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Heart Rhythm Problems: Should I Get an Implantable Cardioverter-Defibrillator (ICD)?

You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.

Heart Rhythm Problems: Should I Get an Implantable Cardioverter-Defibrillator (ICD)?

Get the facts

Your options

  • Get an ICD.
  • Don't get an ICD.

This decision aid focuses on whether to get an ICD (implantable cardioverter-defibrillator) when you do NOT have heart failure. The ICD decision for heart failure patients raises some different issues.

Key points to remember

  • An ICD constantly checks your heart rate and rhythm. It is designed to fix a dangerous abnormal heart rhythm and prevent sudden death.
  • Your doctor may suggest an ICD if you are at risk of having an abnormal heart rhythm that could cause sudden death.
  • Your doctor also will consider other health problems you may have to see how high your risk is for a deadly heart rhythm and whether an ICD could prevent it.
  • The shock from an ICD hurts briefly. It's been described as feeling like a punch in the chest. But the shock is a sign that the ICD is doing its job to keep your heart beating. The ICD also can use electrical pulses to fix a heart rate that is too fast or too slow, but you usually do not feel those pulses.
  • There are several risks to getting an ICD. Problems can happen during and soon after the surgery to implant the device. Other problems can happen over time.
FAQs

What is an ICD?

An ICD is a battery-powered device that can fix an abnormal heart rate or rhythm and prevent sudden death. The ICD is placed under the skin of your chest. It's attached to one or two wires (called leads). For one type of ICD, these leads go into the heart through a vein. For another type, the lead is placed under the skin so it lies near your heart.

An ICD is always checking your heart rate and rhythm. If the ICD detects a life-threatening rapid heart rhythm, it may try to slow the rhythm back to normal using electrical pulses. If the dangerous rhythm does not stop, the ICD sends an electric shock to the heart to restore a normal rhythm. The device then goes back to its watchful mode.

Some ICDs also can fix a heart rate that is too slow. The ICD does so without using a shock. It can send out electrical pulses to speed up a heart rate that is too slow.

Whether you get pulses or a shock depends on the type of ICD, the type of heart problem that you have, and the way the doctor programs the ICD for you.

How is an ICD placed?

Your doctor will put the ICD in your chest during minor surgery. You will not have open-chest surgery. You probably will have local anesthesia. This means that you will be awake but feel no pain. You also will likely have medicine to make you feel relaxed and sleepy.

The doctor will make an incision (cut) in the skin just below your collarbone or at the side of your chest. The doctor will put the ICD leads through the cut. For one type of ICD, your doctor puts one or two leads in a large blood vessel and threads them into the heart. For another type, the lead may be placed under the skin through a small cut in the middle of your chest. Then your doctor connects the leads to the ICD. Your doctor puts the ICD under the skin of your chest and closes the cut. Your doctor also programs the ICD.

Most people spend the night in the hospital, just to make sure that the device is working and that there are no problems from the surgery.

You may be able to see a little bump under the skin where the ICD is placed.

How does it feel to get a shock from an ICD?

The shock from an ICD hurts briefly. It's been described as feeling like a punch in the chest. But the shock is a sign that the ICD is doing its job to keep your heart beating. You won't feel any pain if the ICD uses electrical pulses to fix a heart rate that is too fast or too slow.

There's no way to know how often a shock might occur. It might never happen.

It's possible that the ICD could shock your heart when it shouldn't. If that were to happen, you would have pain. The shock could make you fall out of bed, and that could injure you.

In rare cases, the shock could cause the heart to quiver, or flutter, and stop pumping blood. This is called ventricular fibrillation (say "ven-TRICK-yuh-ler fib-ruh-LAY-shun"), which can be deadly. If this happened, the ICD would shock your heart again to stop the fluttering.

Many people say that they have a good quality of life with an ICD. But shocks—and the fear of shocks—can make some people worry too much. They may be afraid all the time that the ICD might shock them. This worry can reduce a person's quality of life.

What are the benefits of an ICD?

An ICD can help lower the risk of sudden death from a dangerous heart rhythm.

How well an ICD may work for you depends on several things. These include whether you have already survived a life-threatening heart rhythm. Your doctor can help you understand how well an ICD might help you.

What are the risks of an ICD?

There are several risks to getting an ICD. But the risks are different for each person. The risks also depend on the type of ICD that you get. Your doctor can help you understand what your risks are from an ICD.

