Heart Rhythm Problems: Should I Get an Implantable Cardioverter-Defibrillator (ICD)?

You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.

Heart Rhythm Problems: Should I Get an Implantable Cardioverter-Defibrillator (ICD)?

1

Get the
Facts

2

Compare
Options

3

Your
Feelings

4

Your
Decision

5

Quiz
Yourself

6

Your Summary

Get the facts

Your options

Get an ICD.
Don't get an ICD.

This decision aid focuses on whether to get an ICD (implantable cardioverter-defibrillator) when you do NOT have heart failure. The ICD decision for heart failure patients raises some different issues.

Key points to remember

An ICD constantly checks your heart rate and rhythm. It is designed to fix a dangerous abnormal heart rhythm and prevent sudden death.
Your doctor may suggest an ICD if you are at risk of having an abnormal heart rhythm that could cause sudden death.
Your doctor also will consider other health problems you may have to see how high your risk is for a deadly heart rhythm and whether an ICD could prevent it.
The shock from an ICD hurts briefly. It's been described as feeling like a punch in the chest. But the shock is a sign that the ICD is doing its job to keep your heart beating. The ICD also can use electrical pulses to fix a heart rate that is too fast or too slow, but you usually do not feel those pulses.
Even with an ICD, you may still need to take medicine to help prevent a deadly abnormal heart rhythm.

FAQs

What is an ICD?

An ICD is a battery-powered device that can fix an abnormal heart rate or rhythm and prevent sudden death. The ICD is placed under the skin of your chest. It's attached to one or two wires (called leads). Most of the time, these leads go into the heart through a vein. The lead is sometimes placed under the skin so it lies near your heart.

An ICD is always checking your heart rate and rhythm. If the ICD detects a life-threatening rapid heart rhythm, it tries to slow the rhythm back to normal using electrical pulses. If the dangerous rhythm does not stop, the ICD sends an electric shock to the heart to restore a normal rhythm. The device then goes back to its watchful mode.

Some ICDs also can fix a heart rate that is too slow. The ICD does so without using a shock. It can send out electrical pulses to speed up a heart rate that is too slow.

Whether you get pulses or a shock depends on the type of problem that you have and how the doctor programs the ICD for you.

How is an ICD placed?

Your doctor will put the ICD in your chest during minor surgery. You will not have open-chest surgery. You probably will have local anesthesia. This means that you will be awake but feel no pain. You also will likely have medicine to make you feel relaxed and sleepy.

Your doctor makes a small cut (incision) in your upper chest. Your doctor puts the ICD leads through the cut. For one type of ICD, your doctor puts one or two leads (wires) in a large blood vessel and threads them into the heart. For another type, the lead is placed under the skin so that it lies near your heart. Your doctor places the ICD under the skin of your chest. He or she attaches the leads to the ICD. Then the cut will be closed with stitches. Your doctor also programs the ICD.

In some cases, the doctor may be able to put the ICD in another place in the chest so that you don't have a scar on your upper chest. This would allow you to wear clothing with a lower neckline and still keep the scar covered.

Most people spend the night in the hospital, just to make sure that the device is working and that there are no problems from the surgery.

You may be able to see a little bump under the skin where the ICD is placed.

How does it feel to get a shock from an ICD?

The shock from an ICD hurts briefly. It's been described as feeling like a punch in the chest. But the shock is a sign that the ICD is doing its job to keep your heart beating. You won't feel any pain if the ICD uses electrical pulses to fix a heart rate that is too fast or too slow.

There's no way to know how often a shock might occur. It might never happen.

It's possible that the ICD could shock your heart when it shouldn't. If that were to happen, you would have pain. The shock could make you fall out of bed, and that could injure you.

In rare cases, the shock could cause the heart to quiver, or flutter, and stop pumping blood. This is called ventricular fibrillation (say "ven-TRICK-yuh-ler fib-ruh-LAY-shun"), which can be deadly. If this happened, the ICD would shock your heart again to stop the fluttering.

