Living with life-threatening arrhythmias: what the implantable cardioverter defibrillator can do for you

Due to the advances in treatment and prevention of heart problems, most patients with cardiac conditions are not at a substantially increased risk of dying suddenly from an arrhythmia. However, some people do have an increased risk. For example, people who have survived large heart attacks in the past, people who have previously had a dangerous arrhythmia, or some people who have an inherited cardiac condition. Sometimes heart specialists may recommend an implantable cardioverter defibrillator (ICD) or a subcutaneous implantable cardioverter defibrillator (sICD).

What is an ICD?

An ICD consists of a generator that is implanted under the skin at the front of the upper chest. One, or more, leads are connected and these are positioned in the heart. The ICD monitors the heart rhythm. If dangerous rhythms are detected then the ICD is able to deliver a shock to the heart. This resets the heart rhythm and can save the person's life. Some patients need leads that go to their heart in order that the ICD can 'pace' the heart (like a pacemaker). However, this is not always necessary and then a subcutaneous sICD may be appropriate. This uses leads which pass under the skin around the outside of the chest wall and do not need to enter the heart.

How are ICDs implanted?

For any particular patient, the treating cardiologist will discuss the best type of device and lead configuration. Implantation of ICDs is done either with local anaesthetic and sedation or with general anaesthetic. The operation usually takes between one to three hours and the patient can go home within 24 hours.

Life after ICD surgery

After ICD surgery certain lifestyle changes may be required. However, many patients are able to lead full and active lifestyles with devices in place. The device is monitored periodically and generator changes are required at intervals in order to replenish the battery. Further information is available on the British Heart Foundation website.