Staten Island Heart's Doctors, Board Certified Cardiologists, Specializing in the treatment, care and prevention of Cardiovascular Disease. Located in Staten Island and Brooklyn, New York.
Automatic Implantable Cardioverter-Defibrillators (AICD)
What is an automatic implantable cardioverter-defibrillator?
The implantable defibrillator (AICD) is an electronic device like a large pacemaker that is implanted surgically in a pocket formed in the chest wall. It consists of a pulse generator that can deliver a powerful shock to the heart; electrodes to sense the rhythm of the heart and to deliver the shock to the heart muscle; and a computer and circuitry that tells the AICD when to discharge the shock.
The first implantable defibrillators required open-chest surgery to implant the electrodes. Fortunately, the present units do not require open chest surgery for implantation. The electrodes can be inserted through a large vein that runs beneath the collar bone and directed into the heart under x-ray guidance (fluoroscopy). The pulse generator is then buried under the skin of the chest wall, the electrodes are inserted into the heart through the veins, and the pulse generator is surgically buried under the skin of the abdomen or chest.
Why are AICDs needed and how do they work?
Some people are at very high risk for sudden death. This group includes those whose heart suddenly stops pumping blood due to loss of an organized heartbeat (ventricular fibrillation) or an excessively rapid heartbeat (ventricular tachycardia). These rhythm disturbances can result in loss of consciousness and/or death. When these rhythms occur in a hospital setting with the heart rhythm being monitored, such as in the coronary care unit, an electrical shock can be quickly given, restoring the heart to a normal rhythm. Many episodes, however, occur outside hospitals and the victims can die unless CPR is administered quickly and defibrillation accomplished by a medic unit. Because the resources are not always available in a timely fashion, patients at high risk for these events may receive a defibrillator.
The defibrillator monitors the heart rhythm. When a life threatening rhythm is detected, the device can delived a powerful electrical shock to the heart restoring normal rhythm. A variety of sophisticated electrical therapies can be selected by your cardiologist depending on the type of heart rhythm being treated. The batteries are designed to last approximately 3 to 5 years and deliver about 100 shocks.
.
Who is a candidate for an AICD?
Today's candidates for an AICD fall into three categories. The first is someone who has recurrent ventricular tachycardia that is poorly controlled by drugs. A second group is those patients who have survived ventricular fibrillation but have not had an acute heart attack. Such people are at high risk for another episode of ventricular fibrillation. Into the third group fall certain people who have structural defects of their heart. These defects include massive dilation or excessive thickening of the heart muscle. Some of these patients are at high risk for arrhythmias and testing can indicate that an implantable defibrillator is the therapy of choice.
Prior to implantation of an AICD, a sophisticated test called an electrophysiological study (EPS) may be performed. This procedure measures the vulnerability of the heart for a potentially fatal event. It is used to help decide whether to use an AICD or whether to use drugs for treatment. The newer AICD units can be implanted without major surgery. The cardiologist will determine whether the risks outweigh the benefits.
What are the benefits of an AICD?
Currently available research evidence shows that AICDs prolong life in people who have them. For many, the quality of life is much improved. Most do not need to take drugs, which often have uncomfortable side effects. Many patients greatly appreciate the peace of mind given them by the device. They no longer have to worry about spells of unconsciousness. Some can resume driving automobiles without worry.
What are the complications of an AICD?
The defibrillator unit can cause local discomfort. The most common long-term complication is the delivery of shocks when the patient does not need them. This is less of a problem with more recent devices. The patient is usually quite aware of each shock, even though it is very short in duration. The patient's doctor should be notified of every shock the patient feels. When the batteries have depleted their energy, the pulse generator must be replaced. Replacement of the pulse generator requires only minor surgery. Another consideration is the cost. It is estimated that evaluation, EPS studies, surgical implantation, and the device itself may cost between $45,000 and $55,000. Replacement of a depleted pulse generator costs only a fraction of the initial amount.
What happens after AICD implantation?
Recovery time after implantation of newer AICD units is quite short. Hospital stays are rarely longer than 3 or 4 days and there is quick return to prior activity levels. People with AICDs must continue to follow their doctor's recommendations regarding medication, diet, and exercise.