Many people say that they have a good quality of life with an ICD. But shocks—and the fear of shocks—can make some people worry too much. They may be afraid all the time that the ICD might shock them. This worry can reduce a person's quality of life.

What are the benefits of an ICD?

An ICD can help lower the risk of sudden death from a dangerous heart rhythm.

For people who have survived a life-threatening heart rhythm: Studies have shown that an ICD can lower the risk of death more than heart rhythm medicine can. In one study, ICDs lowered the number of deaths from 18 out of 100 people to 11 out of 100. ^{footnote 1}
For people who are at risk for a life-threatening heart rhythm but have not had one: Studies have shown that an ICD in certain people can lower the risk of death more than heart rhythm medicine can. ^{footnote 2} For example, in one study ICDs lowered the number of deaths from 9 out of 100 people to 4 out of 100. ^{footnote 3}

What are the risks of an ICD?

There are several risks to getting an ICD. But the risks are different for each person. The risk for problems associated with the implant procedure might be higher for people who are age 80 or older. The risks also depend on the type of ICD that you get.

During the procedure. If problems happen during the procedure, doctors likely can fix them right away.

Serious bleeding could occur after placement of the ICD. This happens from 1 to 6 times out of 100. Serious bleeding doesn't happen 94 to 99 times out of 100. ^{footnote 4}
A lung could collapse (pneumothorax) from a buildup of air in the space between the lung and the chest wall. But a pneumothorax can be treated, and people recover well. This happens less than 1 time out of 100. This doesn't happen 99 times out of 100. ^{footnote 4}
In the hospital, serious problems, such as heart injury or stroke, happen less than 1 time out of 100. Serious problems don't happen 99 times out of 100. ^{footnote 5}

After the procedure. Problems after the procedure can be minor, like mild pain, or serious, like an infection. But your doctor can solve most of these problems. And most people do not have long-term problems.

You may have pain, bleeding, or bruising soon after the procedure.
The leads that attach to the heart may break or stop working right. This can happen between 2 and 15 times out of 100 after 5 years of having the ICD. So it does not happen about 85 to 98 times out of 100. ^{footnote 6} But the risk of a lead breaking or not working right appears to increase over time. One long-term study found that, after 10 years, 20 out of 100 leads had problems. This also means that 80 out of 100 leads didn't have problems. ^{footnote 7} If a lead does break or does not work anymore, you would need surgery. The surgery would be more complex than that needed to replace an ICD battery.
You could get an infection where the ICD is placed. This happens about 1 to 2 times out of 100. So there is no infection about 98 to 99 times out of 100. ^{footnote 8}
The ICD could shock the heart when it shouldn't. There is no way to know if or when this could happen. It might never happen. In studies, these shocks happened to 3 to 21 out of 100 people over 1 to 5 years. This means that these shocks didn't happen in 79 to 97 people out of 100. ^{footnote 5} Your doctor will program your ICD to lower the risk of one of these shocks.
There also is a chance that a manufacturer may recall an ICD for a problem. If this were to happen, you might need surgery to take out the ICD and leads.

Daily precautions. You'll need to take steps to safely use electric devices. Some electric devices have a strong electromagnetic field. This field can keep your ICD from working right for a short time. Check with your doctor about what you need to avoid and what you need to keep a short distance away from your ICD. Many household and office electronics do not affect your ICD.

What follow-up do you need after getting an ICD?

You will need regular monitoring and checkups with your doctor to make sure that the ICD is working well and that the programming is right for you.

It's important to keep taking any medicines your doctor has prescribed. You'll also need to follow a healthy lifestyle. This includes eating heart-healthy foods, getting regular exercise, and not smoking.

If the ICD gives you a lot of shocks, your doctor may prescribe the rhythm-control medicine amiodarone. This medicine helps prevent abnormal heart rhythms and may keep the ICD from sending shocks too often. Your doctor also could suggest catheter ablation to lower the number of times the ICD shocks you. Catheter ablation can lower the chance of some abnormal heart rhythms, such as atrial fibrillation or ventricular tachycardia. These rhythms can cause the ICD to shock you.

An ICD runs on a battery that lasts from 5 to 8 years. To have the battery replaced, you will need minor surgery.

