BY: NOUAYING KUENOVEMBER 12, 2012

Implantable Cardioverter-Defibrillator

What is an implantable cardioverter- defibrillator?

An implantable cardioverter-defibrillator or ICD

refers to a device that helps to regulate the heart.

Problems the ICD Solve

ICD’s are used to treat ventricular tachycardia and ventricular fibrillation.

ICD’s have aided with the prevention of sudden cardiac death in adults.

Used to treat arrhythmias- atrial flutter, atrial fibrillation.

Brugada Syndrome

Long QT Syndrome

Bradycardia

Sick Sinus Syndrome

History of the ICD

ICD was invented by Michael Mirowski. It was prompted by the sudden death of a colleague. After building a prototype device, it was tested and refined in animals.

Initially introduced to humans in 1980 despite skepticism and criticism.

Early batteries only lasted for two years or less.

Approved by the FDA in 1985

Initial ICD devices were large and bulky.

Early devices were known as “shock boxes”.

Technological advances have made ICD more convenient and safe. Initially, was used as a last resort treatment.

February 2008, the smallest patient ever received the ICD procedure. The patient was a five week old infant weighing in at 4.9 kg.

Current Technology

The ICD pulse generator is a battery powered computer like device that is about the size of a Mason jar lid.

One or two lead wires will connect the heart muscle to the pulse generator.

ICD continuously monitors the heart for any abnormalities.

Methods

The ICD generator is implanted under the skin, beneath the shoulder. It can also be implanted in the abdominal area.

A single chamber ICD will have one lead in the ventricle.

A dual chamber ICD will have two leads in both the atrium and ventricle.

In order to test the ICD, doctors will induce arrhythmia. During this time, the patient will be put under.

Once the test is complete, the doctor will close the incision where the ICD is placed.

Different shocks will perform different jobs for the ICD.

To determine whether or not you may need an ICD, doctors will diagnose you by different means.

Current device batteries are expected to live up to 6 years or longer.

Most people who use it do not have any daily concerns with living with an ICD.

After a 6-24 month period after operation, most patients had successful transitions with their lives.

The minimum patient weight requirements is 10kg, but the ideal weight is 15-20kgs.

Limitations

The price of an ICD may cost from $10,000-$100,000. It depends on the maker of the device and the function.

Some complications may occur after operation that will require medical attention.

An ICD does not interfere with everyday life, but has a psychological impact.

Women were more susceptible to having troubles with coping and having anxiety.

Shocks from the ICD produce fear and anxiety.

Children are too vulnerable to the complications of the ICD, whether internal or external.

Future of ICD

The price of the ICD will be lowered and become more accessible.

The size of the pulse generator will be reduced, becoming more convenient.

The battery life will be prolonged.

The device will become more useful in pediatrics, and become a primary option for children.

References

Bryant III, Roosevelt, Amir Aboutalebi, Jeffrey J. Kim, Naomi Kertesz, and David L.S Morales. "Epicardial Implantable Cardioverter-Defibrillator System Placed in a 4.9-kg Infant." Texas Heart Institute Journal 38 (2011): 421-23. EBSCO. Web.

Flemme, Inger, Ingela Johansson, and Anna Stromberg. "Living with Life-saving Technology-coping Strategies in Implantable Cardioverter Defibrillators Recipients." Journal of Clinical Nursing 21.3 (2012): 311-21. Print.

MacFadden, Derek R., Eugene Crystal, Andrew D. Krahn, Iqwal Mangat, Jeffrey S. Healey, Paul Dorian, David Birnie, Christopher S. Simpson, Yaariv Khaykin, Arnold Pinter, Kumaraswamy Nanthakumar, Andrew J. Calzavara, Peter C. Austin, Jack V. Tu, and Douglas S. Lee. "Sex Differences in Implantable Cardioverter-Defibrillator Outcomes: Findings From a Prospective Defibrillator Database."Annals of Internal Medicine 156.3 (2012). EBSCO. Web.

McAlister, Finlay A., Justin Ezekowitz, Donna M. Dryden, Nicola Hooton, Ben Vandermeer, Carol Friesen, Carol Spooner, and Brian H. Rowe. "Cardiac Resynchronization Therapy and Implantable Cardiac Defibrillators in Left Ventricular Systolic Dysfunction." Agency for Healthcare Research and Quality.EBSCO. Web.

Naccarelli, Gerald V., and Enrico P. Veltri. Implantable Cardioverter-defibrillators. Boston: Blackwell Scientific Publications, 1993. Print.

Singer, Igor, S. Serge. Barold, and A. John. Camm. Nonpharmacological Therapy of Arrhythmias for the 21st Century: The State of the Art. Armonk, NY: Futura Pub., 1998. Print.