internal defibulator

[miriam48]

Husband is needing one.  Want to know what different brands are available in the hospitals.  Which are the best?

[BobRBob]

Does a person with a pacemaker or ICD have to take anti-coagulant drugs (Coumadin/Warfarin)?  I haven't been able to find anything about this. I wonder because of the implanted leads. If they are exposed to the blood flow in the heart,  could they lead to clotting?

I have lone afib which is controlled with Sotalol, for now at least. I have been in NSR since early July with only three short afib episodes. However, the Sotalol really slows down my heart even though I am on a very low dose. Increasing the dose, if it became necessary, might require a pacemaker to keep my heart rate up to speed. I take a regular Aspirin daily but that's all. I'd like to avoid Coumadin and as long as I remain in NSR, it isn't required.

[Mom2four85]

I think it depends on the brand and model you have; how often it's utilized.

I have Teligen 1100 (boston scientific) and mine are supposed to last anywhere between 7 - 10 years.

[memenich1]

how often do the batteries need changed and how do they do this?

[BionicBabe]

I have a Boston Scientific ICD. I have friends who have Medtronic ICDs. Medtronics makes the most of these devices. Boston Scientific is second in the industry. Both companies have had recalls. I can't say which is better. I have a friend who does ongoing research on this very question. For a while he was convinced Medtronic was best, now he's not so sure. Other questions to consider. If your husband has the choice, he might want to ask about subpectoral versus subcutaneous implant. I didn't have a choice...didn't even know that these devices could be implanted under the muscle. I am young and given the choice in the future, I would probably opt for subpectoral. My device is very noticable. He might also ask about which vein the leads will be placed in. There are several options. The largest vein, the subclavian is often the vein of choice, but I recently learned that this vein can be pinched more easily than other veins which can lead to lead fracturing, which can lead to inappropriate shocks and need to replace leads. I'm not an expert, but just giving you some things to consider.

[Jerry_NJ]

Thanks, and thanks for other details you've shared with me over the last 10 days or so.

As far as I know my only problem is AFib, none of the ventricle problems like what I read to be very unpleasant PVC.  I am almost unaware of my AFib, other than when I want to get physically active like walk up a steep hill, level ground isn't a problem if I'm just walking.  

My cardiologist advised me that my lack of serious discomfort and my ability to take warfarin without complications suggests we do nothing.  He did on my continued interest in getting back in sinus refer me to a partner who is an EP with whom I underwent my last unsuccessful electro CV.  

[BLM_56]

A pacemaker is most assurredly not a defibrillator.  What most people call a pacemaker is a pulse generator the supplies small electrical pulses to either the ventricles or atria or both to trigger a heart beat.  It runs at low voltage and generally very low current.  Also most people's pulse generator runs on an as-needed basis to control bradiacardia - i.e. slow heartbeat.  The devices sense the onset of a period of low heartrate - 30 or les bpm - and sends pulses to one or more chambers of the heart to electronically initiate a beat at a rate the approaches normal.  Having had episodes of irregularly irregular rhythm I can say from personal experience that human beings don't generaly function well at 30bpm.  I once got down to 30 and the world was going SERIOUSLY gray and my vision was getting very "tunnely" before my rate came back up.  I suspect that I would have lost consciousness had my rate stayed that low much longer.  Pulse generators (pacemakers) can sense on one or two leads and pulse on one or two leads in any combination - 1s1p, 1s2p, 2s1p, or 2s2p - depending on the model.  Sove folks - like me - have their implant running full time 24/7/52.  If my device fails I will drop to around 44bpm and I will get very mellow and the color level in my vision will be turned WAAYYYY down.  But I will still be conscious and able to get help.

Here is a quote from Wikipaedia: "An implantable cardioverter-defibrillator (ICD) is a small battery-powered electrical impulse generator which is implanted in patients who are at risk of sudden cardiac death due to ventricular fibrillation. The device is programmed to detect cardiac arrhythmia and correct it by delivering a jolt of electricity. In current variants, the ability to revert ventricular fibrillation has been extended to include both atrial and ventricular arrhythmias as well as the ability to perform biventricular pacing in patients with congestive heart failure or bradycardia."

