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Implantable Cardioverter Defibrillator at Garnet Health
An implantable cardioverter defibrillator (ICD) is a pager-sized device which is implanted in your chest like a pacemaker. It works by detecting and stopping dangerous, abnormal heartbeats (arrhythmias).
How Does A Cardioverter Defibrillator Work?
This device is connected to an electrical conductor, or electrode wires, positioned inside the heart or on its surface. These electrode wires are used to sense the cardiac rhythm, pace the heart and deliver electrical shocks, if necessary. The various leads are tunneled to a pulse generator, which is implanted in a pouch beneath the skin of the chest or abdomen. These generators are typically a little larger than a wallet and have electronics that automatically monitor and treat heart rhythms recognized as abnormal.
When an ICD detects an elevated, irregular and rapid heart rhythm, it shocks the heart to restore the normal rhythm. ICDs also offers a host of other sophisticated functions such as storage of detected arrhythmic events and the ability to do “non-invasive” electrophysiologic testing.
Implanting A Cardioverter Defibrillator
A cardioverter defibrillator is implanted surgically by a physician. Before it is implanted, your physician will evaluate your medical history and feasibility to receive an implantable cardioverter defibrillator. If an ICD is needed, the pulse generator will be implanted either under your collarbone on the left or right side of your chest, or in your abdomen.
In either place, the generator will be placed in a “pocket” the physician creates under your skin or, sometimes, in your muscles. One end of the lead wire is put into a vein that goes to your heart. The wire is moved through the vein until it reaches the heart. The other end of the wire is attached to the pulse generator.
Once the system is in place, the physician will make your heart go into a fast rhythm to test the ICD. At this time, the physician will program the ICD to treat your specific heart rhythm problem.
For treatment of patients at risk for sudden cardiac arrest (SCA), Garnet Health Medical Center implants the S-ICD® System – the world’s first and only implantable cardioverter defibrillator (ICD) that provides defibrillation therapy without touching the heart.
Like Transvenous ICDs, the S-ICD System provides effective defibrillation for life-threating ventricular arrhythmias. Unlike Transvenous ICDs, the S-ICD System leaves the heart and vasculature untouched resulting in low risk of systemic infection, no risk of vascular injury, preservation of venous access and avoidance of risks associated with endovascular lead extraction. The S-ICD System has two main components:
- The pulse generator, which powers the system, monitors heart activity, and delivers a shock if needed
- The electrode, which enables the device to sense the cardiac rhythm and serves as a pathway for shock delivery when necessary.
Both components are implanted just under the skin—the generator at the side of the chest, and the electrode beside the breastbone. Implantation with the S-ICD System is straightforward and can be done using only anatomical landmarks which removes the need for fluoroscopy (an X-ray procedure that is required for standard leads to be placed in the heart).
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Peter Frommer, M.D. Heart Center at Garnet Health Medical Center
707 East Main Street
Middletown, NY 10940