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By Mayo Clinic staffBecause of their capabilities, ICDs have become standard treatment for anyone who has survived cardiac arrest and are used increasingly in individuals who are at high risk of sudden cardiac arrest. If you have an ICD, your risk of sudden death from cardiac arrest is significantly lower than it would be if you were treated only with medications to correct your heartbeat.
If you're at high risk of ventricular tachycardia and ventricular fibrillation, an ICD may be your best defense against cardiac arrest. Once you have an ICD, it's likely you'll need to keep it for life. Although the electrical shocks may be unsettling, they're evidence that the ICD is effectively treating your heart rhythm problem and protecting you from sudden death. Talk to your doctor about how to best care for your ICD.
After your procedure, you'll need to take some precautions to avoid injuries and make sure your ICD works properly.
Short-term precautions
You'll likely be able to return to normal activities, such as exercise, work and sex, soon after you recover from surgery. During the first four weeks following surgery, however, your doctor may ask you to refrain from:
- Vigorous above-the-shoulder activities or exercises, including golf, tennis, swimming, bicycling, bowling or vacuuming
- Lifting anything weighing more than 5 pounds
- Playing contact sports
- Strenuous exercise programs
Long-term precautions
Problems with your ICD due to electrical interference are rare. Still, take precautions with the following:
- Cellular phones and other mobile devices. It's safe to talk on a cell phone, but avoid placing your cell phone within six inches (about 15 centimeters) of your ICD implantation site when the phone is turned on. Although unlikely, your ICD could mistake a cell phone's signal for a heartbeat and slow your heartbeat, causing symptoms such as sudden fatigue.
- Security systems. After surgery you'll receive a card that says you have an ICD. Show your card to airport personnel because the ICD may set off airport security alarms. Also, hand-held metal detectors often contain a magnet that may interfere with your ICD. Ask the security personnel to limit scanning with a hand-held detector to less than 30 seconds over the site of your ICD or make a request for a search by hand.
- Medical equipment. If a doctor is considering any medical procedure that involves electromagnetic energy, such as magnetic resonance imaging (MRI) or magnetic resonance angiography (MRA), tell him or her that you have an ICD.
- Power generators. Stand at least two feet (0.6 meters) from welding equipment, high-voltage transformers or motor-generator systems. If you work around such equipment, your doctor can arrange a test in your workplace to see if the equipment affects your ICD.
Devices that present little or no risk to your ICD include microwave ovens, televisions and remote controls, radios, MP3 players, toasters, electric blankets, electric shavers and electric drills.
Driving restrictions
If you have an implantable cardioverter-defibrillator to treat ventricular arrhythmia, driving a vehicle presents a special challenge. The combination of arrhythmia and shocks from your ICD may cause fainting, which would be dangerous if you're driving.
The American Heart Association's guidelines discourage driving during the first six months after your procedure if your ICD was implanted due to a previous cardiac arrest or ventricular arrhythmia. If you experience no shocks during this period, you will likely be able to begin driving again. But if you later experience a shock, with or without fainting, tell your doctor and follow his or her recommendations.
In most cases, you will need to stop driving until you've been shock-free for another six months. There is some controversy regarding this topic. For example, the European Heart Rhythm Association recommends waiting only three months before driving if your ICD was implanted due to a previous cardiac arrest or arrhythmia, while the American Heart Association recommends waiting six months. Talk to your doctor to get advice for your situation.
If you have an implantable cardioverter-defibrillator but have no history of life-threatening arrhythmias, you can usually resume driving within weeks after your procedure, with your doctor's approval, if you've had no shocks. Discuss your specific situation with your doctor. You usually can't get a commercial driver's license if you have an ICD.
Battery life
The lithium battery in your implantable cardioverter-defibrillator can last up to seven years. During your regular checkups, which should occur every three to six months, your doctor or nurse will check the battery. When the battery is nearly out of power, your old shock generator is replaced with a new one during a minor outpatient procedure.
ICDs and end-of-life issues
If you have an ICD and become terminally ill with a condition unrelated to your heart, such as cancer, it's possible that your ICD could prolong the process of dying. Doctors and researchers have varied opinions on turning off an ICD in end-of-life situations.
If you have an ICD implanted and are concerned about turning it off in an end-of-life situation, talk to your doctor. You may also want to talk to family members or another person designated to make medical decisions for you about what you'd like to do in end-of-life care situations.
- Implantable cardioverter defibrillator. National Heart, Lung, and Blood Institute. http://www.nhlbi.nih.gov/health/dci/Diseases/icd/icd_all.html. Accessed Aug. 25, 2010.
- Epstein AE, et al. ACC/AHA/HRS 2008 guidelines for device-based therapy of cardiac rhythm abnormalities. Circulation. 2008;117:e350.
- Arnsdorf MF, et al. Role of implantable cardioverter-defibrillator for the secondary prevention of sudden cardiac death. http://www.uptodate.com/home/index.html. Accessed Aug. 25, 2010.
- Eckstein J, et al. Necessity for surgical revision of defibrillator leads implanted long-term: Causes and management. Circulation. 2008;117:2727.
- Kleemann T, et al. Annual rate of transvenous defibrillation lead defects in implantable cardioverter-defibrillators over a period of >10 years. Circulation 2007;115:2474.
- Epstein AE, et al. Addendum to "Personal and public safety issues related to arrhythmias that may affect consciousness: Implications for regulation and physician recommendations: A medical/scientific statement from the American Heart Association and North American Society of Pacing and Electrophysiology." Circulation. 2007;115:1170.
- Vijgen J, et al. Consensus statement of the European Heart Rhythm Association: Updated recommendations for driving by patients with implantable cardioverter defibrillators. Europace. 2009;11:1097.
- Lampert R, et al. HRS expert consensus statement on the management of cardiovascular implantable electronic devices (CIEDs) in patients nearing end of life or requesting withdrawal of therapy. Heart Rhythm. 2010;7:1008..
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