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					ICD STUDY DAY


          Sue Hughes
      Senior Chief Cardiac
      Clinical Physiologist.
         18th June 2009
ICD STUDY DAY

• Implantable
• Cardioverter
• Defibrillator.
ICD STUDY DAY

• What does an ICD do?

  An ICD detects and treats fast heart rhythms,
  or tachycardias.
 It also includes a pacemaker (possibly
  Biventricular if required).
 A Biventricular pacemaker has a third wire and
  tries to strengthen the heart
ICD STUDY DAY

• Who needs an ICD?

 Secondary prevention-somebody who has
 survived a cardiac arrest.

 Primary Prevention- somebody deemed to be
 at risk of sudden cardiac death.
ICD STUDY DAY

• How does an ICD work?

  An ICD treats tachycardias or fast heart
  beats.
  There are 2 types of fast heart beat;
1. Ventricular tachycardia- usually fast and
  regular.
 2.Ventricular fibrillation- very fast and
  disorganised
ICD STUDY DAY

• An ICD treats these tachycardias in 2
  different ways.

• Antitachycardia pacing commonly called ATP

• .Delivering a shock to the heart
ICD STUDY DAY

• What is ATP?

 A run of paced beats , faster than the
 detected tachycardia, to try and slow the
 heart to a normal rate.

 ATP is usually painless and is very successful
 at converting VT.
ICD STUDY DAY

• What is a DC shock?



 A shock delivered to the heart by the device
 to convert any VT not terminated by ATP, or
 VF (very fast rhythm).
ICD STUDY DAY

• If ATP works so well, why do we need
   shocks?
   ATP works well on fast, regular rhythms (VT).
 If ATP is unsuccessful for VT then a shock will
   be delivered.
Very fast, irregular rhythms (VF) are usually
   treated with a shock.
ICD STUDY DAY

• All ICDS are programmed specifically to the
  individuals requirements.
• The ICD is usually programmed in zones, and each
  zone has its own therapies or treatment.
• Eg any rhythm above 220 bpm is classed as VF and
  is treated with shock therapy .

• A VT zone would be programmed to coincide with a
  patients documented VT rate, and would always have
  some ATP programmed.
• .
ICD STUDY DAY

• If a patients condition or requirements
  change, these zones can easily be altered in
  the ICD clinic.
ICD STUDY DAY

• If a patient has experienced a shock, we like
  to see them in clinic, to check that the shock
  was appropriate.
• Assess the patients underlying condition.
ICD STUDY DAY



 If a patient has multiple shocks, or is still
 unwell after a shock has been delivered then
 they need to present at their nearest A+E
 Department.
ICD STUDY DAY



• Why do we need to follow up ICDs so
  regularly?
• Especially if therapy has never been
  delivered.
ICD STUDY DAY

• Battery and lead checks.

• Analysis of any therapy delivered.

• Patient and family support.
REMOTE ICD FOLLOW UP

• We now offer remote follow up for all
  Medtronic ICDs.
• Soon to offer remote follow up to selected
  Boston Scientific and St Jude ICDs
• We currently have 360 patients using the
  home monitoring system and it is proving to
  be very popular.
• Patients transmit their ICD information
  through their telephone line.
• We analyse the data via a secure website.
All patients should have (and carry with them) a
  european ID card, they may also have a
  smaller LHCH unique ID card.
New cards are available with the new hospital
  contact details
LIVING WITH AN ICD

• Patient and staff information websites.

• Medtronic.com.
• BSCI.com
• Stj.com
DO’S AND DON’TS

Driving

Primary prevention patients cannot drive for 1
 month after implant.

Secondary prevention patients cannot drive for
  6 months after implant
DO’S AND DON’TS

• Further driving guidelines
• A further 6/12 month ban after any shock therapy
  and/ or symptomatic ATP.
• If therapy was delivered due to an inappropriate
  cause eg AF or programming issues then driving may
  resume after 1/12 month.
• After any revision of leads or altering anti arrhythmic
  medication- no driving for 1/12.
• 1/52 off driving is required after ICD box change.
• More detailed information is available from
  the DVLA website.
• www.dvla.gov.uk
DO’S AND DON’TS

• Having an ICD is not only meant to save your
  life, if required, but hopefully to improve your
  quality of life.



• We would hope that you can return to the
  activities that you enjoy. However……
• There are some restrictions….
DO’S AND DON’TS

  DON’T’S

• MRI scans
• Lithotripsy on abdominal implants.
• TENS machines used above the waist
DO’S AND DON’TS

 USE WITH CAUTION;
Mobile phones-Keep phone out of breast pocket
  over device, use contralateral ear.

Keep high output phones eg boat phones at
  least 15cm away from ICD.
• Shop security systems- walk quickly through.

• Airport security metal detectors- request hand
  or wand search, wand should be moved once
  over ICD , not slowly back and forth.
DO’S AND DON’TS

• Use with caution
• Power tools- not too close to the ICD and
  don’t use full body weight .
• Repetitive weight lifting has been known to
  cause lead fracture.
• TENS machines (pain relief) are not
  recommended with an implanted ICD.

• Arc welding not recommended.

• Industrial Magnetic and electrical fields may
  need further investigation.
FREQUENTLY ASKED QUESTIONS

• How long will an ICD battery last?

• This varies on the make, model and how
  much it is used. The battery level is monitored
  at every clinic visit.
• The average battery life is 4-6 years.
FREQUENTLY ASKED QUESTIONS

• Should patients exercise ?

YES. Physical exercise is essential for a healthy
  heart. Warm up gently and work within limits.
Gradually build up your exercise level.
FREQUENTLY ASKED QUESTIONS

Exercise considerations, beware of vulnerable
  situations

Only swim if accompanied.

Don’t climb ladders.
FREQUENTLY ASKED QUESTIONS


Is it safe to touch somebody who is having a
   shock?
Yes, you may feel them jump but you will not
   receive a shock
LIVING WITH AN ICD.


Recent guidelines produced by the MHRA.
(Medicines and Healthcare products Regulatory
  agency)
LIVING WITH AN ICD

ICDs need to be deactivated prior to routine surgery,
   and reactivated and checked after the surgery to
   avoid any possible risk of interference.
 Training has been provided to allow this service to be
   provided in the local district hospitals.
 However routine follow up and troubleshooting of ICDs
   will remain at The Liverpool Heart and Chest
   Hospital.
THANK YOU

				
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