A Guide For Patients

Please use this space to write down any questions you may have:

Some Useful WebsitesSome Useful Websites

MonashMonashHeartHeartwww.monashheart.org.au

ICD ManufacturersICD Manufacturerswww.medtronic.comwww.bostonscientific.com (Guidant)www.sorin.com (ELA)www.biotronik.com www.sjm.com (St Jude Medical)

Patient InformationPatient Informationwww.heartfoundation.com.auwww.arrhythmiaalliance.com www.hrsonline.org

Acknowledgement: Stuart Allen, Cardiac Technologist, MonashHeart.

MonashHeart, Monash Health

is committed to providing

outstanding cardiac services

for cardiac patients of all ages

Every 10 minutes, an Australian dies from cardiovascular disease making it the biggest killer of all Australians

MonashHeart treats more acute heart attack patients than anywhere else in Victoria

Each year MonashHeart treats close to 8000 patients with acute heart problems, the most in Victoria

MonashHeart operates one of the busiest cardiac CT scanners in the world

MonashHeart is the only cardiac service in Victoria, South Australia and Tasmania to treat heart patients of all ages; from pre birth to our senior citizens

MonashHeart is an internationally and nationally recognised leader in cardiovascular research

Fundraising Manager Health Monash

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Having An Implantable Cardioverter Defibrillator (ICD)

MonashHealth

The types of fast heart rhythms are explained below:

Ventricular Tachycardia (VT)

This is when the heart beats rapidly with an electrical ‘short circuit’ within the ventricular muscle. The heart rate may range from 140 to over 200 beats a minute. During VT, the heart does not pump blood as efficiently as it does during its normal rhythm. Therefore, there is less oxygen in the circulation or low blood pressure, which may lead to dizziness and fainting. Some people may experience only mild symptoms, but if left untreated VT may lead to a more life threatening condition called ventricular fibrillation.

Ventricular Fibrillation (VF)

Ventricular fibrillation (VF) is more serious than VT because it causes ‘sudden cardiac death’ if not treated immedately. The heart’s electrical system and pumping cycle are completely disorganised, and the heart provides little or no blood flow to the body. Consciousness is lost in seconds, and immediate cardiopulmonary resuscitation (CPR) must be started in order to sustain the person until the arrival of qualified medical assistance. This is known as a cardiac arrest.

Several treatment options are available for survivors of a cardiac arrest. These therapies are provided by an electrophysiologist (a cardiologist with a specialisation in the electrical function of the heart).

The Heart’s Electrical System

How Does An ICD Work?

The ICD has a complex computerised electrical system.It determines if your heart rhythm is abnormal (VT or VF) and needs correction. If the ICD detects an abnormal heart rhythm it delivers therapy in the form of electrical impulses or shocks directly to the heart muscle to correct the abnormal rhythm. ICD devices also have a pacemaker inside them, which can stop the heart from beating too slowly. Very occasionally the ICD may deliver a shock for a fast heart rhythm that is not VT or VF - this is called an ‘inappropriate therapy’.

Your cardiologist can show you a model of an ICD and talk to you about how the device works in more detail.

What Are The Risks Of Having An ICD?

Risks at the time of the procedure:

Damage to blood vessels when placing the ICD wires into the heart causing bleeding or severe bruising.Puncture of the lung causing an air leak from the lung (1-2%).Damage to any existing ICD or pacemaker wires (rare).

Risks after the procedure:

Movement of the ICD wires requiring repositioning (2-3%).Bleeding from the wound (2-3%).Infection of the wound or wires within the circulation (1-2%).Failure of ICD or lead (very rare).

As with all invasive procedures there are some risks that we feel should be outlined in advance. Overall, it should also be stated that most complications can be remedied and are rarely life threatening.

A more detailed list of potential complications can be provided by your treating electrophysiologist.

Preparation For Your ICD

On the day of your procedure, you will be visited by your cardiologist. They will give you and your family information, support and advice about what to expect before, during and after your ICD is inserted and exactly how an ICD works.

Some preparation will be needed before you have your ICD fitted. This will be explained by the nurses caring for you.

The doctor will explain the procedure and possible complications. You will then need to sign a consent form. If you are unsure of anything, ask the doctor before signing the form. The procedure is undertaken using x-rays, therefore if there is any risk of you being pregnant you must inform a member of the team looking after you.

