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ICD: Living Well With It

Introduction

An implantable cardioverter-defibrillator (ICD) helps protect you against dangerous heart rhythms. It's important to know how this device works and how to keep it working right. Learning a few important facts about ICDs can help you get the best results from your device.

You may have a device that combines an ICD with a pacemaker, which keeps your heart from beating too slowly. To learn about pacemakers, see Heart Problems: Living With a Pacemaker.

  • Use certain electric devices with caution. Some electric devices have a strong electromagnetic field. This field can keep your ICD from working right for a short time. Check with your doctor about what you need to avoid and what you need to keep a short distance away from your ICD.
  • Know what to do when you get a shock from your ICD.
  • Be sure that any doctor, dentist, or other health professional you see knows that you have an ICD.
  • Always carry a card in your wallet that tells what kind of device you have. Wear medical alert jewellery that says you have an ICD.
  • Have your ICD checked regularly to make sure it's working right.
  • It's common to be anxious that the ICD might shock you. But you can take steps to think positively and worry less about living with an ICD.

How do you get the best results from an ICD?

Use certain electric devices with caution

Some electric devices have a strong electromagnetic field. This field can keep your ICD from working right for a short time. These devices are in your home, garage, workplace, and hospital.

Many other devices do not affect how an ICD works. You can use these safely when they are in good working condition.

Check with your doctor or the manufacturer of your ICD. They can give you a full list of what is safe, what you need to avoid, and what you need to keep a short distance away from your ICD.

Here are some examples.

Devices to avoid

Avoid devices with strong electromagnetic fields, such as:

  • MRI machines, unless you have a device that is safe in an MRI machine or your doctor says you can safely have an MRI done with your ICD.
  • Certain welding equipment.
  • Electronic body-fat scales.

Devices to be cautious around

Keep your ICD at least 0.6 m (2 ft) away from:

  • Induction cooktop stoves.
  • Jumper cables.
  • Table saws.

Keep your ICD at least 30 cm (12 in.) away from:

  • Car battery chargers.
  • Ignition systems of gasoline-powered engines or tools.
  • CB radios.

Keep your ICD at least 15 cm (6 in.) away from:

  • Cell phones and smartphones.
  • Tablets and e-readers.
  • Wearable devices that use wireless technology, such as fitness trackers.
  • Hair dryers.
  • Vacuum cleaner motors.
  • Small magnets.
  • Electric-powered tools such as a drill, lawn mower, or saw.

Do not stand near:

  • Anti-theft detectors in stores.
  • Security systems in airports.

Devices that do not affect an ICD

  • Kitchen and bathroom equipment:
    • Bathroom appliances (such as curling irons, battery-powered shavers, and electric toothbrushes)
    • Kitchen appliances (such as toasters, blenders, electric can openers, and refrigerators)
    • Microwave, gas, and electric ovens
  • Other household items:
    • Heating pads and electric blankets
    • Washing machines and dryers
    • Remote controls
    • TVs, CD players, DVD players
    • Garage door openers
  • Office equipment:
    • Computers
    • Copy machines
    • Printers

What to do if you get a shock

If you get a shock from your ICD, follow the plan you set up with your doctor. In general, your plan depends on how you feel after you get a shock and how many times you get a shock.

After one shock:

  • Call 911 or other emergency services immediately if you feel bad or have symptoms like chest pain.
  • Call your doctor or pacemaker/ICD clinic soon if you feel fine right away. Your doctor may want to talk about the shock and schedule a follow-up visit.

After a second shock within 24 hours:

  • Call your doctor right away, even if you feel fine right away.
  • After a shock, do some breathing exercises. They may help you relax.
    • Sit or lie in a comfortable position. Put one hand on your belly just below your ribs and the other hand on your chest.
    • Take a deep breath in through your nose, and let your belly push your hand out. Your chest should not move.
    • Breathe out through pursed lips as if you were whistling. Feel the hand on your belly go in, and use it to push all the air out.
    • Breathe in and out like this until you feel more relaxed.

Call your doctor if an alarm goes off

Some ICDs have an alarm system that can tell you when to call your doctor. The alarm does not mean that your ICD is not working. It means that your doctor needs to check something on your ICD. For example, an alarm might mean that the battery needs to be checked.

Your doctor can tell you what your alarm will sound like or feel like. You might hear beeping. Or you might feel a vibration, like a cell phone vibration.

Call your doctor right away if you hear or feel an alarm.

Having medical tests and procedures

Many medical tests and procedures won't affect your ICD. But some procedures include electromagnetic fields that could affect how your ICD works. To be safe:

  • Let your doctors, dentists, and other health professionals know that you have an ICD before you have any test, procedure, or surgery.
  • Have your dentist talk to your doctor before you have any dental work or surgery.
  • If you need physiotherapy, have the therapist contact your doctor before using ultrasound, heat therapy, or electrical stimulation.
  • If you need an MRI, check with your doctor first. An MRI can be done if you have an ICD that is safe for an MRI. If you have another type of ICD, the test might be done safely in certain cases, but you will need to talk with your doctor about the benefits and risks.

