AICD Implantation cost in India

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What is AICD?

An implantable cardioverter defibrillator (ICD or AICD) is a permanent device in which a lead (wire) inserts into the right ventricle and monitors the heart rhythm. It is implanted similar to a single chamber pacemaker and the generator lies in the upper chest area and venous access is through the subclavian vein. 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. ICDsdetect 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 is done?

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 you’re 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.

Who needs 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

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

Diagnosis/Preparation for procedure

• 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.

During 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

You'll usually be released on the day of your surgery, once the anesthesia has worn off. You'll need to arrange for a ride home because you won't be able to drive right away. Because some defibrillators have leads placed through the veins into the heart, you'll need to avoid abrupt movements that raise your left arm above shoulder-height for two to three weeks. This is so the leads don't move until the area has had time to heal. That also means no driving during that time. If you got a subcutaneous defibrillator, there are no leads placed through the veins, so there aren't any restrictions on driving or lifting your arm above your shoulder.

Treating pain after your procedure

After surgery, you may have some pain in the incision area, which can remain swollen and tender for a few days or weeks. Your doctor might prescribe pain medication. As your pain lessens, you can take an over-the-counter pain reliever, such as acetaminophen. Aspirin and ibuprofen aren't recommended because they may increase your risk of bleeding. Unless your doctor instructs you to do so, don't take pain medication containing aspirin because it can increase the risk of bleeding.

Precautions

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