Before your ICD is fitted:

You must have nothing to eat or drink for at least six hours before your procedure.You will need to remove your street clothes or pyjamas and put on a hospital gown.If you have a bath, shower or wash prior to the procedure, please do not use any creams, oils or body lotions.You will be given some antibiotics before the procedure.You will be transferred to the “cardiac cath-lab” on a trolley/bed.

In The Cardiac Catheterisation Laboratory Catheterisation Laboratory

You may be awake during the time your ICD is fitted. If so, you will be given drugs which will make you feel very relaxed. In some circumstances you may require a full general anaesthetic for the entire procedure. Yourskin will be cleaned with an iodine solution, and sterile drapes placed around the areas of your body where the specialists will be working. There will be an x-ray camera above you and you will be attached to a heart monitor.

The “cardiac cath-lab” is a specialised x-ray room, where your ICD will be implanted. The team involved in your procedure consists of an electrophysiologist, nurses, cardiac technologist and a radiographer. The cath lab staff are highly trained and will be happy to answer any questions you may have. As MonashHeart is a teaching hospital it is not unusual for students or members of staff to observe procedures.

Further checks may be performed to ensure the ICD can detect and correctly treat any abnormal rhythms. This may include having the device deliver a shock, during which you will receive a short general anaesthetic if the initial implant has been performed with sedation. The cut will then be stitched with dissolving sutures, and a dressing applied.

Local anaesthetic will be used to numb the skin and tissues. Once this has taken effect, a cut about 6 to 7 cm long will be made to fit your ICD. When the wire(s) are in place, the cardiac technologist will perform some checks and once these are satisfactory the ICD will be connected. It will then be inserted under the skin.

The whole procedure normally takes between 45 to 90 minutes. You may be transferred to the anaesthetic recovery room after which you will spend two to four hours in the Immediate Care Centre/recovery area or be transferred directly back to your ward. Because of the sedation you may not remember anything about the operation.

On return to the Immediate Care Centre/ward, your wound will be checked regularly for any bleeding or swelling. You will need to stay resting in your bed for least two hours (depending how sleepy you are). Your nurse will advise you when you can get up. When the local anaesthetic wears off, your wound will feel sore, but this can be treated with simple pain killers.

You are advised to limit the movement of your arm on the side that the ICD has been fitted in order to reduce the potential risk of the wire(s) moving.

You may need to have a chest x-ray to ensure the ICD wire(s) are in good position and to check there are no other complications.

It is usually necessary to check the ICD before you leave hospital. You will need to have the ICD programmed and its function checked. Most patients go home on the day the ICD is fitted or the next day.

On Return To The On Return To The Immediate Care Centre / WardImmediate Care Centre / Ward

Care Of Your Wound

The dressing to your wound can be removed approximately seven days after the ICD has been fitted and the wound should then be left uncovered. The stitches in the wound are dissolvable and do not require removal. You may see some bruising around the wound area. It is advisable for the first couple of weeks to wear loose clothing, so that your clothes do not rub on your wound. You are not exempt from wearing a seatbelt. If you find this causes discomfort, a cotton wool pad placed over the ICD site may be helpful.

If any further bruising, swelling or bleeding develops, or if your wound starts to ooze any secretions or becomes hot and tender to touch, contact your local doctor or the Emergency Department at once and inform the Pacing Office, MonashHeart.If infection is suspected, it is vital that a MonashHeart implanting physician is consulted BEFORE any antibiotics are prescribed.

While your wound is healing, you must be careful how it is cleaned. A bath or shower is fine provided that your wound is fully dried afterwards. You are advised not to use any strong smelling soaps, talcum powder, body lotion, deodorants or perfumes while your wound is healing.

Advice For ‘At Home’Advice For ‘At Home’

You will be given a temporary ICD identification card at the time of the implant. A permanent identification card will be sent to you in the post. If you lose your identification card please contact the Pacing Office, MonashHeart at once.

Your first ICD check is at around six weeks. This appointment is automatically made for you. It is important that you are careful with any vigorous activities using your arm of the side of the ICD for about one month, unless advised otherwise by your implanting cardiologist. This will give the wound time to heal and the wire(s) time to settle into place.