Travelling

You can travel safely with a cardiac device. But you'll want to be prepared before you go.

  • Bring a list of the names and phone numbers of your doctors.
  • Bring your cardiac device identification card with you.
  • Know what to do when going through airport security.

Driving

If you have an arrhythmia or an ICD that makes it dangerous for you to drive, your doctor might suggest that you stop driving, at least for a short time. You probably don't have to stop or limit driving if your arrhythmia doesn't cause bad symptoms. To learn more, see Heart Rhythm Problems and Driving.

Letting others know

  • Carry an ICD identification card with you at all times. The card should include manufacturer information and the model number. Your doctor can give you an ID card.
  • Wear medical alert jewellery stating that you have an ICD.

Going to follow-up visits

If you think you have an infection near your device, call your doctor right away. Signs of an infection include:

  • Changes in the skin around your device, such as swelling, warmth, redness, and pain.
  • An unexplained fever.

Exercising safely

Ask your doctor what sort of activity and intensity is safe for you. ICDs are set to shock at a specific heart rate. So your target heart rate during exercise will probably be at least 10 to 15 beats below the ICD discharge heart rate.

You doctor can help you learn how to use a rating of perceived exertion (RPE) as a way to tell how hard you are exercising. This can help you keep your heart rate at a safe level during exercise.

Stop exercising and call your doctor if you have:

  • Pressure or pain in your chest, neck, arm, jaw, or shoulder.
  • Dizziness, light-headedness, or nausea.
  • Unusual shortness of breath or tiredness.
  • A heartbeat that feels unusual for you: too fast, too slow, or skipping a beat.
  • Other symptoms that cause you concern.
  • A shock from your ICD.

Having sex

Most people who have an ICD (implantable cardioverter-defibrillator) can have an active sex life. If your doctor says that you can exercise and be active, then it's probably safe for you to have sex.

After you get the device implanted, you'll let your chest heal for a short time before resuming sex. If you or your partner is worried about resuming sex, talk with your doctor about your concerns. Your doctor or another health professional can give you support and advice.

What if I get shocked? Many people with ICDs worry that their ICD might shock them during sex. The risk of getting a shock during sex seems to be the same as during any other similar level of exercise. If you get a shock during sex, you will follow your plan about when to call your doctor.

Will my partner get shocked? Some people worry that if they get shocked during sex, their partner might be hurt. But your partner will not be shocked or feel any pain if you get shocked.

Coping with worry about ICD shocks

You may feel nervous about living with an ICD, and you may worry about getting shocked.

The shock can be uncomfortable. It may feel like you are being kicked in the chest. For many people, getting a shock can cause anxiety and depression.

It's common to be worried about living with an ICD. After all, you don't know when a shock might occur, and a shock could be a reminder that your heart is not as healthy as it could be. But if you take a few simple steps, you can feel better about having an ICD.

  • Try to replace a negative thought about the ICD with a positive one. For example: When you start to worry about getting a shock, remind yourself that the ICD is there to help save your life. Or try to focus on the positive things in your life, such as loving relationships, pleasant activities, or good friends.
  • Talk to your doctor about making an action plan for what to do if you get shocked.
  • Don't make changes in what you do. You may want to avoid an action because you think it caused the shock. But a shock can occur at any time, and you can't prevent shocks by your actions alone. Don't stop doing things you enjoy to try to avoid a shock.

Planning for the future

As you plan for your future and your end of life, include plans for your ICD. You can make the decision to turn off your ICD as part of the medical treatment you want at the end of life. You can put this information in your advance directive.

References

Other Works Consulted

  • Indik JH, et al. (2017). 2017 HRS expert consensus statement on magnetic resonance imaging and radiation exposure in patients with cardiovascular implantable electronic devices. Heart Rhythm, 14(7): e97–e153. DOI: 10.1016/j.hrthm.2017.04.025. Accessed May 25, 2018.
  • Lampert R, et al. (2010). HRS Expert Consensus Statement on the Management of Cardiovascular Implantable Electronic Devices (CIEDs) in patients nearing end of life or requesting withdrawal of therapy. Heart Rhythm, 7(7): 1008–1026. Available online: http://www.hrsonline.org/Policy/ClinicalGuidelines/upload/ceids_mgmt_eol.pdf.
  • Sears SF, et al. (2005). How to respond to an implantable cardioverter-defibrillator shock. Circulation, 111(23): e380–e382.
  • Vasquez LD, et al. (2010). Sexual health for patients with an implantable cardioverter-defibrillator. Circulation, 122(13): e465–e467.
  • Wilkoff BL, et al. (2008). HRS/EHRA expert consensus on the monitoring of cardiovascular implantable electronic devices (CIEDS): Description of techniques, indications, personnel, frequency, and ethical considerations. Heart Rhythm, 5(6): 907–925. Available online: http://www.hrsonline.org/Practice-Guidance/Clinical-Guidelines-Documents/HRS-EHRA-Expert-Consensus-on-the-Monitoring-of-Cardiovascular-Implantable-Electronic-Devices/2008-Monitoring-of-CIEDs.

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