I can understand your husband not wanting an ICD but he may be being a bit naive about his situation. If a person with heart damage continues to have runs of vt regardless if he feels healthy that doesn't safe guard him from sudden death if the cardiologist deems he is at risk. Arrhythmia issues come and go with varying degrees of intensity which means it may only take one bad run that his heart is unable to convert back to normal sinus rhythm that could cause a fatal deterioration into Vfib which is pretty deadly if not treated quickly. I guess I would ask if he still has the cardiomyopathy or has his heart fully recovered? When he gets VT how long does it last? For just a few beats or for minutes or longer? If he is only getting brief runs then the signal may not be getting caught in a reentry circuit but if the doctor truly suspects there is enough heart damage from the cardiomyopathy then exercising and meds will not guarantee he will avoid sudden death. That doesn't mean it will happen because no one can predict these kinds of things but simple lifestyle changes does not cure one from scar tissue causing issues within the heart to fall into dangerous rhythms. Reentry circuits can be caused by two factors mostly. Being born with extra muscle fibers that allow the electrical signal in the heart to get caught in a loop causing it to beat faster than normal. Most of them occur in the atria and are not dangerous. The other reentry circuit is caused by scarring from previous heart attacks or other heart damage that act as a conduit for the signal to get caught in a loop causing the heart to beat fast as well. This tends to happen in the ventricles causing VT. If vt does not revert on its own it can deteriorate into Vfib which is essentially cardiac arrest. I am not a doctor and there could be other risk factors for people who don't have reentry vt but still get runs of them that are dangerous in the context of having cardiomyopathy so I would maybe ask him to seek a second opinion or get a better understanding of his situation, how his heart is behaving, from his doctor. There are different kinds of cardiomyopathy and understanding his type may help him see his situation for what it truly is. Also I would recommend that you learn CPR for your own peace of mind. But glad to hear he is taking steps to live a heart healthy lifestyle.
I am no expert, but I would think that runs of VT in the setting of a reduced ejection fraction is far too serious to treat with natural remedies or OTC medication.
I do not understand why he refuses a defibrillator just because he feels well. It would provide an excellent protection from sudden cardiac death and provide safety for both his family and himself. I would think that when the defibrillator is implanted, it is more or less forgotten.
I do hope he will follow the advice from his cardiologist. He would not recommend an ICD/defibrillator if he did not have any reason to do so.
Best of luck to you both.
RE - "would think that when the defibrillator is implanted, it is more or less forgotten. "
Although I agree with you and Michelle that he would be better off with an ICD than not, it is not maintenance and complication free by any means. If he still has VT, ICD doesn't correct it and it will deliver painful shocks that run the battery down along with ER visits. He will still need the VT to be treated (probably by ablation if the center is good at it - if not he has to search for a center that's good at it) and also optimal tuning of the ICD so he doesn't get unnecessary shocks. It is a high maintenance item if not done right. And SCD can still happen even though the risk is a lot lower. See VTACH trial results published by Kuck.
First of all to refuse to have an ICD because: "it delivers painful shocks that run the battery down" is misleading.
The circuitry does not activate unless there is a life-threatening rhythym. In general the devices and technology is mature. One does not go and "search for a center good at optimal tuning".
Failure to defibrillate results in death. As in "end of life".
CPR is not effective in reversing ventricular fibrilation.
In view of your prersentation implantation of an ICD is the reasonable and prudent choice.
No cpr alone would likely not bring one out of vfib but it can keep the person alive long enough for life saving measures to be taken. It is the only hope in that instance and an ambulance should be called immediately. The bottom line is doctors are very cautious about prescribing an icd unless they deem it absolutely necessary. As the others have said, it could save his life. Please help him to get more educated on the matter. I am not sure what the protocols for having an external defibrillator in your home are, I know they are pretty standard in an office setting so maybe you can see if you can get trained for that and have one on hand if something dire happens. Again though not sure in a home setting what the rules are.
