J Am Coll Cardiol ; e Ambrose JA, Singh M. Pathophysiology of coronary artery disease leading to acute coronary syndromes. FPrime Rep. J Am Coll Cardiol ; American College of Cardiology.
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Heart Failure. Previous Heart Attack. Inherited Heart Defects. Recap CAD is a risk factor for sudden death. If you have heart disease of almost any type, it is important to know your ejection fraction.
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June 1, Research health conditions Check your symptoms Prepare for a doctor's visit or test Find the best treatments and procedures for you Explore options for better nutrition and exercise Learn more about the many benefits and features of joining Harvard Health Online ». Sign Me Up. Wires from electrodes on your chest go to a battery-operated recording device carried in your pocket or worn on a belt or shoulder strap. While wearing the monitor, you'll keep a diary of your activities and symptoms.
Your doctor will compare the diary with the electrical recordings and try to figure out the cause of your symptoms. If you're having an ICD implanted, you'll likely be asked to avoid food and drinks for at least 8 hours before the procedure. Talk to your doctor about any medications you take and whether you should continue to take them before the procedure to implant an ICD. A specialist will insert an IV into your forearm or hand and give you a medication called a sedative to help you relax.
During surgery, the doctor guides one or more flexible, insulated wires leads into veins near your collarbone to your heart using X-ray images as a guide. The ends of the leads attach to your heart. The other ends attach to a device shock generator that's implanted under the skin beneath your collarbone. The procedure usually takes a few hours. Once the ICD is in place, your doctor will test it and program it for your specific heart rhythm needs.
Testing the ICD might require speeding up your heart and then shocking it back into a normal rhythm. Depending on the problem with your heartbeat, your ICD could be programmed for:.
Usually, only one shock is needed to restore a normal heartbeat. Sometimes you might have two or more shocks during a hour period. Having three or more shocks in a short amount of time is called an electrical or arrhythmia storm. If you have an electrical storm, you should call or seek emergency medical help to see if your ICD is working properly or if you're having abnormal heartbeats. If necessary, the ICD can be adjusted to reduce the number and frequency of shocks.
You may need medications to make your heart beat regularly and decrease your risk of an ICD electrical storm. You'll usually be released on the day after your procedure. You'll need to arrange to have someone to drive you home and help you while you are recovering. The area where the ICD is implanted can be swollen and tender for a few days or weeks. Your doctor might prescribe pain medication.
Aspirin and ibuprofen aren't recommended because they may increase your risk of bleeding. You'll need to avoid abrupt movements that raise your left arm above your shoulder for up to eight weeks so the leads don't move until the area has healed. You may need to limit your driving, depending the type of ICD received. Your doctor will give you instructions on when it's safe to return to driving and other daily activities. Your doctor will probably tell you to avoid contact sports indefinitely.
Heavy contact may damage your device or dislodge the wires. Problems with your ICD due to electrical signals electrical interference are rare.
In studies, ICDs lowered the number of people who died from any reason from about 30 out of to about 20 out of What are the risks of an ICD? Serious bleeding could occur after placement of the ICD. This happens from 1 to 6 times out of Serious bleeding doesn't happen 94 to 99 times out of But a pneumothorax can be treated and people recover well.
This happens less than 1 time out of This doesn't happen 99 times out of Serious problems don't happen 99 times out of Pain, bleeding, or bruising soon after the procedure. The leads that attach to the heart may break or stop working right. This can happen between 2 and 15 times out of after 5 years of having the ICD.
So it does not happen about 85 to 98 times out of One long-term study found that, after 10 years, 20 out of leads had problems. This also means that 80 out of leads didn't have problems. The surgery would be more complex than that needed to replace an ICD battery. You could get an infection where the ICD is placed.
This happens about 1 to 2 times out of So there is no infection about 98 to 99 times out of There is no way to know if or when this could happen. In studies, these shocks happened to 3 to 21 out of people over 1 to 5 years.
This means that these shocks didn't happen in 79 to 97 people out of There also is a chance that a manufacturer may recall an ICD for a problem. If this were to happen, you might need surgery to take out the ICD and leads. What follow-up do you need after getting an ICD? Compare your options. You probably will spend the night in the hospital, just to make sure that there are no problems. You would need to have minor surgery to replace the battery after 5 to 8 years.
You keep taking your heart failure medicine and following a healthy lifestyle. An ICD may lower the risk of sudden death in some people who have heart failure. An ICD can fix a heart rate that is too fast or too slow without using a shock. You may have peace of mind that a dangerous heart rhythm could be fixed right away. Problems can happen during or soon after the procedure to place the ICD.
Examples include a lead tearing the heart or a lung collapsing. The manufacturer could recall an ICD for a problem. If the ICD gives you too many shocks, you also may need to take a rhythm-control medicine or have catheter ablation.
You may take a rhythm-control medicine to prevent abnormal heart rhythms. You avoid the risks of surgery. You won't worry about when the ICD might shock you. You could have an abnormal heart rhythm that could cause sudden death.
Personal stories about getting an ICD for heart failure These stories are based on information gathered from health professionals and consumers. What matters most to you? I want to do everything I can to prevent a deadly heart rhythm.
I'm not worried that the ICD might shock me. I would worry all the time that the ICD might shock me. I don't mind having a device inside my body. I don't like the idea of having a device inside my body. I'm not worried about the small risks of surgery. I'm concerned that something could go wrong with the surgery. I'm not concerned that the ICD or the leads could break. My other important reasons: My other important reasons:. Where are you leaning now? What else do you need to make your decision?
Check the facts. True Sorry, that's not right. Not everyone who has heart failure needs an ICD. Your doctor may suggest an ICD if you are at risk of having an abnormal heart rhythm that could cause sudden death.
False You're right. I'm not sure It may help to go back and read "Get the Facts. True You're right. But the shock is a sign that a possibly deadly heart rhythm has been fixed. An ICD also can use painless pulses to fix a fast or slow heart rate. False No, that's not right. True That's right. The ICD or the wires that attach to it could break. If that happens, you might need surgery to fix the problem.
You also will need surgery to replace the battery, which lasts 5 to 8 years. False Sorry, that's not right. You also will need surgery to replace the battery. Decide what's next. Yes No. I'm ready to take action. I want to discuss the options with others. I want to learn more about my options. Your Summary. Your decision Next steps. Your knowledge of the facts Key concepts that you understood. Key concepts that may need review. Getting ready to act Patient choices.
What matters to you.
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