Heart Rhythm Problems: Should I Get an Implantable Cardioverter-Defibrillator (ICD)
What is a Decision Point?
Heart Rhythm Problems: Should I Get an Implantable Cardioverter-Defibrillator (ICD)?You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them. Heart Rhythm Problems: Should I Get an Implantable Cardioverter-Defibrillator (ICD)? Get the facts Your options
This decision aid focuses on whether to get an ICD (implantable cardioverter-defibrillation) when you do NOT have heart failure. The ICD decision for heart failure patients raises some different issues. Key points to remember
FAQs What is an ICD?An ICD is a battery-powered device that can fix an abnormal heart rate or rhythm and prevent sudden death. The ICD is placed inside the chest. It's attached to one or two wires (called leads) that go into the heart through a vein. An ICD is always checking your heart rate and rhythm. If the ICD detects a life-threatening rapid heart rhythm, it tries to slow the rhythm to get it back to normal. If the dangerous rhythm does not stop, the ICD sends an electric shock to the heart to restore a normal rhythm. The device then goes back to its watchful mode. An ICD also can fix a heart rate that is too fast or too slow. It does so without using a shock. It can send out electrical pulses to speed up a heart rate that is too slow. Or it can slow down a fast heart rate by matching the pace and bringing the heart rate back to normal. Whether you get pulses or a shock depends on the type of problem that you have and how the doctor programs the ICD for you. How is an ICD placed?Your doctor will put the ICD in your chest during minor surgery. You will not have open-chest surgery. You probably will have local anesthesia. This means that you will be awake but feel no pain. You also will likely have medicine to make you feel relaxed and sleepy. Your doctor makes a small cut (incision) in your upper chest. He or she puts one or two leads (wires) in a vein and threads them to the heart. Then your doctor connects the leads to the ICD. Your doctor programs the ICD and then puts it in your chest and closes the incision. In some cases, the doctor may be able to put the ICD in another place in the chest so that you don't have a scar on your upper chest. This would allow you to wear clothing with a lower neckline and still keep the scar covered. Most people spend the night in the hospital, just to make sure that the device is working and that there are no problems from the surgery. You may be able to see a little bump under the skin where the ICD is placed. How does it feel to get a shock from an ICD?The shock from an ICD hurts briefly. It's been described as feeling like a punch in the chest. But the shock is a sign that the ICD is doing its job to keep your heart beating. You won't feel any pain if the ICD uses electrical pulses to fix a heart rate that is too fast or too slow. There's no way to know how often a shock might occur. It might never happen. It's possible that the ICD could shock your heart when it shouldn't. If that were to happen, you would have pain. The shock could make you fall out of bed, and that could injure you. In rare cases, the shock could cause the heart to quiver, or flutter, and stop pumping blood. This is called ventricular fibrillation (say "ven-TRICK-yuh-ler fib-ruh-LAY-shun"), which can be deadly. If this happened, the ICD would shock your heart again to stop the fluttering. Many people say that they have a good quality of life with an ICD. But shocks—and the fear of shocks—can make some people worry too much. They may be afraid all the time that the ICD might shock them. This worry can reduce a person's quality of life. What are the benefits of an ICD?
What are the risks and side effects of an ICD?There are several risks to getting an ICD. But the risks are different for each person. The risk for problems associated with the implant procedure might be higher for people who are age 80 or older.
The ICD could shock the heart when it shouldn't. There is no way to know if or when this could happen. It might never happen. 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?You will need regular checkups with your doctor to make sure that the ICD is working. It's important to keep taking any medicines your doctor has prescribed. You'll also need to follow a healthy lifestyle. This includes eating heart-healthy foods, getting regular exercise, and not smoking. If the ICD gives you a lot of shocks, your doctor may prescribe the rhythm-control medicine amiodarone. This medicine helps prevent abnormal heart rhythms and may keep the ICD from sending shocks too often. Your doctor also could suggest catheter ablation to lower the number of times the ICD shocks you. Catheter ablation can lower the chance of some abnormal heart rhythms, such as atrial fibrillation or ventricular tachycardia. These rhythms can cause the ICD to shock you. An ICD runs on a battery that lasts from 5 to 8 years. To have the battery replaced, you will need minor surgery. If you get an ICD, you have to be careful not to get too close to some devices with strong magnetic or electrical fields. These include MRI machines, battery-powered cordless power tools, and CB or ham radios. But most everyday appliances are safe. Why might your doctor recommend an ICD?Your doctor may advise you to get an ICD if you have had a dangerous abnormal heart rhythm, or if you are at risk for having one. Compare your options Compare
Get an ICD
Get an ICD
Don't get an ICD
Don't get an ICD
Personal stories Are you interested in what others decided to do? Many people have faced this decision. These personal stories may help you decide. Personal stories about considering an ICDThese stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions. My doctor said there's a good chance I could get a really bad heart rhythm that could make my heart stop. We talked about an ICD. I'm a little nervous about getting shocked. But if it could save my life, it's worth it, so I'm going to get one. Cassius, age 62 I've had a couple of episodes of palpitations from a really fast heart rate. But I'm taking medicine, and it seems to be working. I'm not ready to get an ICD. Federico, age 66 I just got some test results back that show there's a chance I could get a heart problem that causes my heart to stop. I have absolutely no symptoms, and the idea of an ICD scares me. But the idea of having my heart stop scares me more. I'm going to get an ICD. Cherie, age 70 My doctor told me that my heart problem might be fixed if we destroy some heart tissue that is causing it. The procedure is called ablation. It might correct the problem, so I don't need to have an ICD. I'm going to try that. If it doesn't work, then I'll talk to my doctor about getting an ICD. Martin, age 66 What matters most to you? Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements. Reasons to get an ICD Reasons not to get an ICD I want to do everything I can to prevent a deadly heart rhythm. I would rather use only medicine to lower my chance of a deadly heart rhythm. More important Equally important More important I'm not worried that the ICD might shock me. I would worry all the time that the ICD might shock me. More important Equally important More important I don't mind having a device inside my body. I don't like the idea of having a device inside my body. More important Equally important More important I'm not worried about the small risks of surgery. I'm concerned that something could go wrong with the surgery. More important Equally important More important My other important reasons: My other important reasons: More important Equally important More important Where are you leaning now? Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now. Getting an ICD NOT getting an ICD Leaning toward Undecided Leaning toward What else do you need to make your decision? Check the facts 1.
