Cardiology Published: March 2015 Review date: March 2018 Reference no: 2532v1 Imperial College Healthcare NHS Trust

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1 Cardiology Published: March 2015 Review date: March 2018 Reference no: 2532v1 Imperial College Healthcare NHS Trust

2 An Implantable Cardioverter Defibrillator or ICD is a device which has a pulse generator battery powered electronic circuit and can constantly monitor your heart rhythm through electrodes (leads). The ICD device will either be single chamber (one lead), dual chamber (two leads) or biventricular (three leads CRT-D) depending on the type of heart problem you have. You have had or are at greater risk of having dangerous heart rhythms. The ICD can be life-saving because it stops these problems by pacing the heart or by delivering a small electric shock that can restore a normal heart rhythm. Most people have a local anaesthetic with sedation but, in some cases, a general anaesthetic may be used. The doctor will inject local anaesthetic (usually just below your left collar bone) and make a small cut. The device will be implanted near the left shoulder. Sites can vary and this will be discussed with you. The ICD leads will be passed through a main vein in the chest to the heart first. The leads are secured and the defibrillator function may be checked while you are sedated. The wound is then closed with stitches or a special type of medical glue. A dry dressing may be applied following stitches. You will have the opportunity to speak to a specialist nurse about the ICD either while you are in hospital, via a clinic appointment, or over the telephone. All cardiac procedures carry a small risk. This will be discussed in more detail by the specialist nurse or cardiologist. The procedure usually lasts between one to three hours, depending on the number of leads implanted. This includes the time to set up and test the device. If you are not already in hospital then you will be asked to come in for a day and, potentially, an overnight stay. The ICD is slightly larger than a small matchbox - there may be a small bulge where it has been implanted. The implant site may be sore and bruising visible. You will have a small scar under your collarbone and you should keep the wound clean and dry until it has healed. You will probably be allowed to go home once a chest x-ray has been carried out. You may also be invited to join a cardiac rehabilitation programme, which has been shown to have significant benefits such as improving physical activity and wellbeing. Please contact the specialist nurses if you would like to attend the programme.

3 Care and management of your ICD will be co-ordinated by the ICD clinic (cardiac investigation centre). An initial appointment will be sent to you for an ICD check around four to six weeks after the implant. You will need to come to the department to have your ICD checked at regular intervals (usually every 6-12 months). Home monitoring can be discussed as well. A cardiac physiologist is specially trained to follow-up patients with ICDs. These checks do not replace seeing your cardiologist in the outpatient clinic. During the first month do not raise your elbow above your shoulder - this will allow your wound to heal and the leads to settle. Avoid strenuous arm movements such as lifting heavy loads, playing golf or swimming until you are seen in the ICD clinic. If the implant area becomes sore, swelling occurs or there is any discharge or oozing, please contact the ICD clinic, or, if out of hours, go to your nearest urgent care centre: Group 1 Private Licence Depending on the medical reasons why you require an ICD, you will be barred from driving for an initial period of either: one month from the date of your implant if the device was implanted for preventative reasons without a previous cardiac event, or six months if you have had a previous cardiac event Please visit the DVLA website ( or contact the arrhythmia nurses for clarification. Group 2 Licences You will be permanently barred from holding a Large Goods Vehicle (LGV), Passenger Carrying Vehicle (PCV), or C1 (Medium Goods)/D1 (Minibus) licence. To contact the DVLA: Write to: Drivers Medical Enquiries DVLA Swansea SA99 1TU Telephone: (Monday to Friday, to 17.30, Saturday, to 13.00) Treatment delivered by the ICD might impair safe driving. Therefore, if you have a driving licence and have been experiencing abnormal heart rhythms due to treatment delivered by the ICD, you must inform the DVLA.

