Defibrillator Insertion: Implant for Life by Lisa Esposito

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Defibrillator Insertion: Implant for Life by Lisa Esposito

Post by freckles1880 » November 26th, 2014, 2:41 pm ... int=98e708

Defibrillator Insertion: Implant for Life
ICDs can prevent sudden cardiac death – but they take an emotional toll.


Each month about 10,000 Americans have an ICD implanted, and with a price tag of $30,000 to $50,000, the procedure isn't cheap.

By Lisa Esposito Nov. 26, 2014 | 9:00 a.m. EST + More

If you’re at risk for sudden cardiac arrest, an implantable cardioverter defibrillator – a small, battery-operated device that resides in your chest to detect abnormal heart rhythms – can deliver a shock to your heart if needed, quite possibly keeping you alive. But having an ICD also means living in suspense – wondering if and when the next disruptive jolt will occur.

Jolting Experience

On his 60th birthday, in 2006, Al Geddis of Pennsylvania got a gift he never wished for: an ICD. A heart attack left his heart damaged and scarred, and his ejection fraction – a measurement of how much blood the heart pumps with each contraction – was far too low. He was deemed at risk for sudden cardiac arrest and a candidate for a defibrillator device. He went home with the implant, not really knowing what to expect.

The first shock happened as he stepped out of the shower. He says it felt as if he’d twisted his back and put a kink in it, and it took a couple minutes to recognize what had happened. The second time, there was no doubt. “They call it the ‘Jesus jolt,’” Geddis says. “When it hits you in cases like that, you go ‘Jesus’ or blurt out a lot of other things.” He says it felt like a kick to the chest.

The device can fire while you’re asleep, or anywhere you go. It’s happened to Geddis in the grocery store. As his daughter drove him to the hospital, he talked to an emergency room doctor on the phone, until he got another jolt and “the phone went flying through the car.”

Eight years and eight shocks later, Geddis is now on his second device, a more complex, advanced version called a cardiac resynchronization therapy defibrillator. He’s had a procedure called ventricular ablation to address his arrhythmias, and it seems to be working – he hasn’t had a jolt in more than three years. Geddis notes that ICD technology is improving, and the devices can be programmed and respond better, which helps reduce shocks.

If you’ve been told you’re an ICD candidate, Geddis advises asking your doctor key questions, such as: "What are the odds of getting a jolt in the first year and thereafter?" “What if I need an MRI?” and “What about driving?

Geddis is involved with the ICD Support Group, a tight-knit online community whose members share information and discuss “some pretty heavy issues,” including inappropriate shocks, which are those delivered for causes other than potentially life-threatening ventricular tachycardia or ventricular fibrillation, and the possibility of post-traumatic stress disorder.

Your Personal Defibrillator

You’ve seen automated external defibrillators – those devices with the bolt-and-heart design to be used in the event of a cardiac arrest emergency. An ICD means having your own internal defibrillator in place, ready to respond when every second counts.

The device consists of a pulse generator, which contains a battery and tiny computer that can determine the heart’s rhythm, using information received by the device’s one or more leads. Leads, attached to one or more of the heart’s chambers, sense the heart’s electrical activity and send impulses to the pulse generator. Device options depend on a patient’s individual needs.
The ICD monitors your heart rhythm and when it detects an abnormality, sends low-energy pulses to correct it. But if that doesn’t work, or the heart goes into fibrillation, the ICD sends a high-energy pulse that lasts less than a second, but is very forceful, even painful.

Who Needs an ICD?

Every month, about 10,000 Americans have an ICD implanted, according to the American Heart Association. The cost for an ICD implant alone is estimated at $30,000 to $50,000.

Daniel Cantillon, a physician who specializes in cardiac electrophysiology at the Cleveland Clinic, says heart failure is a common denominator among patients who require implantable defibrillators. When the heart muscle is severely weakened, it can’t always pump well enough to meet the body’s needs.

An arrhythmia is when the heart beats much too quickly, too slowly or erratically. Certain arrhythmias can lead to sudden cardiac arrest – when the heart suddenly stops beating (it’s not the same as a heart attack).

In ventricular fibrillation, the most common lethal arrhythmia, the lower chambers of the heart, the ventricles, pulsate rapidly instead of beating steadily. The heart is not able to pump blood during V-fib, and the person will go into arrest if a heartbeat cannot be restored.

Certain genetic and other conditions make patients more vulnerable to sudden cardiac arrest, including arrhythmias such as long QT syndrome and Brugada syndrome. Sudden cardiac arrest can happen to people with no apparent heart disease or risk factors, and no previous history of arrhythmia.

Types of Prevention

ICD candidates fall into two broad categories. “Secondary prevention is basically a patient who’s already suffered a cardiac arrest who was fortunate enough to survive that incident,” Cantillon says. Primary prevention is a far more common reason for ICD implantation in the United States. This applies to people who’ve never had a cardiac arrest but are vulnerable. “We’re trying to be proactive; we’re trying to implant the defibrillator before the cardiac arrest happens,” he explains.

