Implantable Cardioverter Defibrillator Surgery Procedure Available at Cayuga Medical Center

By Malcolm Brand, MD, FACC

 

An estimated 300,000 Americans die each year from sudden cardiac death (SCD). This occurs when ventricular tachycardia or ventricular fibrillation cause the heart to beat so rapidly it cannot function properly, causing a sudden dangerous drop in blood pressure. This condition, called arrhythmia, can lead to cardiac arrest within minutes. It is treated with an electrical shock to the heart to disrupt the arrhythmia and restore a normal heartbeat.

 

People with known coronary artery disease, a history of heart attack, and congestive heart failure are at risk for SCD because scar tissue from previous cardiac events can disrupt the normal electrical signals inside the heart. Individuals with significantly reduced heart function are at the highest risk.

 

What is an implantable cardioverter defibrillator (ICD)?

 

An implantable cardioverter defibrillator (ICD) treats abnormal arrhythmias that can lead to sudden cardiac death. The ICD is a small computer that is planted under the skin, with wires that attach to the inside muscle tissue of the heart (much like a pacemaker does). The defibrillator monitors every heartbeat, detects significant arrhythmia, and delivers a shock to the heart to disrupt the abnormal rhythm with the goal of restoring normal heart rhythm.

 

When do cardiologists recommend ICD implantation?

 

Patients with significantly reduced heart function are at the highest risk, as are patients with documented abnormal rhythms. Studies have shown that patients in the high-risk category for sudden death benefit from having an ICD, regardless of whether they have had any symptoms or any documented abnormal rhythms. ICDs save lives.

 

Implantable defibrillators have been around since the early 1990s. Originally a person had to survive two out-of-hospital cardiac arrests to qualify to receive this device. However, the odds of surviving these arrests outside the hospital are less than five percent, so those guidelines have changed. There are about 300,000 people in the United States with a history of heart attack, congestive heart failure, and low pump function who would benefit from an ICD, and less than ten percent of those people have ICDs.

 

What are the symptoms preceding sudden cardiac death?

 

Symptoms for SCD include profound palpitations of the heart and sudden syncope, which is the loss of consciousness due to sudden loss of blood pressure.

 

Is the ICD always able to re-establish a normal heartbeat?

 

Sometimes the abnormal rhythm is so malignant the ICD can’t shock the heart to a normal rhythm, but this is not a likely scenario.

 

Does Cayuga Medical Center have a support group for people with ICDs?

 

Yes, we do have a support group for people with ICDs (for more information, call 607-274-4498). Individuals with implanted defibrillators often have anxiety over the occurrence of abnormal arrhythmias and the potential shock from the defibrillator. ICD shock can be painful and sometimes incapacitating. People often worry about what will happen if they receive a shock when they are driving a car, for example. But without the device, a person driving who goes into arrhythmia will surely pass out. The majority of times people with ICDs receive shocks to the heart, the device has saved their lives.

 

Where is the implantation procedure performed?

 

We implant ICDs in the Cardiac Catheterization Center at Cayuga Medical Center. The procedure is performed under local anesthesia with the patient moderately sedated. It takes sixty to ninety minutes and requires one night in the hospital.

 

Dr. Brand is director of Cardiac Catheterization at Cayuga Medical Center. He is board certified in cardiovascular disease and internal medicine, and performs ICD implantation. He is a Fellow of the American College of Cardiology, a Diplomate of the Certification Board of Nuclear Cardiology, and has Special Certification in Pacing and Defibrillation (NASPEX). Dr. Brand is in practice with Ithaca Cardiology Associates, where he can be reached at 607-272-0460.