During the procedure. Problems can happen during or soon after the procedure to implant an ICD. Here are some examples.

  • You may have pain or bruising.
  • Serious bleeding could occur after placement of the ICD.
  • A lung could collapse (pneumothorax) from a buildup of air in the space between the lung and the chest wall.

After the procedure. Problems can also happen months or years after the ICD is implanted. These problems are related to the device or the leads.

  • The leads that attach to the heart may break or stop working right. If a lead does break or does not work anymore, you would need surgery. The surgery would be more complex than that needed to replace an ICD battery.
  • You could get an infection where the ICD is placed.
  • The ICD could shock the heart when it shouldn't. There is no way to know if or when this could happen. It might never happen. Your doctor will program your ICD to lower the risk of one of these shocks.
  • There also is a chance that a manufacturer may recall an ICD for a problem. If this were to happen, you might need surgery to take out the ICD and leads.
  • The idea of living with an ICD and getting shocked worries some people. For some people, getting a shock can cause anxiety and depression.

How do you live well with an ICD?

After the ICD is implanted, you will not drive for a short time. Depending on the reason you got the ICD, you may not be able to drive for one week to a few months. If you get a shock from the ICD, your doctor may ask that you don't drive for a short time.

You'll need to take steps to safely use electric devices. Some electric devices have a strong electromagnetic field. This field can keep your ICD from working right for a short time. Check with your doctor about what you need to avoid and what you need to keep a short distance away from your ICD. Many household and office electronics do not affect your ICD.

You will need regular monitoring and checkups with your doctor to make sure that the ICD is working well and that the programming is right for you.

It's important to keep taking any medicines your doctor has prescribed. You'll also need to follow a healthy lifestyle. This includes eating heart-healthy foods, getting regular exercise, and not smoking.

An ICD runs on a battery that can last several years. If the battery gets low, you can decide whether or not to have minor surgery to replace the ICD.

Talk with your doctor about the possibility of turning off the ICD at the end of life. Many people consider turning off the ICD when their health goals change from living longer to getting the most comfort possible at the end of life. Turning off your ICD is legal. It isn't considered suicide. The decision to leave on or turn off your ICD is a medical decision that you make based on your values.

How can you help make the decision?

Your doctor may advise you to get an ICD if you have had a dangerous abnormal heart rhythm or if you are at risk for having one.

Your personal feelings are just as important as the medical facts. Talk with your doctor about what matters most to you.

You and your doctor will decide whether an ICD is right for you.

Compare your options

Compare

What is usually involved?









What are the benefits?









What are the risks and side effects?









Get an ICD Get an ICD
  • You will have minor surgery to have the ICD put in. Your doctor will numb the area with local anesthesia.
  • You probably will spend the night in the hospital, just to make sure that there are no problems.
  • If the battery gets low, you will have to decide whether to replace the ICD.
  • You keep taking your heart medicine and following a healthy lifestyle.
  • An ICD can prevent sudden death from an abnormal heart rhythm.
  • You may have peace of mind that a dangerous heart rhythm could be fixed right away.
  • Problems can happen during or soon after the procedure to place the ICD. Examples include a lead tearing the heart or a lung collapsing.
  • The manufacturer could recall an ICD for a problem. If this were to happen, you might need surgery to take out the ICD and leads.
  • The shock from an ICD hurts briefly.
Don't get an ICD Don't get an ICD
  • You follow a healthy lifestyle.
  • You may take a rhythm-control medicine to prevent abnormal heart rhythms.
  • You avoid the risks of surgery.
  • You avoid the long-term risks of having the ICD in your body.
  • You won't worry about when the ICD might shock you.
  • You could have an abnormal heart rhythm that could cause sudden death.

Personal stories about considering an ICD

These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.

My doctor said there's a good chance I could get a really bad heart rhythm that could make my heart stop. We talked about an ICD. I'm a little nervous about getting shocked. But if it could save my life, it's worth it, so I'm going to get one.

Cassius, age 62

I'm taking medicine right now for my heart. I'm not ready to get an ICD.

Federico, age 66

I just got some test results back that show there's a chance I could get a heart problem that causes my heart to stop. I have absolutely no symptoms, and the idea of an ICD scares me. But the idea of having my heart stop scares me more. I'm going to get an ICD.

Cherie, age 70

My doctor said I could get an ICD. We talked about how it could help me. But I don't want a device like that inside my body. So I'm not going to get one.

Martin, age 82

What matters most to you?

Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.

