashion ( ventricular fibrillation ). If a disturbance in the heart’s rhythm keeps the heart from delivering blood to the brain and other vital organs, sudden cardiac death (SCD) or cardiac arrest can occur.
ICDs are implanted in patients who:
* Have survived one or more episodes of ventricular tachycardia, ventricular fibrillation, or sudden cardiac death
* Heart attack survivors at high risk for future cardiac arrest
* Individuals with the condition known as hypertrophic cardiomyopathy (an enlarged heart muscle that doesn’t function properly)
* Have a high likelihood of developing sustained ventricular fibrillation or ventricular fibrillation.
RISK FACTORS FOR COMPLICATIONS DURING THE PROCEDURE
* Obesity
* History of smoking
* History of excess alcohol consumption
* Bleeding or blood-clotting irregularities
* Regular use of the following prescription medications: high blood pressure medicine, muscle relaxants, tranquilizers or sedatives, insulin, beta-adrenergic blockers, blood thinners, or cortisone
* Regular use of mind-altering medications.
BEFORE THE PROCEDURE
The following test may be conducted prior to the procedure:
* Blood Tests
* Chest X-rays – a test that uses radiation to take a picture of structures inside the body, especially bones
* Electrocardiogram (ECG, EKG) – a test that records the heart’s activity by measuring electrical currents through the heart muscle
* Electrophysiology study (EPS) – a test that measures the condition of the heart’s electrical system by electrodes placed on the heart through blood vessels.
In the days leading up to the procedure,one should not take aspirin or other anti-inflammatory drugs for one week before surgery, unless told otherwise by the doctor.
One the day before and the day of the procedure, one should eat a light meal and do not eat or drink anything after midnight. If the patient must take medications (which have been approved by the doctor), he/she can do so only with small sips of water.
PROCEDURE
An intravenous line is inserted into the arm to administer a sedative to help with relaxation. The area where the ICD is to be implanted is washed with antiseptic and if necessary, shaved. A local anesthesia is injected at the insertion site to numb the area.
The surgeon makes a small incision below the collarbone on the left or right side. The ICD lead, which carries signals between the heart and the ICD, is threaded through a vein in the upper chest to the heart with the assistance of an x-ray monitor. The physician creates a pocket under the skin at the incision site and implants the ICD.
With the ICD in place, sedation is increased. The surgeon will test the ICD function by initiating cardiac arrest and allowing the ICD to shock the heart back into a normal rhythm. Every precaution is taken to ensure this is a safe process. Once it is determined the ICD is working properly and in the right place, the incision is closed with stitches.
AFTER THE PROCEDURE
The day after the implant, the patient will have an ECG, blood tests, and chest x-ray to ensure the ICD and leads are in the proper position. The ICD function may be checked again, which will require sedation. The pulse, blood pressure, and incision site of the patient will be checked regularly.
TIME TAKEN FOR THE PROCEDURE
About 1-3 hours
POSSIBLE COMPLICATIONS
* Puncture of the heart or lung tissue
* Damage to the vein
* Infection
* Bleeding
* Bruising
POSTOPERATIVE CARE
When the patient returns home, he/she should do the following to help ensure a smooth recovery:
* Clean incision area every day with lukewarm water and mild soap like Cetaphil. Do not scrub the incision area.
* Do not take a shower for five days after the procedure.
* Do not drive for up to six months.
* Avoid lifting objects over 10 lb until six weeks after surgery.
* Avoid vigorous activity, especially those involving the upper body, for 4-6 weeks following surgery.
* Avoid any activity that involves rough contact to the chest or abdomen, such as contact sports.
* Return to work and regular daily activities as soon as possible.
* Make and keep all postoperative appointments.
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| Last Modified :
Monday, May 11, 2009 |
Compiled and edited by the Editorial team and
approved by Expert panel of h4heart.com
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