Why might your doctor recommend an ICD?

Your doctor may advise you to get an ICD if you have had a dangerous abnormal heart rhythm or if you are at risk for having one. You and your doctor will decide whether an ICD is right for you.

Based on personal feelings, some people decide not to get an ICD. For example, they might worry a lot about getting a shock, they may not want to have the surgery to implant the ICD, or they don't want to have a device inside of them.

Talk with your doctor about the possibility of turning off the ICD at the end of life. Many people consider turning off the ICD when their health goals change from living longer to getting the most comfort possible at the end of life. Turning off your ICD is legal. It isn't considered suicide. The decision to leave on or turn off your ICD is a medical decision that you make based on your values.

Compare your options

Compare


What is usually involved?
What are the benefits?
What are the risks and side effects?

Get an ICD Get an ICD

You will have minor surgery to have the ICD put in. Your doctor will numb the area with local anesthesia.
You probably will spend the night in the hospital, just to make sure that there are no problems.
You will need to have minor surgery to replace the battery after 5 to 8 years.
You keep taking your heart medicine and following a healthy lifestyle.

An ICD can prevent sudden death from an abnormal heart rhythm.
An ICD can also fix a heart rate that is too fast or too slow without using a shock.
You may have peace of mind that a dangerous heart rhythm could be fixed right away.

Problems can happen during or soon after the procedure to place the ICD. Examples include a lead tearing the heart or a lung collapsing.
The manufacturer could recall an ICD for a problem. If this were to happen, you might need surgery to take out the ICD and leads.
The shock from an ICD hurts briefly.
If the ICD gives you too many shocks, you also may need to take a rhythm-control medicine or have catheter ablation.

Don't get an ICD Don't get an ICD

You follow a healthy lifestyle.
You may take a rhythm-control medicine to prevent abnormal heart rhythms.

You avoid the risks of surgery.
You won't worry about when the ICD might shock you.

You could have an abnormal heart rhythm that could cause sudden death.

Personal stories about considering an ICD

These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.

My doctor said there's a good chance I could get a really bad heart rhythm that could make my heart stop. We talked about an ICD. I'm a little nervous about getting shocked. But if it could save my life, it's worth it, so I'm going to get one.

Cassius, age 62

I've had a couple of episodes of palpitations from a really fast heart rate. But I'm taking medicine, and it seems to be working. I'm not ready to get an ICD.

Federico, age 66

I just got some test results back that show there's a chance I could get a heart problem that causes my heart to stop. I have absolutely no symptoms, and the idea of an ICD scares me. But the idea of having my heart stop scares me more. I'm going to get an ICD.

Cherie, age 70

My doctor said I could get an ICD. We talked about how it could help me. But I don't want a device like that inside my body. So I'm not going to get one.

Martin, age 82

What matters most to you?

Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.

Reasons to get an ICD

Reasons not to get an ICD

I want to do everything I can to prevent a deadly heart rhythm.

I would rather use only medicine to lower my chance of a deadly heart rhythm.

More important

Equally important

More important

I'm not worried that the ICD might shock me.

I would worry all the time that the ICD might shock me.

More important

Equally important

More important

I don't mind having a device inside my body.

I don't like the idea of having a device inside my body.

More important

Equally important

More important

I'm not worried about the small risks of surgery.

I'm concerned that something could go wrong with the surgery.

More important

Equally important

More important

I'm not concerned that the ICD or the leads could break.

I'm concerned that the ICD or leads will break and I'll need another surgery.

More important

Equally important

More important

My other important reasons:

More important

Equally important

More important

Where are you leaning now?

Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.

Getting an ICD

NOT getting an ICD

Leaning toward

Undecided

Leaning toward

Your Summary

Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.