Reasons to get an ICD

Reasons not to get an ICD

I want to do everything I can to prevent a deadly heart rhythm.

I would rather use only medicine to lower my chance of a deadly heart rhythm.

More important
Equally important
More important

I'm not worried that the ICD might shock me.

I would worry all the time that the ICD might shock me.

More important
Equally important
More important

I don't mind having a device inside my body.

I don't like the idea of having a device inside my body.

More important
Equally important
More important

I'm not worried about the risks of surgery.

I'm concerned that something could go wrong with the surgery.

More important
Equally important
More important

My other important reasons:

My other important reasons:

More important
Equally important
More important

Where are you leaning now?

Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.

Getting an ICD

NOT getting an ICD

Leaning toward
Undecided
Leaning toward

What else do you need to make your decision?

Check the facts

1, I'll feel a painful shock if an ICD fixes a heart rhythm that could cause sudden death.
2, If the battery gets low, I will need to decide whether to have surgery again to replace the ICD.

Decide what's next

1,Do you understand the options available to you?
2,Are you clear about which benefits and side effects matter most to you?
3,Do you have enough support and advice from others to make a choice?

Certainty

1. How sure do you feel right now about your decision?

Not sure at all
Somewhat sure
Very sure

Your Summary

Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.

Your decision  

Next steps

Which way you're leaning

How sure you are

Your comments

Your knowledge of the facts  

Key concepts that you understood

Key concepts that may need review

Getting ready to act  

Patient choices

Credits

Credits
Author Healthwise Staff
Primary Medical Reviewer E. Gregory Thompson MD - Internal Medicine
Primary Medical Reviewer Martin J. Gabica MD - Family Medicine
Primary Medical Reviewer Elizabeth T. Russo MD - Internal Medicine
Primary Medical Reviewer Adam Husney MD - Family Medicine
Primary Medical Reviewer John M. Miller MD, FACC - Cardiology, Electrophysiology
Primary Medical Reviewer Caroline S. Rhoads MD - Internal Medicine
You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.

Heart Rhythm Problems: Should I Get an Implantable Cardioverter-Defibrillator (ICD)?

Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.
  1. Get the facts
  2. Compare your options
  3. What matters most to you?
  4. Where are you leaning now?
  5. What else do you need to make your decision?

1. Get the Facts

Your options

  • Get an ICD.
  • Don't get an ICD.

This decision aid focuses on whether to get an ICD (implantable cardioverter-defibrillator) when you do NOT have heart failure. The ICD decision for heart failure patients raises some different issues.

Key points to remember

  • An ICD constantly checks your heart rate and rhythm. It is designed to fix a dangerous abnormal heart rhythm and prevent sudden death.
  • Your doctor may suggest an ICD if you are at risk of having an abnormal heart rhythm that could cause sudden death.
  • Your doctor also will consider other health problems you may have to see how high your risk is for a deadly heart rhythm and whether an ICD could prevent it.
  • The shock from an ICD hurts briefly. It's been described as feeling like a punch in the chest. But the shock is a sign that the ICD is doing its job to keep your heart beating. The ICD also can use electrical pulses to fix a heart rate that is too fast or too slow, but you usually do not feel those pulses.
  • There are several risks to getting an ICD. Problems can happen during and soon after the surgery to implant the device. Other problems can happen over time.
FAQs

What is an ICD?

An ICD is a battery-powered device that can fix an abnormal heart rate or rhythm and prevent sudden death. The ICD is placed under the skin of your chest. It's attached to one or two wires (called leads). For one type of ICD, these leads go into the heart through a vein. For another type, the lead is placed under the skin so it lies near your heart.

An ICD is always checking your heart rate and rhythm. If the ICD detects a life-threatening rapid heart rhythm, it may try to slow the rhythm back to normal using electrical pulses. If the dangerous rhythm does not stop, the ICD sends an electric shock to the heart to restore a normal rhythm. The device then goes back to its watchful mode.

Some ICDs also can fix a heart rate that is too slow. The ICD does so without using a shock. It can send out electrical pulses to speed up a heart rate that is too slow.

Whether you get pulses or a shock depends on the type of ICD, the type of heart problem that you have, and the way the doctor programs the ICD for you.

How is an ICD placed?

Your doctor will put the ICD in your chest during minor surgery. You will not have open-chest surgery. You probably will have local anesthesia. This means that you will be awake but feel no pain. You also will likely have medicine to make you feel relaxed and sleepy.

