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Implantable Defibrillator (ICD) or Cardioverter Defibrillator

A timely resuscitation, especially defibrillation, is a key life-saving measure for cardiac arrhythmias. Implantable defibrillators are an important method of treatment. 

As the name indicates, an implantable cardioverter defibrillator is affixed like a pacemaker under the skin. The ICD continually monitors the heart and intervenes if a dangerous arrhythmia occurs. The main feature that differentiates the ICD from a common pacemaker is that, if a case of ventricular fibrillation should happen, it delivers an electric shock (defibrillation) which allows the pulse to return to normal. Since the shock sensor is located directly in the heart, the surge strength of the electrical current is significantly lower than if external defibrillation is applied by an emergency physician.  The shock sensor is introduced into an area around the clavicle vein, (clavicle = “collar bone”) and anchored there. An ICD also functions as a "normal pacemaker"; meaning that if the heart rate drops, it can take over the function of the natural pacemaker (sinoatrial node). Besides defibrillating electric shocks, modern ICD units are capable of emitting minute impulses that the patient may not even be aware of, a so-called overstimulation which is activated in order to terminate ventricular tachycardia without shock. The sensor and the pacemaker are housed together and act as a unit. Complex algorithmic-detectors allow the device to distinguish normal heart functions from dangerous rapid heartbeat (tachycardia) or ventricular fibrillation which is possibly fatal if left untreated.

What are the indicators for the implantation of an ICD?

The implantation of an ICD is indicated in patients with either a high probability risk of suffering a rhythmic event which could lead to sudden cardiac arrest, or those who were revived in time after having experienced sudden cardiac arrest. Sudden cardiac death (SCD) is an untreated fatal complication of congenital or acquired heart disease. This fatal form of terminal ventricular fibrillation most often results from the last stages of heart disease.  Ventricular fibrillation can occur within the framework of cases of severe coronary heart disease (CHD) through an acute myocardial infarction or as a complication of severe chronic CHD. 
This "flickering" of the heart muscle is so rapid that the heart is unable to provide more pumping power. Initiating early resuscitation, especially defibrillation, can be a life-saving measure. In order to avoid SCD incidents it is important to identify patients who are at risk.
Determining the pumping capacity of the heart through echocardiography is particularly important in this regard.  If the pumping power is severely restricted, current guidelines indicate an affected patient should be outfitted with a so-called implantable defibrillator (ICD).
In addition to the various forms of CHD (i.e. congestive heart failure; heart weakness or limitation of the pumping power of the heart) the main causes of dangerous ventricular fibrillation are heart muscle inflammation or congenital heart disease (e.g. ARVCM). In cumulative, unclear cases of sudden death within a family, close relatives should be examined for the possible presence of a congenital structural heart disease. Along with genetic tests, especially imaging methods such as echocardiography, cardio - MRI and cardiac catheterization may also be considered. These mild methods can be used to carefully determine whether there is a particular risk for the person concerned. Warning signs signaling possible sudden cardiac death are often severe dizziness or fainting, also known as syncope. It is important to distinguish benign causes from dangerous arrhythmias. The long-term electrocardiogram (a 24 -hour or Holter ECG) is often indicated. In many patients, unfortunately, comes the classic "model effect" to the fore: Just at the moment a long-term ECG is scheduled to be done, the arrhythmia or vertigo attacks do not occur. 
This may be remedied by providing a portable ECG event recorder. If a portable ECG does not result in a diagnosis, the implantation of an implantable event recorder may be indicated. These so-called loop recorder devices are primarily small, implantable devices placed under the skin, which can be read by the doctor in the event of a syncope. This procedure can be performed in either the practice or clinic, or can be transmitted via a telemetry function per telephone. State-of-the-art systems (e.g. a bio-monitor) can automatically transmit dangerous arrhythmias.

Focus: Pacemakers and Electro-Therapy

Pacemaker and defibrillator therapy at the Isar Heart Center in Munich: Highly skilled specialists in cardiology and cardiac surgery focus cooperatively on the pacemaker.

Modern pacemaker systems are highly capable units that can support cardiac function in many ways. These include supplanting the "pace" in the event of a loss of natural rhythm, implantable defibrillators (ICD) capable of ending a dangerous arrhythmia, or improving the pumping performance by multi-chamber systems. As director of the focus group for rhythmology Prof. Thorsten Lewalter contributes his particular expertise in the differentiated diagnosis of cardiac arrhythmias. His work at the University Hospital of Bonn, where he was involved in pioneering developments in pacemaker technology, has made him a leading authority in this field. In conjunction with senior physician Dr. T. Brodherr a strong team is prepared for implantation of all types of pacemaker and defibrillator systems. Complex procedures performed by the heart team, such as sensor extraction, are supported by modern technology, specialist networks and an efficient organization.

OA Dr. med. T. Brodherr
Attending Physician Cardiology