An Implantable Cardioverter Defibrillator (AICD) is a device that is implanted in the chest to monitor and if necessary, correct episodes of rapid heartbeat namely ventricular tachycardia. The AICD sends small electrical charges to the heart to “reset” it when it goes too fast. The AICD stimulates the heart to restore to a normal rhythm. In situations where the heart goes into a ventricular fibrillation, the AICD will give an electric shock (defibrillation) to “reset” the heart to a normal rhythm.

A pacemaker corrects an abnormal heart rhythm that is too slow ie: Bradycardia, whereas AICDs are used to correct a heart rhythm that is too fast ie: tachycardia. An AICD will be used to pace the heart in patients who need both Bradycardia and anti-tachycardia pacing.

Although the main functions of the AICD are Cardioversion and defibrillation, it can also be programmed to do the following:

• Anti-tachycardia pacing. When an AICD senses a fast but rhythmic heartbeat (tachycardia), it releases a series of precisely timed low-intensity electrical pulses that gently interrupt the heart and allow it to return to a slower pace. Whereas both Cardioversion and defibrillation involve shocks that may feel like a sudden kick in the chest, these low-intensity stimuli are generally not felt by the patient.
• Bradycardia pacing. Like an artificial pacemaker, the AICD can sense an abnormally slow heartbeat (Bradycardia) and send small electrical signals to pace the heart until it restores and maintains a normal heart rate.
• The AICD also records heart activity and can transmit this information to the physician during a routine check, allowing the physician to better diagnose and monitor the underlying conditions causing the patient’s arrhythmia.
• An AICD may be recommended for patients who have experienced any of the following:
• Previous heart attacks, with weakened functioning of the left ventricle. The performance of the left ventricle is expressed numerically as the left ventricular ejection fraction. It represents the proportion of blood in the heart that is pumped out with each beat. A normal range is between 55 and 75 percent. An ejection fraction below 40 percent has been shown to increase the risk of sudden cardiac death. In heart attack survivors with reduced ejection fractions, it has been found that an AICD plus Antiarrhythmic drugs significantly lowers the risk of sudden cardiac death, as compared to Antiarrhythmics used alone.
• History of ventricular tachycardia (VT) or ventricular fibrillation (VF). For these patients, AICDs have clearly improved survival compared to Antiarrhythmic drugs.
• Coronary artery disease. Patients with coronary artery disease may have an underlying arrhythmia. Studies have shown that, in patients with coronary artery disease who received an AICD, cholesterol reducing drugs may have an anti-arrhythmic effect that can reduce the recurrence of ventricular tachycardia or ventricular fibrillation.
• Cardiac arrest.

The AICD consists of three parts:

• Generator
• Leads
• Electrodes

This insertion site will be cleaned, shaved and numbed with the injection of a local anesthetic. A small cut (incision) is made in the chest wall just below the collarbone. Another incision is made in the vein just under the collarbone. The wires of the AICD are passed through the vein and attached to the inner surface of the heart. The other ends of the wires are connected to the main box of the AICD, which is inserted into the tissue under the collarbone and above the breast. Once the AICD is implanted, the physician will test it several times by causing the heart to fibrillate, making sure the AICD responds properly. Because the patient is anesthetized, the patient will not feel this test. The incision is then closed by sutures (stitches), staples or surgical glue. The entire procedure takes about an hour.

Immediately following the procedure, a chest x-ray will be taken to confirm the proper placement of the wires in the heart. Patients will rest for several hours and their vital signs will be closely monitored. The AICD’s programming may be adjusted using a magnetic wand that is passed over the chest, during which the patient will not feel anything different.

After the initial operation, the physician may induce ventricular fibrillation or ventricular tachycardia prior to the patient’s discharge. This allows the physician to program the AICD for maximum efficiency.

Depending on the patient’s age and overall health, a short stay in the hospital is usually required following AICD insertion. The physician will provide specific instructions regarding the patient’s appropriate activity level immediately following the procedure. In general, patients may be instructed not to bathe or shower for at least five days after the procedure. They should also avoid contact sports, heavy lifting or vigorous exercise for several weeks, in order to avoid dislodging the wires.

The AICD is implanted into the chest of the patient during a minor surgical procedure (not open-heart surgery). A short stay in the hospital is usually required and some patients may need to take medications that help the heart maintain a normal rhythm (antiarrhythmics). Once the AICD is in place, it runs on batteries for about four to seven years, depending on how often an electric shock is discharged. AICD batteries will not run out unexpectedly. Physicians can detect when the battery is running low during a routine office visit.

People with AICDs need to be careful in certain situations.

Serious complications from the surgery occur in less than 1 percent of cases. These include:

• Severe bruising or bleeding
• Formation of a blood clot
• Torn blood vessel
• Punctured lung or heart muscle
• Stroke
• Heart attack
• Introduction of air into the space between the lung and chest wall
• Death

The risk of having one of these complications is increased if people have certain characteristics, such as the following:

• Advanced age
• Obesity (more than 20 pounds heavier than one’s ideal weight or body mass index 30 or greater)
• Severe lung disease (often due to smoking)
• Use of various medications
• Severely decreased heart function

Life of AICD

The battery of the AICD is sealed within the main box of the AICD. The whole unit must be replaced when the battery is low. Modern AICDs use lithium batteries that need to be replaced every four to seven years, depending on how often an electric shock is discharged.
When a battery is running low, the elective replacement indicator (ERI) is activated. Physicians can detect this activation during a routine office visit. AICDs will continue to function for approximately six months after the ERI is activated, allowing plenty of time to schedule an elective replacement procedure.

Aside from the ERI, changes may occur in the way the AICD operates that will indicate to a physician that the battery is beginning to run low. Patients may or may not be able to feel these changes in function. Regular communication with one’s physician is an important part of a successful experience with an AICD.

The other cardiac procedures are:

• Angioplasty
  
• Heart Valve Replacement
  
• VSD (Ventricular Septal Defect Closures) Closures .. etc

Few Major Hospitals for AICD Implantation are:

• Asian Heart Institute
  
• Wockhardt Hospitals
  
• Narayana Hrudalaya
  
• Piyavate Hospital
  
• Florence Nightingale Hospital
  

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