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How is a defibrillator used ?

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Practicing since : 2003
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I had a defibrillator put in 2 yrs ago after a TIA Nothing has ever happened since then Should I have it removed I had a defibrilllator put in 2yrs ago after a TIA as they found my heart beating too slow. I ve gone thru all the monthly checks and never once had a sense of this kicking in. Maybe the doctors were too fast to put it in. Should I have it removed. My BP and other vitals are fine. I am 64.
Posted Wed, 18 Apr 2012 in Hypertension and Heart Disease
 
 
Answered by Dr. Deepak Anvekar 12 hours later
Hello Teri,

Your question is ideal and let me throw some light on the use of ICD and their importance.

It seems that your doctors had implanted a ICD due to development of bradycardia, or they suspected complete heart block. ICD's generally pace heart, defibrillate it and does cardioversion too. First you have not mentioned why was it implanted.

Arrhythmias result from a problem in the heart's electrical system. Electrical signals follow a certain pathway through the heart. It is the movement of these signals that causes your heart to contract.

During a fast arrhythmia, too many electrical signals are moving through the heart. In addition, the signals often do not travel down the proper pathways. The result: the heart cannot pump enough blood out to the body. The person can pass out, and in some cases death—from a sudden cardiac arrest—follows quickly.

An ICD (implantable cardioverter defibrillator), or defibrillator, helps stop dangerously fast heart rhythms in the ventricles (the heart's lower chambers). The device is used to treat sudden cardiac arrest and to restore a normal heartbeat.
This therefore helps prevent sudden death from a fast arrhythmia.

The device treats your heart by sending electrical energy to the heart through the leads:
1. Very low levels of energy called antitachycardia pacing
2. Low levels of energy called cardioversion
3. High levels of energy called defibrillation

The defibrillator system delivers treatment based on what it senses in your heart, even if you don't feel any symptoms.

I assume that over the past 2 years you have undergone monitoring of the defibrillator activity with your doctors.

In case, your condition was transient and your preexisting condition has subsided, then the defibrillator removal can be considered. But before this is done a full evaluation with EKG, holter monitoring and if needed EPI studies can be done to know if your hearts conduction system is absolutely normal.

In such a scenario, the defribrillator can be removed via a minor procedure. You can consider it in mutual agreement with your doctor.

But if your primary heart condition / complication is still present, it would indicate that you are still at risk of any further episodes of bradycardia, and you must continue to have the ICD in place to prevent any risk of sudden death.

You might consult with your cardiologist for a complete evaluation of your cardiac status, and further interventions as needed.

I hope this answers your questions effectively.

In case you have additional questions or doubts, you can forward them to me, and I shall be glad to help you out.

Regards.

Above answer was peer-reviewed by
 
Follow-up: How is a defibrillator used ? 8 hours later
After the TIA, it was revealed that the left ventricle was beating too slow. Therefore, the ICD was the doctor's answer.
 
 
Answered by Dr. Deepak Anvekar 6 hours later
Hello Teri,

Thanks for writing back,

In the answer above I have mentioned how a defibrillator helps in case of arrthymia (the example illustrates a fast arrhythmia). But the same holds good even in case of a heart beating at a low rate.

Slow beating of the left ventricle, is also called as bradycardia (reduced heart rate). When the heart rate slows to a very low level, it results in a low cardiac output and a shock like state, which can cause sudden death.

In such cases, the treatment includes is placement of a ICD, that has a pacemaker function that provide electrical stimuli, thereby causing cardiac contraction when intrinsic myocardial electrical activity is inappropriately slow or absent. These devices sense intrinsic cardiac electric potentials, and, if too infrequent or absent, they transmit impulses to the heart to stimulate myocardial contraction.

Hence in your condition, the need for removal of the device implanted may not be indicated, as it is providing a pacemaker function as well.

In case, further investigations as mentioned above ( EKG, holter monitoring and if needed EPI studies ) provide normal results, then the decision for removal of the device can be taken.

You might consult with your cardiologist for a complete evaluation of your cardiac status, and further interventions as needed.

I hope this helps.

Regards.



Above answer was peer-reviewed by
 
Follow-up: How is a defibrillator used ? 40 minutes later
Total knee replacement 6yrs ago. I have been in excruciating pain for 3mos or more. Neclear C-scan showed prothesis in tact and x-rays showed nothing. Am I just imagining this? Could it be arthritis?

Thank you,
Teri
 
 
Answered by Dr. Deepak Anvekar 6 hours later
Hello and thanks for writing back ,

Since a physical examination is not possible online, to know more exactly about your arthritis, I might need additional information.

Do you have any of the symptoms mentioned below ?
1. difficulty walking
2. Redness/warmth around a joint (inflammation)
3. Joint stiffness or tenderness - along the joint lines
4. Joint fluid or swelling
5. Bumps or nodules
6. Limited range of motion

Do you feel that your joints get locked occasionally while walking ?

Presence of the above signs and symptoms might indicate that your symptoms could be due to peri-prosthetic arthritis or due to inflammation of the supporting structures ( tendons or ligaments).

X rays usually miss changes of arthritis and is not the best investigation. MRI provides precise information about bones, joints and soft tissues, hence might be very helpful to rule out the cause of your symptoms.

You might consult your orthopedic doctor, who can examine you and provide proper treatment.

I hope this helps to clear the doubts.

Regards.
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