Some patients with defibrillators never require actual “therapies” – the bland medical term for shocks. For them, Cantillon says, “the device serves as kind of a watchdog, monitoring the rhythms all the time.”

Having the Implant

The implantation procedure is usually done at a hospital. It can be done by cardiologists, cardiac surgeons or cardiac electrophysiologists. The minor surgery is similar to pacemaker insertion, in terms of device placement, risks and low-frequency complications, Cantillon says.

But one aspect is unique to the ICD procedure – defibrillation testing. The patient is fully anesthetized for five minutes, during which the clinician induces cardiac arrest. In this controlled environment, Cantillon explains, the working device should successfully deliver a shock and convert the patient’s heart rhythm back to normal. If needed, the clinician can rescue the patient with outside shocks, or treat too-low blood pressure.

Defibrillator Downsides

Complications from ICDs are sometimes mechanical. ICD lead dislodgement, fractures and recalls can put patients through extra procedures to repair or remove their devices. (All devices must be replaced somewhere between four and 10 years as the battery fades.) Deep infections can also require repeat surgeries.

As for physical and emotional effects, cases of PTSD from undergoing these shocks “is very real,” Cantillon says. “Patients understand intellectually that the device saved their life – that it delivered a shock therapy for an arrhythmia that would have killed them,” he says. “But nonetheless, the fear and anxiety over when the next shock will occur can be enormously disruptive into their everyday quality of life, and they can get a lot of the same things that patients with PTSD have – intrusive thoughts [and] nightmares.” Psychiatrists and other therapists can help patients with PTSD.

When patients with unstable arrhythmias begin to receive shocks on a regular basis, or receive multiple shocks at a time, that’s “completely unacceptable,” Cantillon says. At that point, they may need further medical interventions or a procedure called ablation to cauterize arrhythmia-prone areas of the heart.

Blips but No Shocks

Michelle Johnston was 38 in 2009, when her heart stopped beating and she collapsed in the driveway of her Shelburne, Vermont, home. Her husband saved her by performing minute after minute of CPR. After she woke from a medically induced coma about a week later, an ICD was inserted in her chest. Ventricular fibrillation was later found to be the culprit.

Even today, Johnston isn’t quite comfortable with the device’s appearance, whether it’s the shape visibly protruding in her chest or the 3-inch scar, although she copes through humor.
A deeper concern was the anger and survivor guilt she felt for months after her sudden cardiac arrest experience. She was filled with doubts and even angry. She felt the ICD decision had been made for her – that she had little control.

During a visit to her doctor two weeks after getting the device, Johnston asked him to turn it off. He did so remotely from a computer. “Now you can turn it back on,” she recalls telling him, all of two seconds later. But that moment of control helped. Now, she says, she embraces the device and its lifesaving potential. She’s had small rhythm corrections that she calls “blips,” but hasn’t had a major shock to date.

Her second chance at life took on a spiritual aspect, and she was determined to make a difference. She’s now a volunteer, speaker and advocate with the American Heart Association, promoting CPR instruction and heart health awareness so her young daughter will never have to go through what she did.

Johnston doesn’t have any activity limitations with her ICD, although her body lets her know when to take it easy. Otherwise, in her spare time, she does everything from riding roller coasters and motorcycles to zip lining and skiing. Of the device she once resisted, she says, "Now I love it, knowing that someday I might need it to start my heart, which far more outweighs any irritation. I don't know what I would do without it; I truly believe I would have a sense of loss and anxiety – besides my husband and his CPR, it's a lifesaver."

Medtronic-Visia AF implanted 7-8-2016 stayed with the with 6947 Sprint Quattro Secure lead. Original ICD implant 2-4-2009. ICD turned off 10-6-17 as stage 4 lung cancer taking over.
Major heart attack, carcinogenic shock and quad bypass 10-13-08 post myocardial infarction, old inferior MI complicated by shock and CHF, combined, Atherosclerosis, abdominal aortic Aneurysm, Seroma 7 cm, left leg. Stent in the left main vein 10-7-2014

My "Wardens" are my bride of 54+ years and my daughters.

Mary Kay
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Re: Defibrillator Insertion: Implant for Life by Lisa Esposito

Post by Mary Kay » November 26th, 2014, 6:03 pm

Thank you for posting this. I think it is well written. I might have to share it with some of my friends and family.
CHF, Cardiomyopathy and LBBB
EF 20%
St. Jude Bi Vent ICD CRT implanted September 9, 2011
7 shock storm inappropriate due to dislodged lead
damaged lead removed and replaced Sept 26, 2011
EF improved to 50% in December 2012
Carvedilol 12.5 mg 2x
Ramipril 5 mg 2x

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