Your decision

Next steps

Which way you're leaning

How sure you are

Your comments

Your knowledge of the facts

Key concepts that you understood

Key concepts that may need review

Getting ready to act

Patient choices

What matters to you

Print Summary

Credits and References

Credits

Author	Healthwise Staff
Primary Medical Reviewer	E. Gregory Thompson MD - Internal Medicine
Primary Medical Reviewer	Martin J. Gabica MD - Family Medicine
Primary Medical Reviewer	Elizabeth T. Russo MD - Internal Medicine
Primary Medical Reviewer	Adam Husney MD - Family Medicine
Primary Medical Reviewer	John M. Miller MD, FACC - Cardiology, Electrophysiology
Primary Medical Reviewer	Caroline S. Rhoads MD - Internal Medicine

References

Citations

AVID Investigators (1997). A comparison of antiarrhythmic-drug therapy with implantable defibrillators in patients resuscitated from near-fatal ventricular arrhythmias. New England Journal of Medicine, 337(22): 1576–1583.
Al-Khatib SM, et al. (2017). 2017 AHA/ACC/HRS Guideline for management of patients with ventricular tachycardias and the prevention of sudden cardiac death. Circulation, published online October 30, 2017. DOI: 10.1161/CIR.0000000000000549. Accessed November 6, 2017.
Ezekowitz JA, et al. (2003). Implantable cardioverter defibrillators in primary and secondary prevention: A systematic review of randomized, controlled trials. Annals of Internal Medicine, 138(6): 445–452.
Van Rees JB, et al. (2011). Implantation-related complications of implantable cardioverter-defibrillators and cardiac resynchronization therapy devices. Journal of the American College of Cardiology, 58(10): 995–1000.
Uhlig K, et al. (2013). Assessment on implantable defibrillators and the evidence for primary prevention of sudden cardiac death. Technology Assessment Project ID: CRDT0511. Rockville, MD: Agency for Healthcare Research and Quality. http://www.cms.gov/Medicare/Coverage/DeterminationProcess/Downloads/id91TA.pdf. Accessed December 5, 2013.
Eckstein JE, et al. (2008). Necessity for surgical revision of defibrillator leads implanted long-term. Circulation, 117(21): 2727–2733.
Kleemann T, et al. (2007). Annual rate of transvenous defibrillation lead defects in implantable cardioverter-defibrillators over a period of >10 years. Circulation, 115(19): 2474–2480.
Baddour LM, et al. (2010). Update on cardiovascular implantable electronic device infections and their management. A scientific statement from the American Heart Association. Circulation, 121(3): 458–477.

Heart Rhythm Problems: Should I Get an Implantable Cardioverter-Defibrillator (ICD)?

Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.

Get the facts
Compare your options
What matters most to you?
Where are you leaning now?
What else do you need to make your decision?

1. Get the Facts

Your options

Get an ICD.
Don't get an ICD.

Key points to remember

An ICD constantly checks your heart rate and rhythm. It is designed to fix a dangerous abnormal heart rhythm and prevent sudden death.
Your doctor may suggest an ICD if you are at risk of having an abnormal heart rhythm that could cause sudden death.
Your doctor also will consider other health problems you may have to see how high your risk is for a deadly heart rhythm and whether an ICD could prevent it.
The shock from an ICD hurts briefly. It's been described as feeling like a punch in the chest. But the shock is a sign that the ICD is doing its job to keep your heart beating. The ICD also can use electrical pulses to fix a heart rate that is too fast or too slow, but you usually do not feel those pulses.
Even with an ICD, you may still need to take medicine to help prevent a deadly abnormal heart rhythm.

FAQs

What is an ICD?

Some ICDs also can fix a heart rate that is too slow. The ICD does so without using a shock. It can send out electrical pulses to speed up a heart rate that is too slow.

Whether you get pulses or a shock depends on the type of problem that you have and how the doctor programs the ICD for you.

How is an ICD placed?

Most people spend the night in the hospital, just to make sure that the device is working and that there are no problems from the surgery.

You may be able to see a little bump under the skin where the ICD is placed.

How does it feel to get a shock from an ICD?

There's no way to know how often a shock might occur. It might never happen.

It's possible that the ICD could shock your heart when it shouldn't. If that were to happen, you would have pain. The shock could make you fall out of bed, and that could injure you.

What are the benefits of an ICD?