Good advice! Also, his physician gave good, accurate advice as well. The nature of your husband's VT tends to "spiral in", and degrade to where one results in sudden death. 62 is too young to have his ticket punched.... needlessly. You need to talk to your husband!
....also, modern ICD's will step the charge up by delivering a low energy followed by progressively higher charge. Many times a low charge will do the job eliminating the unpleasant effect of a full charge. Please talk to your husband. Based on your brief story, this is not something you want to delay doing.
He still has the cardiomyopathy, judging by the persistently low EF and cardiac arrhythmias.
His coronary arteries are clean.
He gets the VT in runs of 4-10 beats at the rate of 120-160 bpm.
He gets multiple runs of 4 beats and about 4 to 6 runs of 10 beats of monomorphic non-sustained VT in a 24 hour period.
If his heart is not healing from the cardiomyopathy then it does leave him more vulnerable. The runs are super short which is really good but if he is getting them everyday then that is not good so I would encourage him to at least get a second opinion before making any final decisions if you can. He really should be fully informed about his heart condition, if it will improve with what he is doing to be healthier or if it will stay the same or if it will deteriorate. This isn't the type of thing to take casually, information is his best tool for living as long as possible. I wish you the best as you try to guide him. Take care.
You take my words out of context. Re read my first sentence. You have no idea about ICDs and complications. I have a friend who has had ICD implants for over 20 years. During those 20 years, this friend had to have SIX surgeries for battery replacements, lead fractures and infections. She almost died last time. The ICD twice in those years so she is relatively lucky in that her VTs were very infrequent. Each time she had surgery, she was out six months from physical activities that she loves. The programming for the devices are also understandably conservative because of liability issues. Only more recently have the device companies listen to complaints of patients and doctors about unnecessary shocks as Tom wrote. As I said, ICDs doesn't do anything for the VT and the heart getting worse. It is a safety net and that is all, with all its inherent shortcomings. To heal the heart, the source of the VT has to be treated with ablation as medications are ineffective for the vast majority. Unfortunately, there are only around three dozen centers in the US that do sufficient volume but the skills are spreading.
For someone who appears to be fond of quoting printed facts and statistics, I was surprised at your comments regarding implanted ICD's. With annual US implant rates approaching 150,00 new units, the ICD has become commonplace, right up there with pacing devices. Like you, I know someone who has an ICD. This would be my next door neighbor who is a woman as well. By contrast, to your friend, her recovery time, that is the time she took off from her job as an elementary school teacher as well as driving was 9 days; one full week plus the preceding weekend as she had it done on a Friday. She was in the hospital over the weekend for routine observation. It has been in now for just over 1 year. There have been no infections, no complications other than her chest which "hurt like he__!!" for a couple of weeks after the procedure. Oh, and she told me yesterday that the device has fired twice, and that both occasions were very tolerable, sort of a mild "whack" to the torso.
By contrast, my colleague's father, an older man in his very late 70's was receiving frequent charges from his ICD. It reached a point where the conversions were intolerable. So after careful consideration and a family meeting, he asked that it be turned off. He passed away within a week.
Statistics have proven that the ICD is a safe, effective, and when needed, a lifesaver. Like any procedure, complications arise. Logic would indicate that if cardiac ablation was the answer in all cases, they wouldn't be implanting 150,000 units per year.
Your two friends are representative of the range of life quality. John Mandrola wrote a nice article several years ago summarizing his point of view as a doctor that do implants. What I wrote is in complete agreement with what he wrote. Ablation for VT patients is something that has been happening more and more but still very infrequent in comparison to 150K implants per year. One of ten get it because of limited access to experts. More doctors need to trained. Ask your neighbor how she does when her battery requires replacement in 5-7 years. You other friend made a tough decision and he has the right to live the way he wanted. Ablation my have improved his quality of life if it was done earlier. His heart was probably too far gone.