The doctor will make an incision (cut) in the skin just below your collarbone or at the side of your chest. The doctor will put the ICD leads through the cut. For one type of ICD, your doctor puts one or two leads in a large blood vessel and threads them into the heart. For another type, the lead may be placed under the skin through a small cut in the middle of your chest. Then your doctor connects the leads to the ICD. Your doctor puts the ICD under the skin of your chest and closes the cut. Your doctor also programs the ICD.

Most people spend the night in the hospital, just to make sure that the device is working and that there are no problems from the surgery.

You may be able to see a little bump under the skin where the ICD is placed.

How does it feel to get a shock from an ICD?

The shock from an ICD hurts briefly. It's been described as feeling like a punch in the chest. But the shock is a sign that the ICD is doing its job to keep your heart beating. You won't feel any pain if the ICD uses electrical pulses to fix a heart rate that is too fast or too slow.

There's no way to know how often a shock might occur. It might never happen.

It's possible that the ICD could shock your heart when it shouldn't. If that were to happen, you would have pain. The shock could make you fall out of bed, and that could injure you.

In rare cases, the shock could cause the heart to quiver, or flutter, and stop pumping blood. This is called ventricular fibrillation (say "ven-TRICK-yuh-ler fib-ruh-LAY-shun"), which can be deadly. If this happened, the ICD would shock your heart again to stop the fluttering.

Many people say that they have a good quality of life with an ICD. But shocks—and the fear of shocks—can make some people worry too much. They may be afraid all the time that the ICD might shock them. This worry can reduce a person's quality of life.

What are the benefits of an ICD?

An ICD can help lower the risk of sudden death from a dangerous heart rhythm.

How well an ICD may work for you depends on several things. These include whether you have already survived a life-threatening heart rhythm. Your doctor can help you understand how well an ICD might help you.

What are the risks of an ICD?

There are several risks to getting an ICD. But the risks are different for each person. The risks also depend on the type of ICD that you get. Your doctor can help you understand what your risks are from an ICD.

During the procedure. Problems can happen during or soon after the procedure to implant an ICD. Here are some examples.

  • You may have pain or bruising.
  • Serious bleeding could occur after placement of the ICD.
  • A lung could collapse (pneumothorax) from a buildup of air in the space between the lung and the chest wall.

After the procedure. Problems can also happen months or years after the ICD is implanted. These problems are related to the device or the leads.

  • The leads that attach to the heart may break or stop working right. If a lead does break or does not work anymore, you would need surgery. The surgery would be more complex than that needed to replace an ICD battery.
  • You could get an infection where the ICD is placed.
  • The ICD could shock the heart when it shouldn't. There is no way to know if or when this could happen. It might never happen. Your doctor will program your ICD to lower the risk of one of these shocks.
  • There also is a chance that a manufacturer may recall an ICD for a problem. If this were to happen, you might need surgery to take out the ICD and leads.
  • The idea of living with an ICD and getting shocked worries some people. For some people, getting a shock can cause anxiety and depression.

How do you live well with an ICD?

After the ICD is implanted, you will not drive for a short time. Depending on the reason you got the ICD, you may not be able to drive for one week to a few months. If you get a shock from the ICD, your doctor may ask that you don't drive for a short time.

You'll need to take steps to safely use electric devices. Some electric devices have a strong electromagnetic field. This field can keep your ICD from working right for a short time. Check with your doctor about what you need to avoid and what you need to keep a short distance away from your ICD. Many household and office electronics do not affect your ICD.

You will need regular monitoring and checkups with your doctor to make sure that the ICD is working well and that the programming is right for you.

It's important to keep taking any medicines your doctor has prescribed. You'll also need to follow a healthy lifestyle. This includes eating heart-healthy foods, getting regular exercise, and not smoking.

An ICD runs on a battery that can last several years. If the battery gets low, you can decide whether or not to have minor surgery to replace the ICD.

Talk with your doctor about the possibility of turning off the ICD at the end of life. Many people consider turning off the ICD when their health goals change from living longer to getting the most comfort possible at the end of life. Turning off your ICD is legal. It isn't considered suicide. The decision to leave on or turn off your ICD is a medical decision that you make based on your values.

How can you help make the decision?

Your doctor may advise you to get an ICD if you have had a dangerous abnormal heart rhythm or if you are at risk for having one.

Your personal feelings are just as important as the medical facts. Talk with your doctor about what matters most to you.

You and your doctor will decide whether an ICD is right for you.