An ICD can help lower the risk of sudden death from a dangerous heart rhythm.

For people who have survived a life-threatening heart rhythm: Studies have shown that an ICD can lower the risk of death more than heart rhythm medicine can. In one study, ICDs lowered the number of deaths from 18 out of 100 people to 11 out of 100. ¹
For people who are at risk for a life-threatening heart rhythm but have not had one: Studies have shown that an ICD in certain people can lower the risk of death more than heart rhythm medicine can. ² For example, in one study ICDs lowered the number of deaths from 9 out of 100 people to 4 out of 100. ³

What are the risks of an ICD?

During the procedure. If problems happen during the procedure, doctors likely can fix them right away.

Serious bleeding could occur after placement of the ICD. This happens from 1 to 6 times out of 100. Serious bleeding doesn't happen 94 to 99 times out of 100. ⁴
A lung could collapse (pneumothorax) from a buildup of air in the space between the lung and the chest wall. But a pneumothorax can be treated, and people recover well. This happens less than 1 time out of 100. This doesn't happen 99 times out of 100. ⁴
In the hospital, serious problems, such as heart injury or stroke, happen less than 1 time out of 100. Serious problems don't happen 99 times out of 100. ⁵

You may have pain, bleeding, or bruising soon after the procedure.
The leads that attach to the heart may break or stop working right. This can happen between 2 and 15 times out of 100 after 5 years of having the ICD. So it does not happen about 85 to 98 times out of 100. ⁶ But the risk of a lead breaking or not working right appears to increase over time. One long-term study found that, after 10 years, 20 out of 100 leads had problems. This also means that 80 out of 100 leads didn't have problems. ⁷ If a lead does break or does not work anymore, you would need surgery. The surgery would be more complex than that needed to replace an ICD battery.
You could get an infection where the ICD is placed. This happens about 1 to 2 times out of 100. So there is no infection about 98 to 99 times out of 100. ⁸
The ICD could shock the heart when it shouldn't. There is no way to know if or when this could happen. It might never happen. In studies, these shocks happened to 3 to 21 out of 100 people over 1 to 5 years. This means that these shocks didn't happen in 79 to 97 people out of 100. ⁵ Your doctor will program your ICD to lower the risk of one of these shocks.
There also is a chance that a manufacturer may recall an ICD for a problem. If this were to happen, you might need surgery to take out the ICD and leads.

What follow-up do you need after getting an ICD?

You will need regular monitoring and checkups with your doctor to make sure that the ICD is working well and that the programming is right for you.

An ICD runs on a battery that lasts from 5 to 8 years. To have the battery replaced, you will need minor surgery.

Why might your doctor recommend an ICD?

Your doctor may advise you to get an ICD if you have had a dangerous abnormal heart rhythm or if you are at risk for having one. You and your doctor will decide whether an ICD is right for you.

2. Compare your options

	Get an ICD	Don't get an ICD
What is usually involved?	You will have minor surgery to have the ICD put in. Your doctor will numb the area with local anesthesia. You probably will spend the night in the hospital, just to make sure that there are no problems. You will need to have minor surgery to replace the battery after 5 to 8 years. You keep taking your heart medicine and following a healthy lifestyle.	You follow a healthy lifestyle. You may take a rhythm-control medicine to prevent abnormal heart rhythms.
What are the benefits?	An ICD can prevent sudden death from an abnormal heart rhythm. An ICD can also fix a heart rate that is too fast or too slow without using a shock. You may have peace of mind that a dangerous heart rhythm could be fixed right away.	You avoid the risks of surgery. You won't worry about when the ICD might shock you.
What are the risks and side effects?	Problems can happen during or soon after the procedure to place the ICD. Examples include a lead tearing the heart or a lung collapsing. The manufacturer could recall an ICD for a problem. If this were to happen, you might need surgery to take out the ICD and leads. The shock from an ICD hurts briefly. If the ICD gives you too many shocks, you also may need to take a rhythm-control medicine or have catheter ablation.	You could have an abnormal heart rhythm that could cause sudden death.

Personal stories

Personal stories about considering an ICD

These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.