If a moderate level of stimulation does not get the heart to go out of brady (and 0 bpm would count as extreme brady) or V-fib then the device does a cardioversion.  That is it hits the heart with enough current to stop it.  That's right.  Cardioversion involves essentially elctrocuting a person.  Whether done externally or internally the idea is to shock the heart so hard that it stops momentarily.  The hope is that it will reset itself and start up in a normal rhythm and at a normal rate.  Should that fail IIRC it can functionas a pulse generator to keep the person alive to get to a hospital.

Here is the URL to the article on ICDs: http://en.wikipedia.org/wiki/Implantable_cardioverter-defibrillator

Here is the RL to the Wiki article on pacemakers:
http://en.wikipedia.org/wiki/Pacemaker

Jerry, I can tell you that being even partially awake for a cardioversion is rather significantly unpleasant.  When I had my first (of a total of 3) I was starting to come out of the drugs before they were finished.  Generally in cardioversion they hit you 3 times.  As I said I was coming out of the anesthetic when they hit me the third time.  I heard a very loud BANG! and felt like someone kicked me in the chest.  I have been given a muscle relaxant so I did not jump like they do on the medical shows but I definately felt the shock.  I also heard people talking in the background.  I never told my cardiologist about it until last October (some 6 years after my 1st cardioversion) and the look on his face was priceless.  Needless to say for my 2nd and 3rd cv's they gave me something that would keep me in lala land until they gave me the antidote.  for me having a CV is like getting your thumb caught in a door - it feels SSSSSSOOOOOOOOOO GOOD when it's over. ;-)  Like Jerry I get some interesting burns from the pads.  But that is bacause it takes a lot more energy to stop the heart from the outside than from the inside.  The leads of an ICD are actually grown INto the wall of the chamber in which they are attached.

Hope this helps.  Jerry, keep me posted.  I am very glad I only need a pulse generator and not an ICD.

Regards,
Bionic Bill
Cyborg At Large

[Jerry_NJ]

Thanks.  I suffer for AFib, so I'm not sure any of these internal devices apply.  I discuss with my EP when I have session with him on October 6.  This meeting is a follow up on a failed electro-cardioversion that had me in sinus for only two weeks.  He has talked with me by telephone since losing sinus and increased my Metoprolo and said we need to discuss a more powerful dug that requires hospitalization for the start-up two days.  He hasn't mentioned ablation, pacemaker, or defibrillator all of which I plan to bring up.  

From what you say about the "full monty", I guess that's why they put me "out" for electro-cardioversion.  I've had four over the years, most had put me in sinus for about 18 months, and each time I can see where the shock pads were on my chest and back, burn marks. I jokingly (if one can be so, seems you have a sense of humor) characterize the shock as a punishment for the heart that my heart say: "don't do that again, I'll be good and run in sinus".  

[rogera]

An internal defibrillator is not a pacemaker as most folks understand a pacemaker to be. It's really called an implant cardioverter defibrillator and in my case,a single lead model attached to my left ventrical and is supposed to arrest ventricular tachycardia. it does this two ways. 1 thru cardioversion which is very aggresive pacemaking. Mine is programmed to perform cardioversion thru 15 beats. If after 15 beats cardioversion failed to arrest my VT then I get the full monty---35 joules of electricity direct to the old ticker. I have experienced cardioversion, quite painless actually, full defibrillation on the other hand I have not yet had, they say it's lile being kicked in the chest by a mule. If you don't need one, be thankful

[Jerry_NJ]

Is an Internal Defibrillator another name or special function of a "Pacemaker"?  I suffer from AFib and have recently come to understand stopping AFib, via a defibrillation shock, is possible when the Pacemaker includes this function.  From this thread I suspect there is an internal device specifically for stopping AFib, ture?

[kevk]

Hi,
If you can not find the info you are looking for you can try the ***8.***.  There are hundreds of members who have ICD`s of all different makes and models. I have a Guidant Ventak Prizm VR, HE.  I would not say it is any better or worse than any other brand but I have not had any problems with mine.  This is my fourth ICD in over seventeen years.  I have heard good and bad about all of them, Talk with your EP and see what they may recommend.
You are pretty lucky to get a choice in your ICD,  Most people do not get to make that choice.
Good luck and check out the ICD site for some pointers.