Avoid any heavy lifting, strenuous exercise, stretching (for example carrying shopping bags and hanging clothes on the washing line). Household chores like vacuuming and lifting heavy saucepans must be done with caution. If you have to lift anything heavy, make sure you use both hands to take the weight. You may resume a normal sex life when you feel fit but for the first four weeks avoid pressure on your wound.

What To Do If You Have A ShockWhat To Do If You Have A Shock

If you have a shock, you may feel a very firm thump in the chest or back. It is not unusual to find this distressing, especially if it is your first shock. It is unusual to feel any ill effects after a shock but you may feel apprehensive. Above all, try to remain calm. It is unlikely that you will need to go to hospital unless you have received more than one shock or you are unwell (feeling unwell is not the same as feeling nervous or apprehensive). If you receive a shock please call the Pacing Office, MonashHeart (this does not have to be done urgently). If you continue to experience symptoms of dizziness, chest pain or your device gives you a further shock, please call for an ambulance.

Things To Avoid:

Short-wave therapy treatments, eg, slender-tone machines and electrolysis treatments.Direct contact with car ignition systems (if doing car maintenance).High powered radio equipment and TV transmitters. Your own TV and radio are perfectly safe.Welding equipment.Close contact with electrical spark equipment.Never place large magnets near your ICD. (Magnetic bracelets used for arthritis etc should be removed at night). Close contact (less than 15cm) with large stereo speakers should be avoided.Power generators.Before using any electrical exercising sports equipment seek advice from the manufacturer or the gym instructor to check whether it is safe to use.You cannot have an MRI scan with current generation(2009) or older models.

Microwave ovens are normally safe to use, although unserviced or early models (more than 10 years old) should be used at arms length.

Mobile phones should not be carried in a pocket over the ICD. When making or receiving a call you should use the opposite ear to the side of the ICD. Household cordless phones are safe to use.

Shop security systems should cause no problems, but to avoid any potential risks, walk through normally and avoid stopping within 1 metre of the aerials (usually situated at the shop entrance).

If you are unsure if a piece of equipment may affect your ICD, please contact the Pacing Office, MonashHeart. It is important that you carry your ICD identification card at all times, and when attending any hospitals, clinics or dentists for treatment that you inform them that you have an ICD.

Travel

When travelling abroad it is important that you avoid walking through archway metal detector devices. Tell someone at the security area that you have an ICD and show them your identification card if necessary. You may require a hand search to give you travelling clearance. If a hand-held scanning device is used, please ask them not to hold the wand over the device.

Many ICD patients travel abroad regularly, especially as ICD problems are rare. If you have any worries about travelling abroad, the Pacing Office, MonashHeart can obtain addresses of ICD centres throughout the world (please contact the Pacing Office well in advance of your travel date).

After your ICD implant, you may, for a short period, tire more quickly. Gradually increase your exercise as you feel able. Avoid activities that could be dangerous to you should you receive a shock, like rock climbing, swimming/boating alone, climbing a ladder. Avoid contact sports that could cause damage to your device, for example, rugby, judo, football.

You are able to continue most hobbies as soon as you feel able, however if your hobby involves strenuous activity please seek further advice. This will enable you to regain your independence and return to normality. A return to your nor-mal routine will increase your level of confidence and comfort with your device.

Walking, Exercise And SportWalking, Exercise And Sport

Hobbies

FeelingsFeelings

You may experience a whole range of feelings while in hospital or when you go home. You will naturally feel anxious about the device. Feelings of denial, sadness or anger are normal. You may have experienced a stressful, potentially life threatening situation. It may change your thoughts about your life. Some patients feel vulnerable about their need to rely on the device; these feelings should disappear with time. Others feel positive because they are ‘protected’ from a life threatening heart rhythm.

Work

Regarding your return to work, talk to your cardiologist. Contact your occupational health or health and safety officer. If there are any doubts about your safety at work, contact the Pacing Office, MonashHeart who will be able to arrange for a representative from the manufacturer that made your device to visit your workplace to assess any risks.

Driving

For specific advice regarding your ability to drive, please discuss driving with your cardiologist.