2. Compare your options

 Get an ICDDon't get an ICD
What is usually involved?
  • You will have minor surgery to have the ICD put in. Your doctor will numb the area with local anesthesia.
  • You probably will spend the night in the hospital, just to make sure that there are no problems.
  • If the battery gets low, you will have to decide whether to replace the ICD.
  • You keep taking your heart medicine and following a healthy lifestyle.
  • You follow a healthy lifestyle.
  • You may take a rhythm-control medicine to prevent abnormal heart rhythms.
What are the benefits?
  • An ICD can prevent sudden death from an abnormal heart rhythm.
  • You may have peace of mind that a dangerous heart rhythm could be fixed right away.
  • You avoid the risks of surgery.
  • You avoid the long-term risks of having the ICD in your body.
  • You won't worry about when the ICD might shock you.
What are the risks and side effects?
  • Problems can happen during or soon after the procedure to place the ICD. Examples include a lead tearing the heart or a lung collapsing.
  • The manufacturer could recall an ICD for a problem. If this were to happen, you might need surgery to take out the ICD and leads.
  • The shock from an ICD hurts briefly.
  • You could have an abnormal heart rhythm that could cause sudden death.

Personal stories

Personal stories about considering an ICD

These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.

"My doctor said there's a good chance I could get a really bad heart rhythm that could make my heart stop. We talked about an ICD. I'm a little nervous about getting shocked. But if it could save my life, it's worth it, so I'm going to get one."

— Cassius, age 62

"I'm taking medicine right now for my heart. I'm not ready to get an ICD."

— Federico, age 66

"I just got some test results back that show there's a chance I could get a heart problem that causes my heart to stop. I have absolutely no symptoms, and the idea of an ICD scares me. But the idea of having my heart stop scares me more. I'm going to get an ICD."

— Cherie, age 70

"My doctor said I could get an ICD. We talked about how it could help me. But I don't want a device like that inside my body. So I'm not going to get one."

— Martin, age 82

3. What matters most to you?

Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.

Reasons to get an ICD

Reasons not to get an ICD

I want to do everything I can to prevent a deadly heart rhythm.

I would rather use only medicine to lower my chance of a deadly heart rhythm.

       
More important
Equally important
More important

I'm not worried that the ICD might shock me.

I would worry all the time that the ICD might shock me.

       
More important
Equally important
More important

I don't mind having a device inside my body.

I don't like the idea of having a device inside my body.

       
More important
Equally important
More important

I'm not worried about the risks of surgery.

I'm concerned that something could go wrong with the surgery.

       
More important
Equally important
More important

My other important reasons:

My other important reasons:

  
       
More important
Equally important
More important

4. Where are you leaning now?

Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.

Getting an ICD

NOT getting an ICD

       
Leaning toward
Undecided
Leaning toward

5. What else do you need to make your decision?

Check the facts

1. I'll feel a painful shock if an ICD fixes a heart rhythm that could cause sudden death.

  • True
  • False
  • I'm not sure
You're right. The shock from an ICD hurts briefly. But the shock is a sign that a possibly deadly heart rhythm has been fixed.

2. If the battery gets low, I will need to decide whether to have surgery again to replace the ICD.

  • True
  • False
  • I'm not sure
That's right. If the battery gets low, you will need to decide whether to have surgery again to replace the ICD.

Decide what's next

1. Do you understand the options available to you?

2. Are you clear about which benefits and side effects matter most to you?

3. Do you have enough support and advice from others to make a choice?

Certainty

1. How sure do you feel right now about your decision?

     
Not sure at all
Somewhat sure
Very sure

2. Check what you need to do before you make this decision.

  • I'm ready to take action.
  • I want to discuss the options with others.
  • I want to learn more about my options.
 
Credits
By Healthwise Staff
Primary Medical Reviewer E. Gregory Thompson MD - Internal Medicine
Primary Medical Reviewer Martin J. Gabica MD - Family Medicine
Primary Medical Reviewer Elizabeth T. Russo MD - Internal Medicine
Primary Medical Reviewer Adam Husney MD - Family Medicine
Primary Medical Reviewer John M. Miller MD, FACC - Cardiology, Electrophysiology
Primary Medical Reviewer Caroline S. Rhoads MD - Internal Medicine

Note: The "printer friendly" document will not contain all the information available in the online document some Information (e.g. cross-references to other topics, definitions or medical illustrations) is only available in the online version.
 
 

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