Features August 2016 Issue

Reducing Surgeries Key to Healthy Long-term ICD Use

Patients who have an implantable cardioverter defibrillator for decades can reduce their infection risk if they also reduce device-related surgeries.

Improvements in technology and greater patient adherence to heart-healthy lifestyles are allowing individuals with implantable cardioverter defibrillators (ICDs) to live longer with their cardiac devices. ICDs are implanted in the chest and have thin wires (called leads) that extend into the heart to deliver small electric shocks when the heartbeat gets out of rhythm.

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An ICD sits just under the skin. Its leads go to the heart.

But having an ICD for decades means you’re at a higher risk for potentially serious complications, compared with patients who have an ICD for a shorter period. That’s according to a study published in Annals of Internal Medicine. Researchers emphasized the importance of carefully selecting the right type of device for each patient. For example, the rate of complications was higher for patients who received a cardiac resynchronization therapy device (CRT-D), which has three leads, compared with an ICD, which has two leads. Researchers suggest that some patients who receive a CRT-D could get by with an ICD instead.

Bruce Wilkoff, MD, director of Cardiac Pacing and Tachyarrhythmia Devices at Cleveland Clinic, says that longer implantation surgeries, devices with more leads, shorter battery lives, and other factors can all contribute to higher complication rates.

He adds that the higher complication rate among long-term ICD users isn’t necessarily related to the duration of ICD therapy. But rather, the increased risk is related to the number of surgeries a device patient has over his or her lifetime. Multiple surgeries to replace batteries, defective leads or the device itself, as well as non-devicerelated operations, all raise the risk of infection and complications.

“Patients who have an appropriately indicated ICD live longer, despite what other problems they may develop,” Dr. Wilkoff says. “It is important to manage it so that as few surgeries are done, as infections are related to repeat surgeries. So if it is possible to wait until the next battery change, it should be done that way.”

Other ICD Considerations

Deciding what type of device and whether to install a device at all (and try to treat the heart rhythm problem with medications or other procedures instead) requires consideration of many factors, Dr. Wilkoff adds.

A patient’s age and any other health problems should all be evaluated. Women, for example, tend to do better than men with a CRT-D. Certain types of cardiomyopathy may be more suited for treatment with one device over another.

If you have questions about the device being considered for you, talk with your doctor about the risks and benefits of that device or any possible alternatives.

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