What is an Implantable Cardiac Devices?
Implantable cardiac devices can be defined as those cardiac devices that monitor heart rhythm. It delivers life-saving shocks when a dangerous heart rhythm is detected. It could improve survival in patients with heart failure who have a high risk of ventricular fibrillation (VF-Very high heart rate)
An electronic memory is there in the Implantable cardiac devices. It aids in recording electrical patterns of heart when an abnormal heartbeat happens. This recording will be reviewed during regular checkups. The nurse or physician will monitor the frequency of the heart’s electrical conduction system.
Implantable cardiac pacing devices can be defined as an event recorder that is a small monitoring device that is the size of a USB stick or smaller. This device is actually implanted under the skin, utilized to diagnose arrhythmias by recording cardiac events under local anesthesia.
A pacemaker is an actual size of a matchbox used to monitor and treat bradyarrhythmias i.e slow heart rhythms. A defibrillator monitors and treats tachyarrhythmia’s that are fast heart rhythms. It gives protection against sudden cardiac death.
Conditions that are treated using implantable cardiac pacing devices | cardiac devices
- Sinus node disease
- Disorders affecting the atrioventricular (AV) node (e.g. AV block)
- Slow atrial fibrillation
- Ventricular tachycardia
- Primary ventricular fibrillation
Frequent unexplained syncope with loss of muscle tone
- Heart failure with a decreased ventricular function
For people, who have severe forms of arrhythmias- ventricular tachycardia and ventricular fibrillation, devices are implanted to prevent sudden cardiac arrest. Such a device is called as an implantable cardioverter defibrillator. AICD or ICD. This is most effective in preventing Sudden Cardiac Death (SCD).
These devices are the size of a pager that is placed below the collarbone. These devices work through wires or leads and continuously monitor the heart’s rhythm. If the heart beats fast, the ventricles will not have time to fill blood and not pump blood to the body. If it is left unchecked, the rapid heartbeat could cause death. So, the implantable cardiac devices issue a life-saving jolt of electricity to restore the heart’s normal rhythm, prevent sudden cardiac death.
These devices function as pacemakers whenever a heartbeat becomes very slow. The electrophysiologist specialized in arrhythmias studies the heart’s activity and asks other symptoms that may have occurred. Sometimes these devices are programmed to pace the heart to restore its natural rhythm and avoid the shock. Pacing impulse from these devices are not felt by the patient, shocks are felt and are described as a kick in the chest.
Types of Cardiac Devices
Most of the cardiac devices are made in order that will help in controlling the irregular heartbeats in people with heart disorders. These irregular heartbeats are caused due to the problems with the heart’s electrical system. As a result, it will signal the heart to contract and pump blood throughout the body. The different types of cardiac devices that reused effectively are as follows:
It is a small device that is instilled in the chest of the patient. This Cardiac device produces electrical pulses that would aid in keeping the heart beat at a normal rate. Pacemaker comprises a small computer battery that is connected to insulated wires. It extends from device inside the chest to the heart.
The device is instilled in the chest, while the patient is in local anesthesia. The surgery will take less than an hour and patient should stay overnight. But, the doctor may restrict some physical activities for about two weeks. These would include avoiding lifting anything heavier than 10 pounds, swimming, golf or tennis should be restricted.
After a time span of two weeks, your doctor will be examining the implantation site. The doctor will see if the pacemaker is working properly by a wand that transmits information from device to a computer. The information will include device’s battery life, the condition of the lead and any arrhythmias experienced since the pacemaker was implanted. The battery will mostly last from 7 to 13 years.
In every six months, you should visit the hospital so your doctor can restore, analyze the information stored on the device. Monitoring your device will assist the doctor to determine if your device needs reprogramming or replacing.
2. Biventricular Pacemaker: (CRT-d/CRT-p)
This device works as a conventional pacemaker but the difference is that it uses a third wire to send the impulses to the heart. It will help to resynchronize contractions of the left lower chamber of the heart. This device is also called as a cardiac resynchronization device (CRT-d/CRT-p)
The doctors give the patient a local anesthesia and a sedative when this device is being implanted. The surgery will take around two hours to complete and the patient should stay that night in the hospital. This is primarily used in heart failures.
3. Implantable Cardioverter Defibrillator: (AICD/ICD/CRT-D)
Those people who have heart failure or have a risk of irregular heartbeats can use this type of device. So, these people will need a combination of a biventricular pacemaker and implantable cardioverter defibrillator. So, it will help in getting the heartbeat back to normal.
The heart pumps about 60 percent of its blood with each beat. This measurement is termed as ejection fraction. If the ejection fraction of the heart gets to 35 percent or less, a risk for sudden cardiac arrest increases. When the reduced ejection fraction is not caused by any condition, then the doctors suggest implanting an Implantable Cardioverter Defibrillator.
This device will detect an irregular heartbeat and will internally deliver series of pacing pulses or an electrical shock to the heart to correct heart’s rate and rhythm. This device will store the information that how many electrical shocks were delivered to the heart. The device contains built-in pacemakers that send appropriate electrical impulses to the heart when it starts to beat slowly.
This device is implanted in the chest below the collarbone. The surgery will take about an hour and the patient should stay overnight in the hospital. The doctor would suggest the patient in restricting some activities including driving, lifting items heavier than 10 pounds till your follow-up appointment two weeks after surgery. The battery of the device lasts for 5 to 10 years.
4. Implantable Cardiac Loop Recorder:
This device is a wireless cardiac monitor called a loop recorder. And this device records the rhythm of your heart for around three years. This device is smaller than the size of an AAA battery. The device is implanted beneath the upper chest to record the electrical activity of your heart like an electrocardiogram.