In general, for private driving licences, the following rules apply (legal requirements mandated by licensing authorities):

You are not allowed to drive for six months after a cardiac arrest and your device must have been implanted without a shock for this six-month period.Patients who had the device implanted for safety reasons but have not had a cardiac arrest may be eligible to drive after one month (please discuss this with your doctor).If you have a discharge (shock) or pacing treatment from the device you may be precluded from driving until you have been free from further events for six months.The device must be subjected to regular follow up.Patients with ICDs cannot hold a commercial driving licence.

The ICD ClinicThe ICD Clinic

Now that you have an ICD, it is important that you attend the ICD device clinic for your ICD to be checked.

The first check is after four to six weeks. If this is your first visit to the ICD clinic you will need to bring a referral from your GP so that you can claim a Medicare rebate for your visit. Otherwise you will be liable for the full cost of the ICD check.The second check is after three months.You will then need to have your ICD checked at least once a year but more commonly, twice a year.

All your appointments are made automatically for you. If you are unable to attend, phone the Pacing Office or ICD/pacemaker device clinic as soon as possible and a new appointment will be sent to you.

If possible we encourage you to make your own way to the clinic, or to get a relative to bring you. However, if you live in a nursing home or hostel and no transport is available or no one can bring you, then your residence should be able to organise transport for you.

The life of an ICD is normally between four and seven years, after which time your ICD will need replacing (no, it can’t be recharged!). It will be carefully monitored each time you visit the ICD clinic and when the battery begins to show signs of running down you will then be asked to come back more frequently to have it checked. When the ICD needs changing, you will need to come back into hospital for the day.

Now that you have ICD fitted there should be no restrictions or limitations to your lifestyle (besides those mentioned in this booklet). It is important that you continue to live a normal, happy, healthy life and enjoy the benefits that your ICD will provide for you.

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Some Useful Telephone Numbers

ICD Appointment Enquiries:

Dr David Adam MonashHeart 9594 2249Valley Hospital 9790 9338Wonthaggi 5671 3353

Dr Jeff Alison MonashHeart 9594 2249Suite F 9594 2788Melbourne Heart CareBrighton 9592 2177

Dr Stewart Healy MonashHeart 9594 2249

Dr Emily Kotschet Suite B 9594 2461Melbourne Heart CareBrighton 9592 2177

Dr Jack Krafchek MonashHeart 9594 2249

Technical Enquiries Only:Technical Enquiries Only:03 9594 2248 (9.30 am to 5 pm, 24 hr answering machine)

The receptionists are not medically trained and therefore will not be able to answer any questions directly. The receptionistwill take a message and a trained member of staff will return your call. The above numbers should only be only used for general enquiries relating to your ICD.

Pacing OfficePacing OfficeAddress:Address: Pacing Office

MonashHeartLevel 2, Monash Medical Centre246 Clayton Rd, ClaytonVictoria 3168

Telephone:Telephone: 03 9594 2249 or 1300MHEART (1300 643 278)

Fax:Fax: 03 9594 6239

Website:Website: www.monashheart.org.au

Introduction

Your doctor has recommended you have an Implantable Cardioverter Defibrillator (ICD) implanted. This booklet has been written to

help you understand the need for an ICD, what will happen when you have an ICD fitted and the care you will receive afterwards. If there is anything you do not understand please ask a member of the MonashHeart team.

MonashHeart has over 20 years’ experience in ICDs and over 100 are implanted each year. The number of ICDs implanted by MonashHeart continues to rise each year.

Normal Heart Conduction

Within the heart there are specialised pacemaker cells which discharge electricity that stimulates your heart muscle to pump. These pacemaker cells are situated in the sino atrial node (SA node) within the right upper chamber of the heart (right atrium). This is the heart’s natural pacemaker and starts an electrical impulse, which passes through both upper chambers of the heart. It then passes through connecting fibres called the atrio ventricular node (AV node) to activate the lower chambers (the ventricles) and cause the heart’s pumping action. Electrical problems within the ventricles can sometimes give rise to serious heart rhythm problems.

Sometimes the electrical system of the heart can become damaged or scarred, leading to potentially dangerous heart beats. In certain conditions, dangerous rhythms can arise without previous damage. In most of these situations, an ICD can help return the heart to a normal beat.

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