Implantable Cardioverter-Defibrillator (ICD) Cost In India
The ICD implantation Cost in India between USD 14000 into USD 19000.
The Success rate of ICD Implantation is over 98%. The complications could arise because of harm to blood vessels, stroke or heart disease, or kidney cells.
The patient must stay 5 days in the hospital and 9 times beyond the hospital.
Tests demanded before ICD Implantation are Heart tracking, ECG findings, Echocardiogram, CT Scan, MRI, and Chest X-Ray.
Overview
An implantable cardioverter-defibrillator (ICD) is a small battery-powered device placed in your chest to monitor your heart rhythm and detect irregular heartbeats. An ICD can deliver electric shocks via one or more wires connected to your heart to fix an abnormal heart rhythm.
You might need an ICD if you have a dangerously fast heartbeat (ventricular tachycardia) or a chaotic heartbeat that keeps your heart from supplying enough blood to the rest of your body (ventricular fibrillation). Ventricles are the lower chambers of your heart.
ICDs detect and stop abnormal heartbeats (arrhythmias). The device continuously monitors your heartbeat and delivers electrical pulses to restore a normal heart rhythm when necessary. An ICD differs from a pacemaker — another implantable device used to help control abnormal heart rhythms.
Why it's done
You’ve likely seen TV shows in which hospital workers “shock” an unconscious person out of cardiac arrest with electrified paddles. An ICD does the same thing only internally and automatically when it detects an abnormal heart rhythm.
An ICD is surgically placed under your skin, usually below your left collarbone. One or more flexible, insulated wires (leads) run from the ICD through your veins to your heart.
Because the ICD constantly monitors for abnormal heart rhythms and instantly tries to correct them, it helps when your heart stops beating (cardiac arrest), even when you are far from the nearest hospital.
How an ICD works?
When you have a rapid heartbeat, the wires from your heart to the device transmit signals to the ICD, which sends electrical pulses to regulate your heartbeat. Depending on the problem with your heartbeat, your ICD could be programmed for:
- Low-energy pacing. You may feel nothing or a painless fluttering in your chest when your ICD responds to mild disruptions in your heartbeat.
- A higher-energy shock. For more-serious heart rhythm problems, the ICD may deliver a higher-energy shock. This shock can be painful, possibly making you feel as if you’ve been kicked in the chest. The pain usually lasts only a second, and there shouldn’t be discomfort after the shock ends.
Usually, only one shock is needed to restore a normal heartbeat. Sometimes, however, you might have two or more shocks during a 24-hour period.
Having three or more shocks in a short time period is known as an electrical or arrhythmia storm. If you have an electrical storm, you should seek emergency care to see if your ICD is working properly or if you have a problem that’s making your heart beat abnormally.
If necessary, the ICD can be adjusted to reduce the number and frequency of shocks. You may need additional medications to make your heart beat regularly and decrease the chance of an ICD storm.
An ICD can also record the heart’s activity and variations in rhythm. This information helps your doctor evaluate your heart rhythm problem and, if necessary, reprogram your ICD.
Subcutaneous ICD
A subcutaneous ICD (S-ICD) is a newer type of ICD available at some surgical centers. An S-ICD is implanted under the skin at the side of the chest below the armpit. It’s attached to an electrode that runs along your breastbone.
You may be a candidate for this device if you have structural defects in your heart that prevent inserting wires to the heart through your blood vessels, or if you have other reasons for wanting to avoid traditional ICDs. Implanting a subcutaneous ICD is less invasive than an ICD that attaches to the heart, but the device is larger in size than an ICD.
Who needs an ICD
You’re a candidate for an ICD if you’ve had sustained ventricular tachycardia, survived a cardiac arrest or fainted from a ventricular arrhythmia. You might also benefit from an ICD if you have:
- A history of coronary artery disease and heart attack that has weakened your heart.
- A heart condition that involves abnormal heart muscle, such as enlarged or thickened heart muscle.
- An inherited heart defect that makes your heart beat abnormally. These include long QT syndrome, which can cause ventricular fibrillation and death even in young people with no signs or symptoms of heart problems.
- Other rare conditions that may affect your heart rhythm.
Risks associated with ICD implantation?
Risks associated with ICD implantation are uncommon but may include:
- Infection at the implant site
- Allergic reaction to the medications used during the procedure
- Swelling, bleeding or bruising where your ICD was implanted
- Damage to the vein where your ICD leads are placed
- Bleeding around your heart, which can be life-threatening
- Blood leaking through the heart valve where the ICD lead is placed
- Collapsed lung (pneumothorax)
Diagnosis of ICD
To determine whether you need an ICD, your doctor might perform a variety of diagnostic tests, which may include:
- Electrocardiography (ECG). This noninvasive test uses sensor pads with wires attached (electrodes) placed on your body to measure your heart’s electrical impulses. Your heart’s beating pattern offers clues to the type of irregular heartbeat you have.
- Echocardiography. This noninvasive test uses harmless sound waves that allow your doctor to see your heart without making an incision. During the procedure, a small instrument called a transducer is placed on your chest to collect reflected sound waves (echoes) from your heart and transmit them to a machine that uses the sound wave patterns to compose images of your beating heart on a monitor. These images show how well your heart is functioning and the size and thickness of your heart muscle.
- Holter monitoring. Also known as an ambulatory electrocardiogram monitor, a Holter monitor records your heart rhythm for 24 hours. Wires from electrodes on your chest go to a battery-operated recording device carried in your pocket or worn on a belt or shoulder strap.
While wearing the monitor, you’ll keep a diary of your activities and symptoms. Your doctor will compare the diary with the electrical recordings and try to figure out the cause of your symptoms.