"My doctor said there's a good chance I could get a really bad heart rhythm that could make my heart stop. We talked about an ICD. I'm a little nervous about getting shocked. But if it could save my life, it's worth it, so I'm going to get one."

— Cassius, age 62

"I've had a couple of episodes of palpitations from a really fast heart rate. But I'm taking medicine, and it seems to be working. I'm not ready to get an ICD."

— Federico, age 66

"I just got some test results back that show there's a chance I could get a heart problem that causes my heart to stop. I have absolutely no symptoms, and the idea of an ICD scares me. But the idea of having my heart stop scares me more. I'm going to get an ICD."

— Cherie, age 70

"My doctor said I could get an ICD. We talked about how it could help me. But I don't want a device like that inside my body. So I'm not going to get one."

— Martin, age 82

3. What matters most to you?

Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.

Reasons to get an ICD

Reasons not to get an ICD

I want to do everything I can to prevent a deadly heart rhythm.

I would rather use only medicine to lower my chance of a deadly heart rhythm.

More important

Equally important

More important

I'm not worried that the ICD might shock me.

I would worry all the time that the ICD might shock me.

More important

Equally important

More important

I don't mind having a device inside my body.

I don't like the idea of having a device inside my body.

More important

Equally important

More important

I'm not worried about the small risks of surgery.

I'm concerned that something could go wrong with the surgery.

More important

Equally important

More important

I'm not concerned that the ICD or the leads could break.

I'm concerned that the ICD or leads will break and I'll need another surgery.

More important

Equally important

More important

My other important reasons:

More important

Equally important

More important

4. Where are you leaning now?

Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.

Getting an ICD

NOT getting an ICD

Leaning toward

Undecided

Leaning toward

Credits

By	Healthwise Staff
Primary Medical Reviewer	E. Gregory Thompson MD - Internal Medicine
Primary Medical Reviewer	Martin J. Gabica MD - Family Medicine
Primary Medical Reviewer	Elizabeth T. Russo MD - Internal Medicine
Primary Medical Reviewer	Adam Husney MD - Family Medicine
Primary Medical Reviewer	John M. Miller MD, FACC - Cardiology, Electrophysiology
Primary Medical Reviewer	Caroline S. Rhoads MD - Internal Medicine

References

Citations

AVID Investigators (1997). A comparison of antiarrhythmic-drug therapy with implantable defibrillators in patients resuscitated from near-fatal ventricular arrhythmias. New England Journal of Medicine, 337(22): 1576–1583.
Al-Khatib SM, et al. (2017). 2017 AHA/ACC/HRS Guideline for management of patients with ventricular tachycardias and the prevention of sudden cardiac death. Circulation, published online October 30, 2017. DOI: 10.1161/CIR.0000000000000549. Accessed November 6, 2017.
Ezekowitz JA, et al. (2003). Implantable cardioverter defibrillators in primary and secondary prevention: A systematic review of randomized, controlled trials. Annals of Internal Medicine, 138(6): 445–452.
Van Rees JB, et al. (2011). Implantation-related complications of implantable cardioverter-defibrillators and cardiac resynchronization therapy devices. Journal of the American College of Cardiology, 58(10): 995–1000.
Uhlig K, et al. (2013). Assessment on implantable defibrillators and the evidence for primary prevention of sudden cardiac death. Technology Assessment Project ID: CRDT0511. Rockville, MD: Agency for Healthcare Research and Quality. http://www.cms.gov/Medicare/Coverage/DeterminationProcess/Downloads/id91TA.pdf. Accessed December 5, 2013.
Eckstein JE, et al. (2008). Necessity for surgical revision of defibrillator leads implanted long-term. Circulation, 117(21): 2727–2733.
Kleemann T, et al. (2007). Annual rate of transvenous defibrillation lead defects in implantable cardioverter-defibrillators over a period of >10 years. Circulation, 115(19): 2474–2480.
Baddour LM, et al. (2010). Update on cardiovascular implantable electronic device infections and their management. A scientific statement from the American Heart Association. Circulation, 121(3): 458–477.

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