ICD implantation in India: implantable defibrillators explained

What is an ICD and how is it fitted?

An ICD has a pulse generator, which holds the battery and circuits, and one or more leads that sense the heart’s electrical activity. MedlinePlus describes two main designs. A transvenous ICD uses leads passed through veins into the heart and can also work as a pacemaker. A subcutaneous ICD (S-ICD) uses a lead placed under the skin along the breastbone, so nothing sits inside the veins. The S-ICD cannot pace the heart. It can only correct a dangerous rhythm when one happens.

For an S-ICD, MedlinePlus describes a small cut under the left arm, with the generator placed in a pocket on the lower left chest. The device is tested during the procedure. It is done under general anaesthetic or with sedation, as your team directs.

Who may be considered for an ICD?

According to MedlinePlus the people who may need an ICD include those who:

• have already had ventricular tachycardia or ventricular fibrillation
• have a weakened or enlarged heart after heart attacks, heart failure or cardiomyopathy
• have certain inherited or congenital conditions that raise the risk of these rhythms

MedlinePlus adds that a cardiologist may favour an S-ICD for younger or active people, those with an infection risk or past device infection, or those whose veins are hard to reach. The final choice rests with your electrophysiologist.

Which reports does an electrophysiologist usually ask for?

For a remote opinion, ask the hospital whether it needs:

• an echocardiogram showing how well the heart pumps
• ECGs and any recordings of fast rhythms
• Holter or event monitor reports
• a cardiac MRI or angiogram, if you have had one
• a summary of any cardiac arrest or fainting episode
• a list of medicines and any family history of sudden death

How do I plan an ICD trip?

MedlinePlus says most people go home the same day after an S-ICD. A transvenous device may need a longer stay. Either way, allow time for assessment, the implant, a wound review and device programming before you fly. Your electrophysiologist decides when you are fit to travel.

MedlinePlus describes arm restrictions for several weeks after an S-ICD, including not raising the arm above the shoulder. That makes lifting luggage unwise, so travel with an attendant. You will receive an ID card and possibly a home monitor. Ask whether that monitor works in your country. Most importantly, find a clinic at home that can check your make of device and review any shocks.

What should I ask the hospital before booking?

• Do I need a transvenous ICD or would an S-ICD suit me?
• Do I also need pacing or cardiac resynchronisation?
• Can my home clinic read and programme this device?
• Will home monitoring work from my country?
• What should I do if I receive a shock while travelling?
• When will I be cleared to fly and to drive?