I need to have an ICD if I have heart problems.
2.
I'll feel a painful shock if an ICD fixes a heart rhythm that could cause sudden death.
3.
I might need surgery again someday if the ICD breaks or if it needs a new battery.
Decide what's next 1.
Do you understand the options available to you? 2.
Are you clear about which benefits and side effects matter most to you? 3.
Do you have enough support and advice from others to make a choice? Certainty 1.
How sure do you feel right now about your decision? Not sure at all Somewhat sure Very sure 2.
Check what you need to do before you make this decision. 3.
Use the following space to list questions, concerns, and next steps. Your Summary Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision. Your decisionNext steps Which way you're leaning How sure you are Your comments Your knowledge of the factsKey concepts that you understood Key concepts that may need review Getting ready to actPatient choices Credits and ReferencesCredits
References Citations
You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them. Heart Rhythm Problems: Should I Get an Implantable Cardioverter-Defibrillator (ICD)?Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.
1. Get the factsYour options
This decision aid focuses on whether to get an ICD (implantable cardioverter-defibrillation) when you do NOT have heart failure. The ICD decision for heart failure patients raises some different issues. Key points to remember
FAQs What is an ICD?An ICD is a battery-powered device that can fix an abnormal heart rate or rhythm and prevent sudden death. The ICD is placed inside the chest. It's attached to one or two wires (called leads) that go into the heart through a vein. An ICD is always checking your heart rate and rhythm. If the ICD detects a life-threatening rapid heart rhythm, it tries to slow the rhythm to get it back to normal. If the dangerous rhythm does not stop, the ICD sends an electric shock to the heart to restore a normal rhythm. The device then goes back to its watchful mode. An ICD also can fix a heart rate that is too fast or too slow. It does so without using a shock. It can send out electrical pulses to speed up a heart rate that is too slow. Or it can slow down a fast heart rate by matching the pace and bringing the heart rate back to normal. Whether you get pulses or a shock depends on the type of problem that you have and how the doctor programs the ICD for you. How is an ICD placed?Your doctor will put the ICD in your chest during minor surgery. You will not have open-chest surgery. You probably will have local anesthesia. This means that you will be awake but feel no pain. You also will likely have medicine to make you feel relaxed and sleepy. Your doctor makes a small cut (incision) in your upper chest. He or she puts one or two leads (wires) in a vein and threads them to the heart. Then your doctor connects the leads to the ICD. Your doctor programs the ICD and then puts it in your chest and closes the incision. In some cases, the doctor may be able to put the ICD in another place in the chest so that you don't have a scar on your upper chest. This would allow you to wear clothing with a lower neckline and still keep the scar covered. Most people spend the night in the hospital, just to make sure that the device is working and that there are no problems from the surgery. You may be able to see a little bump under the skin where the ICD is placed. How does it feel to get a shock from an ICD?The shock from an ICD hurts briefly. It's been described as feeling like a punch in the chest. But the shock is a sign that the ICD is doing its job to keep your heart beating. You won't feel any pain if the ICD uses electrical pulses to fix a heart rate that is too fast or too slow. There's no way to know how often a shock might occur. It might never happen. It's possible that the ICD could shock your heart when it shouldn't. If that were to happen, you would have pain. The shock could make you fall out of bed, and that could injure you. In rare cases, the shock could cause the heart to quiver, or flutter, and stop pumping blood. This is called ventricular fibrillation (say "ven-TRICK-yuh-ler fib-ruh-LAY-shun"), which can be deadly. If this happened, the ICD would shock your heart again to stop the fluttering. Many people say that they have a good quality of life with an ICD. But shocks—and the fear of shocks—can make some people worry too much. They may be afraid all the time that the ICD might shock them. This worry can reduce a person's quality of life. What are the benefits of an ICD?
