Cardioverter defibrillator: A solution for dangerously abnormal heartbeats

Written by: Dr Oliver Guttmann
Published: | Updated: 05/03/2020
Edited by: Robert Smith

If you suffer from heart rhythm issues, it can be quite scary – especially if it’s life-threatening. Luckily, there’s a device that can significantly improve heartbeat irregularities. We spoke with Dr Oliver Guttmann, a leading consultant cardiologist to discuss the implantation of a cardioverter defibrillator. It’s similar to a pacemaker, however, it also contains a computer that can track your heart rate and rhythm and treat the heart rhythm if needed.

 

cardioverter defibrillator implant

What is the benefit of a cardioverter defibrillator (ICD)?

An ICD is a small electrical device. It is used to treat some types of abnormal life-threatening heart rhythms, which can lead to cardiac arrest. It checks your heart rhythm all the time and can give your heart electric signals or shocks to get your heart rhythm back to normal again. You might need an ICD if you have had a life-threatening heart rhythm abnormality. This can happen suddenly, without any warning and you might be at risk of having one again.

You might have had tests, which include imaging of your heart or testing for faulty genes. These could have shown an inherited or acquired heart condition (such as hypertrophic cardiomyopathy, dilated cardiomyopathy, arrhythmogenic cardiomyopathy or myocarditis) or rhythm abnormality, which could put you at a high risk of having life-threatening heart rhythms.

You might have heart failure and low pumping function of your heart, which could also put you at high risk for dangerous heart rhythms.
 

How will I be asked to prepare for the procedure?

You may have several tests before you have an ICD. This includes an electrical recording of your heart rhythm (ECG), ultrasound of your heart (echocardiogram), blood tests and may include other tests such as a cardiac event recorder, electrophysiological study, a coronary angiogram or a MRI scan of your heart. Most devices are fitted as a day case. The procedure takes place in a cardiac catheter lab and takes about one hour depending on the type of device you are having.
 

What happens during the procedure?

You will not be able to eat or drink for a few hours before the procedure. A member of the team in the cardiac catheter lab will meet you and take you to the lab. You will meet all the members of the team including the lab technicians, nurses, radiographers and doctors. You will then be asked to lie on the cath lab table and you will be given a sedative and local anaesthetic to make sure that you are relaxed and that you are not experiencing any discomfort. The site for the device insertion will be cleaned and sometimes shaved and then covered with a sterile drape. The doctors will then start the procedure.

A small cut is made in the skin, usually under the left collarbone and the leads that go into the pumping chambers of the heart and touch the inner heart muscle are inserted. The position will be checked by X-ray and by electrical signals. Once the leads are in place, the cardiologist makes a small ‘pocket’ under your skin or muscle, where the pulse generator (a small box) is implanted. The wound will then be closed with sutures or a special glue.
 

What is the recovery like?

When you get back to the ward the nurse will check your blood pressure and heart rhythm and will make sure there is no bleeding, pain or swelling. You will then be allowed to sit up and walk around and to eat and drink.

You will feel some discomfort and there can be bruising around the site and you might need to take painkillers for a few days. It is important to keep your wound dry and not to lift your arm above your shoulder for the first six weeks. You might have a chest X-ray before you go home and the stitches are usually removed after one week.

You will receive an ICD identification card and a number to call if your ICD delivers a shock. The ICD is usually checked at your hospital after 4-6 weeks and then usually on a six monthly or yearly basis.
 

If you feel you could have a heart muscle condition or have queries about a pacemaker or cardioverter defibrillator, or have any issues related to your cardiovascular health, we recommend booking an appointment with a specialist such as Dr Oliver Guttmann. You can book an appointment by visiting his Top Doctors profile.

By Dr Oliver Guttmann
Cardiology

​Dr Oliver Guttmann is the Consultant Cardiologist for Inherited and Inflammatory Cardiovascular Diseases and Interventional Cardiology at St Bartholomew’s Hospital and the One Heart Clinic in London. He is also an Honorary Associate Professor at University College London.

Dr Guttmann sees patients related to all areas of adult cardiology (high blood pressure, high cholesterol and palpitations) for which he has a special interest in chest pain/angina management and coronary intervention, including  angiography and stenting. Dr Guttmann also specialises in inherited cardiac conditions, especially hypertrophic cardiomyopathy and the management of myocarditis.

Dr Guttmann studied medicine at Cambridge University and University College London. Following this, he was awarded both his membership of the Royal College of Physicians and Dr.med qualification from the Ludwig-Maximilians-University in Munich, Germany in 2008.

His research in atrial fibrillation and stroke in hypertrophic cardiomyopathy, which was funded by the British Heart Foundation, gained him his MD (Res) degree from the University College London in 2016. Dr Guttmann completed his cardiology training at the London Chest Hospital, Heart Hospital and Barts Heart Centre in 2017.

He publishes routinely in peer-reviewed journals and book chapters and has written medical articles on inherited inflammatory heart muscle disease, risk stratification in cardiomyopathy and outcomes after percutaneous coronary intervention. He is the Clinical Lead of the Coronary Care Unit at Barts Heart Centre and is a member of the British Cardiovascular Intervention Society and the Working Group on Pericardial and Myocardial Disease of the European Society of Cardiology.

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