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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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