What are the risks and side effects of an ICD?There are several risks to getting an ICD. But the risks are different for each person. The risk for problems associated with the implant procedure might be higher for people who are age 80 or older.
The ICD could shock the heart when it shouldn't. There is no way to know if or when this could happen. It might never happen. 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?You will need regular checkups with your doctor to make sure that the ICD is working. It's important to keep taking any medicines your doctor has prescribed. You'll also need to follow a healthy lifestyle. This includes eating heart-healthy foods, getting regular exercise, and not smoking. If the ICD gives you a lot of shocks, your doctor may prescribe the rhythm-control medicine amiodarone. This medicine helps prevent abnormal heart rhythms and may keep the ICD from sending shocks too often. Your doctor also could suggest catheter ablation to lower the number of times the ICD shocks you. Catheter ablation can lower the chance of some abnormal heart rhythms, such as atrial fibrillation or ventricular tachycardia. These rhythms can cause the ICD to shock you. An ICD runs on a battery that lasts from 5 to 8 years. To have the battery replaced, you will need minor surgery. If you get an ICD, you have to be careful not to get too close to some devices with strong magnetic or electrical fields. These include MRI machines, battery-powered cordless power tools, and CB or ham radios. But most everyday appliances are safe. Why might your doctor recommend an ICD?Your doctor may advise you to get an ICD if you have had a dangerous abnormal heart rhythm, or if you are at risk for having one. 2. Compare your options
Personal storiesAre you interested in what others decided to do? Many people have faced this decision. These personal stories may help you decide. Personal stories about considering an ICDThese stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions. "My doctor said there's a good chance I could get a really bad heart rhythm that could make my heart stop. We talked about an ICD. I'm a little nervous about getting shocked. But if it could save my life, it's worth it, so I'm going to get one." — Cassius, age 62 "I've had a couple of episodes of palpitations from a really fast heart rate. But I'm taking medicine, and it seems to be working. I'm not ready to get an ICD." — Federico, age 66 "I just got some test results back that show there's a chance I could get a heart problem that causes my heart to stop. I have absolutely no symptoms, and the idea of an ICD scares me. But the idea of having my heart stop scares me more. I'm going to get an ICD." — Cherie, age 70 "My doctor told me that my heart problem might be fixed if we destroy some heart tissue that is causing it. The procedure is called ablation. It might correct the problem, so I don't need to have an ICD. I'm going to try that. If it doesn't work, then I'll talk to my doctor about getting an ICD." — Martin, age 66 3. What matters most to you?Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements. Reasons to get an ICD Reasons not to get an ICD I want to do everything I can to prevent a deadly heart rhythm. I would rather use only medicine to lower my chance of a deadly heart rhythm. More important Equally important More important I'm not worried that the ICD might shock me. I would worry all the time that the ICD might shock me. More important Equally important More important I don't mind having a device inside my body. I don't like the idea of having a device inside my body. More important Equally important More important I'm not worried about the small risks of surgery. I'm concerned that something could go wrong with the surgery. More important Equally important More important My other important reasons: My other important reasons: More important Equally important More important 4. Where are you leaning now?Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now. Getting an ICD NOT getting an ICD Leaning toward Undecided Leaning toward 5. What else do you need to make your decision?Check the facts1. I need to have an ICD if I have heart problems.
You're right. Not everyone with heart problems 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.
2. I'll feel a painful shock if an ICD fixes a heart rhythm that could cause sudden death.
You're right. The shock from an ICD hurts briefly. 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 rhythm.
3. I might need surgery again someday if the ICD breaks or if it needs a new battery.
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.
Decide what's next1. Do you understand the options available to you? 2. Are you clear about which benefits and side effects matter most to you? 3. Do you have enough support and advice from others to make a choice? Certainty1. How sure do you feel right now about your decision? Not sure at all Somewhat sure Very sure 2. Check what you need to do before you make this decision.
3. Use the following space to list questions, concerns, and next steps. Credits
References Citations
Note: The "printer friendly" document will not contain all the information available in the online document some Information (e.g. cross-references to other topics, definitions or medical illustrations) is only available in the online version. Last Revised: June 2, 2011 Author: Healthwise Staff Medical Review: E. Gregory Thompson, MD - Internal Medicine & Rakesh K. Pai, MD, FACC - Cardiology, Electrophysiology eMedicineHealth Medical Reference from Healthwise 
This information does not replace the advice of a doctor. Healthwise disclaims any warranty or liability for your use of this information. Your use of this information means that you agree to the Terms of Use. How this information was developed to help you make better health decisions. To learn more visit Healthwise.org © 1995-2012 Healthwise, Incorporated. Healthwise, Healthwise for every health decision, and the Healthwise logo are trademarks of Healthwise, Incorporated. |
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