Cardiac Rhythm Devices (ICDs)
Hi, my name is Steve.
This is Melanie and this is Michelle, and we're nurses from the Heart Rhythm Device clinic at the Mazankowski Heart Institute.
We're here today to tell you why you're getting a device, what the device is going to do, and what to expect when living with the device.
Your doctor has recommended that you receive a cardiac rhythm device because you're having problems with your heart's electricity.
The heart sends signals from the top to the bottom.
Your heart has trouble receiving signals and the device that you will receive will help to correct that issue.
ICD stands for implantable cardioverter defibrillator.
If your heart goes into a fast, life threatening rhythm, the device will treat it to get your rhythm back to normal.
Many people have an ICD for safety, like a little paramedic sitting in your chest.
If you have a slow heart rate, the ICD can also pace to prevent your heart rate from being too slow.
An implantable cardioverter defibrillator, or ICD, is used to treat a dangerously fast heartbeat.
It is small enough to fit into the palm of your hand and weighs 69 to 85 grams.
The ICD monitors your heart for very fast and potentially dangerous rhythm disorders.
The device is surgically placed or implanted just under the skin in the chest area.
The ICD is attached to 1 or 2 thin coated wires called leads, which are placed in or on the heart muscle.
When an abnormal heart rhythm occurs, the ICD sends a shock to the heart muscle to defibrillate, or stop the cycle of rapid twitching.
Interrupting the pattern of the rhythm disorder allows the heart to resume its normal rhythm.
Before your procedure you will come to cardiac recovery, a pre-op holding area and a recovery area.
You will be put into a gown, put on a heart monitor, have an IV [intravenous] and some other preparation will be done.
You will come to the EP [electrophysiology] procedure room and lie on a table.
You will again be put on a cardiac monitor.
There will be some sterile, green drapes over your face, but you will be awake.
You will be able to talk and the nurses will check on you to see if you are comfortable throughout the procedure.
You'll get some medication to make you relaxed.
After your procedure, you go back to the recovery area for some monitoring before you go home.
You will be seen by a device clinic registered nurse.
You will have a gauze dressing.
Please do not shower or bath for the first 2 days.
After 2 days, wash your hands and remove the tape and gauze.
You will then see little tapes on your skin called steri-strips.
Now you should shower daily to let water run over the incision and gently pat it dry.
It is OK if some soap touches the incision, but do not use lotions or powders until it is fully healed.
Do not soak in water, such as a pool or a bathtub, until it is fully healed, because this can cause infection.
Please see your family doctor in 7 to 10 days to check the incision.
The steri-strips can be removed at this visit, or you can take them off while in the shower at home.
Most incisions will heal well, but it is important to watch for signs of infection or complications.
Please call the clinic if you have any questions or concerns.
Signs to watch for are: redness, swelling that causes the skin to feel tight, bruising that extends beyond the area of the incision or returns after it is healed.
Also note if the skin feels hot or changes colour.
Watch for drainage, fever, or chills.
Tenderness is normal, but please call if the pain returns or increases significantly after the first few days.
If you are unsure, please call.
This is what we are here for.
It is much easier to catch a problem early instead of late.
The clinic phone number is on the bottom of every appointment letter you receive and it is also on the instruction papers we will give you after your procedure.
These are some examples of incisions that are all healed.
You can see that one shows the skin is a different colour when it is healed.
This is normal.
It is just how some people heal.
The scar fades overtime.
We're going to ask you to restrict your arm movement on the side that the device was implanted for the next 6 to 8 weeks.
We don't want you to reach way out and we don't want you to reach way up over your head.
We also don't want you lifting anything more than 5 pounds, or the weight of a milk jug.
If you normally use your arms to help push yourself out of the bed, or you have a walker that you lean on, we ask that you not do that for the 6 to 8 weeks.
That will put pressure on the pectoral muscle and it might dislodge the leads.
We want you to kind of take it easy around the house, avoid doing extraneous or hard work like that, but anything else - we do want you to continue walking, and aerobic exercise is just fine.
The 3 most important things for you to remember are: incision care, when to call the clinic, and arm movement and lifting restrictions.
This information is also written on the instruction papers you will receive after the procedure.
You will have a driving restriction.
Your physician will confirm how long the driving restriction will be.
You will be given a temporary ID card for your device which has the serial number of the device.
This is temporary paper.
The company will mail you a permanent one in a few months.
You should keep it in your wallet at all times.
Then you will show airport security if you're traveling as you go through the security system.
You should let all healthcare professionals know that you have the device.
People often have questions about what objects in the environment will interfere with their device.
Not that many really.
It is completely safe for you to use a microwave.
Household items such as a television, computer, heating blankets, etc. are safe.
Personal care items such as a razor, hair dryer, and curling iron are safe.
Small handheld hobby tools are usually safe if you are not sure, call the 1-800 number on your device card.
You can use your cell phone almost anytime.
What we do ask is that you do not use your cell phone on the side in which your device was implanted.
We also ask that you do not put the cell phone in your breast pocket.
Objects that you do need to avoid being in close contact with are often heavy industrial machinery or industrial magnets.
Avoid TENS [transcutaneous electrical nerve stimulation] or Doctor Ho machines because they use direct electrical stimulation.
The best way to find out if a piece of equipment is safe or not is to phone the 1-800 number on your ID card.
The company has specialists that can give you advice.
Another common question people have is, “Can I have an MRI [magnetic resonance imaging]?"
Yes, it may be possible, but that would be for further discussion with your physician.
The defibrillator may treat a dangerous heart rhythm by giving you a shock.
A shock is not a small twinge of muscle soreness.
Most of our patients tell us it's like getting a large kick in the chest.
It is unpleasant, but it can save your life.
It is important to know what to do if you get a shock first.
Rest for 10 to 15 minutes.
If you feel absolutely fine, call the device clinic that day.
If you do not feel well or if you get more than one shock, you need emergency care.
Call an ambulance or go to the nearest emergency.
Do not drive yourself to the emergency because this puts you and others in danger.
If you have a shock, according to Canadian guidelines, you are not legally allowed to drive until you see your EP (electrophysiologist) doctor in the clinic.
If you receive a shock from your defibrillator, it can be upsetting.
Talk to your doctor and nurse at clinic.
Sometimes expressing your feelings can help you.
Some people talk to their family doctor to get some counseling support.
If you need to talk to someone, it just makes you like many other people with defibrillators.
Expressing your feelings can help you move on and enjoy life.
Your first clinic visit will be approximately 6 weeks after your device procedure.
You will receive a written appointment letter with instructions.
Our clinic is located on the 2nd floor of the Mazankowski Alberta Heart Institute.
After the initial 6 week visit, generally you will come at 3 months and then again every 6 months.
This video was developed for you by the team of registered nurses at the Mazankowski Heart Rhythm Device Clinic.
We offer special thanks to Doctor Sivakumaran, our medical director for suggesting this project, to Tobie Guinez, our nurse manager, for her support and enthusiasm.
Also, we appreciate our patients whose identity is not shown but who consented to allow pictures to be taken of their incisions.
And heartfelt thanks to Abbott, Boston Scientific, and Medtronic for animations and pictures in this video.