4 You must tell the DVLA if you have a driving licence and: you develop a notifiable medical condition or disability There is a small risk of damage to your ICD from an exceptionally violent impact, so heavy contact sports should be avoided. a condition or disability has got worse since you got your licence (DVLA Medical conditions, disabilities and driving, November 2014) Seatbelts Patients with an ICD are not exempt from wearing a seatbelt. It may be necessary to place a small pad over the ICD to alleviate any discomfort which a seatbelt may cause. Most people can return to their normal activities and jobs. The exception is arc welding and some other jobs involving industrial machinery which has a powerful magnetic field, or jobs involving television, radio or radar transmission equipment. A magnet placed very close to the ICD will temporarily deactivate its ability to treat fast heart rhythms. When the magnet is removed, the ICD is reactivated. Therefore, magnets should not be placed close to the ICD. Exceptionally strong (e.g. industrial) magnets should be avoided. Magnets can be found in a variety of electrical devices including Hi-Fi speakers and in magnetic buttons found in some trendy clothes. All current ICDs are protected against mobile phone interference. However, avoid keeping a mobile phone in a shirt or jacket pocket over your ICD (even if it is switched off). A general rule of thumb for most electronic gadgets would be to keep them at least six inches (fifteen centimetres) away from the ICD. Properly maintained domestic electrical appliances, including microwave ovens, will not adversely affect the function of the ICD. If you are unsure whether an electrical appliance could affect your ICD, first contact the manufacturer. If they are unable to answer your questions please contact the ICD clinic for advice. If in doubt, please discuss your concerns at your next ICD check, or speak to an arrhythmia nurse. Most ICDs are currently not compatible with MRI scans, but normal x-rays and CT scans are safe. If you have concerns about medical treatments, please discuss them with the department, doctor or dentist treating you. Medical staff may wish to contact the ICD clinic regarding any possible interaction with your device. If you still have concerns please contact the ICD clinic. You should avoid doing activities that could be dangerous if your ICD delivers any treatment for example, skiing, swimming alone and climbing ladders or scaffolding.

5 You may wish to consider wearing a MedicAlert bracelet to inform medical staff that you have an ICD. Find out more online at Telephone: info@medicalert.org.uk Most ICDs last approximately eight years, but this depends on how much pacing or shock therapy is required over the device s lifetime. The battery life is monitored at each ICD check. When it is time for your device to be replaced, an appointment will be arranged for you to be admitted, most likely as a day case procedure. You will be given a device identification card at your first ICD check (within four to six weeks of your implant procedure). Please carry this with you at all times. Travel is safe but you are advised to show airport security staff your ID (ICD card) then follow their instructions about walking through the security archway or using the handheld wand. If they ask you to walk through the archway, go through at a brisk pace - it is more likely to set off the alarm than cause problems with your ICD. Always ensure that you have adequate travel insurance. Having an ICD should not affect your sex life. If you receive a shock from your ICD it will not harm anyone in contact with you. Some patients feel down or even depressed after an ICD implant. The reasons for this vary from patient to patient and not everyone is affected. Getting back to normal activities can help, as can speaking to a clinical psychologist who is part of our cardiac rehabilitation team. There may come a time where your health deteriorates and you no longer wish to receive shocks from your device. This is something you should discuss in advance with your medical team. The shock treatment from an ICD can be turned off if required (whilst leaving the pacemaker function on). This can only be done by a specialist cardiac physiologist in conjunction with a consultant cardiologist.

6 Alternatively, you may wish to express your concerns in writing to: If you have any queries about your ICD please contact: ICD clinic: (Monday to Friday, to 17.00) Arrhythmia nurse specialists: (Monday to Friday, to 17.00) Chief Executive - Complaints Imperial College Healthcare NHS Trust Trust Headquarters The Bays, South Wharf Road London W2 1NY Important This leaflet can be provided on request in large print, as a sound recording, in Braille, or in alternative languages. Please contact the communications team on If you receive one or two shocks but otherwise feel well, contact the ICD clinic from Monday to Friday between and to arrange an appointment for the next working day: Hammersmith Hospital If you receive one or two shocks or more than two shocks and feel unwell, ring 999 to attend your local A&E. We aim to provide the best possible service and staff will be happy to answer any questions you may have. If you have any suggestions or comments about your visit, please either speak to a member of staff or contact the patient advice and liaison service (PALS) on (Charing Cross, Hammersmith and Queen Charlotte s & Chelsea hospitals), or (St Mary s and Western Eye hospitals). You can also PALS at pals@imperial.nhs.uk. The PALS team will listen to your concerns, suggestions or queries and is often able to help solve problems on your behalf.