- Event recorder. Your doctor might ask you to wear a pager-sized device that records your heart activity for more than 24 hours. Unlike a Holter monitor, it doesn’t operate continuously — you turn it on when you feel your heart is beating abnormally.
- Electrophysiology study (EPS). Electrodes are guided through blood vessels to your heart and used to test the function of your heart’s electrical system. This can identify whether you have or might develop heart rhythm problems.
Preparation before the surgery:
The doctor takes a complete medical history and physical examination test before performing the surgical procedure. The patient may be asked about the age and weight of the patient, any past surgeries, allergies to any medicines, previous personal history and family history of heart attacks. In the physical examination, the doctor examines the patient very carefully for any other concerning signs and symptoms.
If a patient is diabetic, the patient is advised to ask the doctor if he/she should continue taking insulin before the procedure or not. The patient is also asked to inform the doctor about any past allergies or surgeries, if any.
The patient is advised to quit smoking, avoid alcohol, avoid drinking or eating anything after midnight or one night before the bypass surgery.
The patient is advised to empty the urinary bladder and bowel, before the test.
The patient has to remove or avoid any jewelry, eyeglasses, hairpins, electronic gadgets or any metal objects and is asked to change into a hospital gown, during the procedure.
During ICD implantation procedure
Usually, the procedure to implant an ICD can be performed with numbing medication and a sedative that relaxes you but allows you to remain aware of your surroundings. In some cases, general anesthesia may be used so that you’re unconscious for the procedure.
During surgery, one or more flexible, insulated wires (leads) are inserted into veins near your collarbone and guided, with the help of X-ray images, to your heart. The ends of the leads are secured to your heart, while the other ends are attached to the generator, which is usually implanted under the skin beneath your collarbone. The procedure usually takes a few hours.
Once the ICD is in place, your doctor will test it and program it for your heart rhythm problem. Testing the ICD might require speeding up your heart and then shocking it back into normal rhythm.
After the procedure:
After the procedure of implanting ICD, the doctor gives general anesthesia to the patient to make him/her unconscious. This is done, in order to check the proper functioning of the heart by giving shock waves to the patient’s heart.
The surgery takes around 2 to 3 hours to complete. The hospitalization of the patient is usually for one to two days. Before getting discharged, the doctors again check the working of the ICD to ensure its proper working. Patients can return to normal activities very soon after the surgery, after approximately 4 to 6 weeks to have a full recovery.
- The doctor may advise some of the following points after the ICD implantation:
- Avoid strenuous physical activity or exercise
- Avoid lifting heavy objects for at least a month
- Avoid playing contact sports
- Avoid vigorous shoulder movements e.g. while swimming, tennis, golf, bowling or bicycling.
- Avoid smoking
The doctor may also suggest taking some painkillers, e.g. ibuprofen or Ultracet (a combination of paracetamol and tramadol), to relieve pain from the surgical site.
After the ICD implanting procedure, frequent doctor visits are required in order to monitor the working of ICD. Some of the activities tracked during these visits include
- Sensing the heart rate properly.
- Total electric shocks delivered.
Battery-life of the ICD. Usually, the battery life is approximately 7 years. But frequent visits to the doctor are necessary to check if the battery needs to be changed or not.
Results
ICDs have become standard treatment for anyone who has survived cardiac arrest, and they’re increasingly used in people at high risk of sudden cardiac arrest. An ICD lowers your risk of sudden death from cardiac arrest more than medication alone.
Although the electrical shocks can be unsettling, they’re a sign that the ICD is effectively treating your heart rhythm problem and protecting you from sudden death. Talk to your doctor about how to best care for your ICD.
After the procedure, you’ll need to take some precautions to avoid injuries and make sure your ICD works properly.
Short-term precautions
You’ll likely be able to return to normal activities soon after you recover from surgery. Follow your doctor’s instructions. For four weeks after surgery, your doctor might ask you to refrain from:
- Vigorous above-the-shoulder activities or exercises, including golf, tennis, swimming, bicycling, bowling or vacuuming
- Lifting anything heavy
- Strenuous exercise programs
Your doctor will probably advise you to avoid contact sports indefinitely. Heavy contact may damage your device or dislodge the wires.
Long-term precautions
Problems with your ICD due to electrical interference are rare. Still, take precautions with the following:
- Cellular phones and other mobile devices. It’s safe to talk on a cellphone, but avoid placing your cellphone within 6 inches (about 15 centimeters) of your ICD implantation site when the phone is turned on. Although unlikely, your ICD could mistake a cellphone’s signal for a heartbeat and slow your heartbeat, causing symptoms such as sudden fatigue.
- Security systems. After surgery, you’ll receive a card that says you have an ICD. Show your card to airport personnel because the ICD may set off airport security alarms.
- Also, hand-held metal detectors often contain a magnet that can interfere with your ICD. Limit scanning with a hand-held detector to less than 30 seconds over the site of your ICD or make a request for a manual search.
- Medical equipment. Let doctors, medical technicians and dentists you see know you have an ICD. Some procedures, such as magnetic resonance imaging (MRI), magnetic resonance angiography (MRA), and radiofrequency or microwave ablation are not recommended if you have an ICD.
- Power generators. Stand at least 2 feet (0.6 meters) from welding equipment, high-voltage transformers or motor-generator systems. If you work around such equipment, your doctor can arrange a test in your workplace to see if the equipment affects your ICD.
- Headphones. Headphones may contain a magnetic substance that can interfere with your ICD. Keep your headphones at least 6 inches (about 15 centimeters) from your ICD.
- Magnets. These might affect your ICD, so it’s a good idea to keep magnets at least 6 inches (15 centimeters) from your ICD site.
- Devices that pose little or no risk to your ICD include microwave ovens, televisions and remote controls, AM/FM radios, toasters, electric blankets, electric shavers and electric drills, computers, scanners, printers, and GPS devices.
