An implantable cardioverter defibrillator (ICD) is a device designed to prevent sudden cardiac death by detecting and treating life-threatening abnormal heart rhythms. It continuously monitors the heart and delivers pacing or shocks if dangerous rhythms are detected.
A resynchronisation pacemaker is a procedure where a third lead is paced over the surface of the left pumping chamber (ventricle), in addition to the lead in the right pumping chamber (ventricle) and right upper chamber (atrium). This allows re-synchronisation of the pumping of the two main chambers and can be a very effective treatment for heart failure. It is sometimes combined with a defibrillator.
Implantable Cardioverter Defibrillator (ICD)
There are two types of ICD
Standard ICD (ICD)
These have one lead in the right pumping chamber (ventricle) that can deliver shocks for life-threatening rhythm disturbances as long as providing pacing if needed. This lead is thicker than a standard pacing lead as it has a coil to deliver shocks. There is often with second lead in the right upper chamber (atrium), like a standard pacemaker. ICD are inserted where often standard pacing may be needed in addition to treating dangerous rhythms.
Subcutaneous ICD (S-ICD)
A subcutaneous ICD (S-ICD) is a type of defibrillator implanted under the skin rather than inside the heart. It provides protection from dangerous arrhythmias without the need for intracardiac leads. This can be used in patients that do not otherwise need standard pacing but just treatment of dangerous heart rhythm disturbances.
Your doctor will recommend which type of ICD is correct for your condition (some people needing an ICD might not be able to have a S-ICD
Why Might I Need an ICD?
ICDs are used in patients with:
- High risk of ventricular arrhythmias
- Previous cardiac arrest
- Severe heart muscle weakness
- Certain inherited heart conditions
What Happens During Implantation?
- ICD: The device is implanted under the skin below the collarbone, with leads placed into the heart via veins. The system is tested before the procedure is completed.
- S-ICD: The device is implanted under the skin on the side of the chest, with a lead positioned just beneath the skin along the chest wall.
Benefits
- Prevents sudden cardiac death
- Continuous heart rhythm monitoring
- Life-saving therapy if required
Recovery
Most patients recover quickly and are discharged within a short period (usually the same day), with follow-up to ensure correct device function. You cannot drive for a few days after ICD insertion, please ask your consultant about timing and regulations
CARDIAC RESYNCHRONISATION PACEMAKER
Cardiac Resynchronisation Therapy Pacemakers (CRT-P): also called biventricular pacing, are used in patients with heart failure due to pump function failure. A resynchronisation pacemaker is a procedure where a third lead is paced over the surface of the left pumping chamber (ventricle), in addition to the lead in the right pumping chamber (ventricle) and right upper chamber (atrium). All three leads are connected to a specialised pacemaker box which allows re-synchronisation of the pumping of the two main pumping chambers (ventricles). This improves the timing of heart contractions, helping the heart pump more efficiently and reducing symptoms of heart failure.
Cardiac Resynchronisation Therapy Defibrillator (CRT-D): If the patient has a condition necessitating a defibrillator as well as a need for resynchronisation therapy pacing then a defibrillator lead is placed in the right pumping chamber (ventricle), in addition to the third lead paced over the surface of the left pumping chamber (ventricle) and , and right upper chamber (atrium) lead. All three leads are connected to a specialised pacemaker box which allows re-synchronisation of the pumping of the two main pumping chambers (ventricles), providing all the benefits described above, as well as delivering defibrillator (ICD) therapies when needed
WHY MIGHT I NEED CARDIAC RESYNCHRONISATION (CRT-P OR CRT-D)?
- Heart failure with reduced ejection fraction
- Electrical dyssynchrony (e.g. left bundle branch block)
- Persistent symptoms despite medication
- Reduced exercise tolerance or breathlessness
- Indications for defibrillator (ICD) lead
How does it work?
A Cardiac Resynchronisation (CRT-P or CRT-D) device uses three leads placed in different chambers of the heart to coordinate contractions between the left and right sides, improving pumping efficiency.
BENEFITS OF CARDIAC RESYNCHRONISATION
- Prevents sudden cardiac death
- Continuous heart rhythm monitoring
- Life-saving therapy if required
WHAT HAPPENS DURING IMPLANTATION?
The device is implanted under the skin below the collarbone, with leads placed into the heart via veins. The system is tested before the procedure is completed.
Recovery
Most patients recover quickly and are discharged within a short period (usually the same day), with follow-up to ensure correct device function. You cannot drive for a few days after CRT-P or CRT-D insertion, please ask your consultant about timing and regulations
FOLLOW-UP OF ICD, S-ICD, CRT-P AND CRT-D
Often you will have one on-site check after device insertion. You will then need follow-up of your device at least once a year to monitor batter life and function. In most cases you will be given a remote monitoring device and your device talks to a station in your home, via Bluetooth, and this is used to check the function of your device and it’s battery life by our Cardiac Rhythm Management team. Please note most insurance companies do not cover the cost of remote monitoring. This can be done on the NHS where any abnormalities are usually discussed with the resident doctor on call and most do not need escalating to a consultant. However, if you want a more bespoke private remote monitoring service, with more frequent downloads and direct contact with our rhythm team analysts, you usually need to pay for this yourself. The differences between NHS and private monitoring of your device will be fully explained at the time you have your device implanted and you will then be asked to sign a consent for which service you would rather have.
BATTERY LIFE OF ICD, S-ICD, CRT-P AND CRT-D
The battery life of devices depends on their usage, which varies from person to person. In most cases even with very heavy use a pacemaker battery lasts 6-15 years, your annual checks will monitor battery life and a change of the pacemaker device is scheduled with 6 months to one year of batter left, so you need never worry about the battery life. Please see the page: ICD, S-ICD, CRT-P AND CRT-D BOX CHANGE
ICD, S-ICD, CRT-P AND CRT-D PROBLEMS
Most problems with device function are detected by the device checks. However, occasionally devices are uncomfortable and can need repositioning and information of this can be found on: RE-SITING OF PACEMAKER OR ICD. Occasionally if checks identify a problem with one or more of the leads then replacement of a pacing or ICD lead may be needed and information of this can be found on: LEAD REPLACEMENT FOR PACEMAKER OR ICD
related treatments & procedures
Explore related treatments and procedures that may be relevant to your care.
Get in touch
Please note that with increased demand, and long NHS waits, our services and office are under more demand than ever. As a result our staff are exceptionally busy and often working under great pressure.