The doctors recommend implanting this device for those who have a rapid and irregular heartbeat. Moreover, this device is used in people who had a stroke earlier but the cause of the stroke is not determined. For implanting the device, the doctor will make a small incision in the upper chest and inserts the device under the skin. The patient can return to daily activities the next day. In addition, the doctor may limit your activity until the incision heals.
This device monitors the activity of the heart for around 36 months before replacement is required. The device is removed through the original incision site through a short. While the device is being implanted in the chest if patient experiences heart palpitations then another person places a handheld recorder over the device to record the heart’s activity. This device can automatically record irregular heart rhythms.
During this procedure, a small incision is made in the skin to the left of the breastbone. The device is loaded into a small plastic applicator which will be used by your doctor to push the device under the skin. Dissolvable sutures are used to close the small puncture. This technique is performed with local anesthesia and the patient may go back home after this procedure.
Frequently Asked Questions (FAQs):
Can implantable cardioverter defibrillators prevent a heart attack?
Implantable cardioverter defibrillators cannot prevent a heart attack that differentiates from sudden cardiac arrest. A heart attack is caused due to blocked vessels that block the normal supply of oxygen-rich blood to the heart. Without oxygen, heart muscle dies. An area of dead muscle is termed as an infarct. Although a heart attack and SCD are separate conditions, they are related. The heart attack can lead to SCD.
Sudden cardiac death is due to an electrical problem in the conduction system. It regulates normal, rhythmic contractions of the heart muscle pumping blood in the body. The heart will not be able to pump blood if the contractions of the ventricles stop. As a result, the brain will not have oxygen and so the person loses consciousness. Moreover, immediate help should be provided or else the patient would die.
How do implantable cardioverter defibrillators differ from the pacemaker?
Both implantable cardioverter defibrillators and pacemaker are cardiac devices that are implanted under the skin and connected to wires, leads placed in the heart. A pacemaker is utilized in order to detect a too-slow heart rate. If the rhythm is too slow then an electrical signal is sent pace the heart so it continues normal beat. The pacemaker sends an electrical signal in order to stimulate the heart to beat. From this device, a heartbeat is detected and a strong electrical shock is delivered to restore the heart. Implantable cardioverter defibrillators also act as pacemakers.
How implantable cardioverter defibrillators help a patient who has suffered a heart attack?
The damage that is done by a heart attack can affect the heart’s electrical system and its ability to pump blood effectively. The damaged heart muscle may result in abnormal electrical signals that could cause deadly heart rhythms.
The most common problem that is seen in patients with sudden cardiac death is coronary artery disease. It is a condition in which arteries supply blood to the heart are blocked. It is due to atherosclerosis that is the hardening of the arteries. In this disease, a fatty substance called plaque built up in the blood vessels that will indirectly affect the normal flow of blood to the heart and other parts of the body.
Can patients use a microwave oven or other appliances if they have Implantable cardiac devices?
The answer is yes. Normal household appliances and woodworking tools will not cause interference. The patient should avoid strong magnetic fields, large magnets, antennas, arc welders, industrial equipment. If you work near industrial equipment, talk about it with your physician or nurse.
Can the patient use a cellular phone?
Yes, the patient can use the phone with these guidelines.
- Hold the phone to the ear on the side of the body opposite of the implanted device.
- Do not take the phone in the ON position in a breast pocket over or within 6 inches of the implantable cardioverter defibrillators.
- Please maintain a minimum of 6 inches between the implantable cardioverter defibrillators and the phone.
Will security systems and airport will be a problem?
Just walk normally, through theft detector systems. Carry your ID card with you at all times. Show the airport security people the card and ask them to search by hand.
Can an implantable cardioverter defibrillators patient drive a car?
Mostly all the physicians have suggested to not drive for 6 months after implantation of implantable cardioverter defibrillators or after a shock.
What should the patient do after receiving a shock?
If one shock has occurred and recovery was immediate, call the device clinic immediately. And If one or more than one shock occurs without rapid recovery, emergency services should be called. If CPR and other lifesaving activities are needed, they should be started immediately.
Fast pacing therapy may be like a palpitation in the chest. The shocks may feel like a sudden painful kick in the chest. But if there is a blackout, the shock may not be felt. Someone touching the patient may feel a small muscle jerk. It will not harm them.
How and when should the battery be replaced?
The battery should be checked at each medical visit and would determine when the implantable cardioverter defibrillators should be replaced. The battery is sealed inside the implantable cardioverter defibrillators. When replacement time arrives the leads will be tested and new implantable cardioverter defibrillators are attached to the leads. Mostly the original leads are reused.
How effective are implantable cardioverter defibrillators?
According to studies conducted on implantable cardioverter defibrillators, they are 99 percent effective in detecting, stopping deadly heart rhythm disorders. While clinical trials were conducted, these are the most successful therapy to prevent sudden cardiac death.
The right candidate for Implantable cardioverter defibrillators
According to some guidelines, physicians and patients decide whether implantable cardioverter defibrillators are best for an individual for sudden cardiac death. The implantable cardioverter defibrillator therapy has benefits for:
a. Primary Prevention: This is a treatment for patients who never experienced the disorders leading to sudden cardiac death but have risk factors. This would include certain patients with an ejection fraction of less than 35 percent. The ejection fraction is a measure of the amount of blood pumped out of the heart with each beat. An ejection fraction below 55 is considered abnormal.
b. Secondary Prevention: It comprises of individuals who have suffered a prior cardiac arrest or who experience spontaneous episodes of ventricular tachycardia. In addition, it also includes patients who have episodes of unexplained fainting. VT is a too-rapid heartbeat that can lead to VF.
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