Cardiac Rhythm Devices – Subcutaneous implantable cardioverter defibrillators (S-ICD)

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.

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.

It will not pace a slow heart rate.

Its purpose is to monitor and treat fast, dangerous rhythms that start in the bottom of your heart.

A subcutaneous ICD sits on the side of your chest.

It has a sophisticated battery and a computer that monitors your heart rhythm by using a thin wire.

The procedure is done in the operating room while you are asleep.

People at risk of a sudden cardiac arrest can be protected with a small implantable device called a defibrillator.

It automatically detects an irregular heart rhythm and produces an electric shock to return the heart to its normal rhythm.

The subcutaneous defibrillator or S-ICD leaves the heart and blood vessels untouched at all times.

Its electrode is placed just under the skin above the breastbone, and the pulse generator is implanted on the left side of the chest.

Depending on the doctor's usual practice, a local or general anesthetic is given to make the patient comfortable during the 1 hour procedure.

An incision is made on the left side of the chest.

A pocket is formed under the skin where the S-ICD device is fitted.

Two small incisions to the left of the breastbone allow the electrode from the S-ICD to be placed just under the skin.

The electrode is then attached to the S-ICD device.

Once the system has been implanted, most doctors test the defibrillator and adjust the settings to work best for the patient's heart.

This includes inducing an irregular heart rhythm, allowing the S-ICD system to detect it and automatically restore normal sinus rhythm.

Finally, the doctor closes the incisions to complete the procedure.

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.

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 “Dr. 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?"  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.

You will have a driving restriction.

Your physician will confirm how long the driving restriction will be.

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 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.