The first implantable defibrillators required open-chest surgery to implant the electrodes. Fortunately, the present units do not require open chest surgery for implantation. The electrodes can be inserted through a large vein that runs beneath the collar bone and directed into the heart under x-ray guidance (fluoroscopy). The pulse generator is then buried under the skin of the chest wall, the electrodes are inserted into the heart through the veins, and the pulse generator is surgically buried under the skin of the abdomen or chest.
Why are AICDs needed and how do they work?
Some people are at very high risk for sudden death. This group includes those whose heart suddenly stops pumping blood due to loss of an organized heartbeat (ventricular fibrillation) or an excessively rapid heartbeat (ventricular tachycardia). These rhythm disturbances can result in loss of consciousness and/or death. When these rhythms occur in a hospital setting with the heart rhythm being monitored, such as in the coronary care unit, an electrical shock can be quickly given, restoring the heart to a normal rhythm. Many episodes, however, occur outside hospitals and the victims can die unless CPR is administered quickly and defibrillation accomplished by a medic unit. Because the resources are not always available in a timely fashion, patients at high risk for these events may receive a defibrillator.
The defibrillator monitors the heart rhythm. When a life threatening rhythm is detected, the device can delived a powerful electrical shock to the heart restoring normal rhythm. A variety of sophisticated electrical therapies can be selected by your cardiologist depending on the type of heart rhythm being treated. The batteries are designed to last approximately 3 to 5 years and deliver about 100 shocks.
.
Who is a candidate for an AICD?
Today's candidates for an AICD fall into three categories. The first is someone who has recurrent ventricular tachycardia that is poorly controlled by drugs. A second group is those patients who have survived ventricular fibrillation but have not had an acute heart attack. Such people are at high risk for another episode of ventricular fibrillation. Into the third group fall certain people who have structural defects of their heart. These defects include massive dilation or excessive thickening of the heart muscle. Some of these patients are at high risk for arrhythmias and testing can indicate that an implantable defibrillator is the therapy of choice.
Prior to implantation of an AICD, a sophisticated test called an electrophysiological study (EPS) may be performed. This procedure measures the vulnerability of the heart for a potentially fatal event. It is used to help decide whether to use an AICD or whether to use drugs for treatment. The newer AICD units can be implanted without major surgery. The cardiologist will determine whether the risks outweigh the benefits.
What are the benefits of an AICD?
Currently available research evidence shows that AICDs prolong life in people who have them. For many, the quality of life is much improved. Most do not need to take drugs, which often have uncomfortable side effects. Many patients greatly appreciate the peace of mind given them by the device. They no longer have to worry about spells of unconsciousness. Some can resume driving automobiles without worry.
What are the complications of an AICD?
The defibrillator unit can cause local discomfort. The most common long-term complication is the delivery of shocks when the patient does not need them. This is less of a problem with more recent devices. The patient is usually quite aware of each shock, even though it is very short in duration. The patient's doctor should be notified of every shock the patient feels. When the batteries have depleted their energy, the pulse generator must be replaced. Replacement of the pulse generator requires only minor surgery. Another consideration is the cost. It is estimated that evaluation, EPS studies, surgical implantation, and the device itself may cost between $45,000 and $55,000. Replacement of a depleted pulse generator costs only a fraction of the initial amount.
What happens after AICD implantation?
Recovery time after implantation of newer AICD units is quite short. Hospital stays are rarely longer than 3 or 4 days and there is quick return to prior activity levels. People with AICDs must continue to follow their doctor's recommendations regarding medication, diet, and exercise.
Send mail to webmaster@siheartdocs.com with
questions or comments about this web site.
Copyright © 2002-2007 Staten Island Heart
Copyright © 2002-2007 Host-U, Inc. and its Licensors
Notice:
All pages and their content are provided as information only. This is not a substitute for medical care or your doctor's attention. Please seek the advice of your Cardiologist or family doctor.
SIHeartDocs.com presents this data "as is", without any warranty of any kind, express or implied. It is impossible to cover every eventuality in any answer, which makes direct contact with your health care provider imperative.
This Site is Designed, Hosted, Managed and Maintained by Host-U,
Inc. 
Staten Island Heart - Board Certified Cardiologists, Practicing in Staten Island and Brooklyn New York. Cardiology Group Specializing in the Treatment and Prevention of Cardiovascular Disease. SIHeartDocs.com