Heart failure

Medical devices for heart failure

Implantable devices are an important treatment option for certain people with heart failure who may be at risk of irregular heart rhythm, or an abnormal muscle contraction that can’t be controlled with medicines. Some of the people we talked to had procedures to fit pacemakers, Implantable Cardioverter Defibrillators (ICDs) and Cardiac Resynchronisation Therapy (CRT) devices, also known as a biventricular pacemakers. 

Implantable cardioverter defibrillators (ICD’s) are used in people with a high risk of serious abnormal rhythm problems in the ventricles or large chambers of the heart. ICDs use a small electrical shock, known as cardioversion to help return the heart rhythm back to normal. If this doesn’t work, or a serious problem is detected, the device will deliver a stronger electrical impulse, known as defibrillation, to return the heart rhythm back to normal. 

We asked Helen Jackson, Advanced Nurse Practitioner in heart failure to help explain implantable devices for heart failure.
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Further information for people with ICDs is available online at the British Heart Foundation. 

A large number of people with heart failure have conduction defects where the two ventricles of the heart do not work together properly – this can be corrected by a cardiac resynchronisation therapy (CRT) pacemaker. This type of pacemaker is known as a CRT-P device and is used to make both the left and right ventricle start beating at the same time again. CRT pacemakers are different from typical pacemakers which only pace the right ventricle and control heart rate. 

A CRT device may be just a pacemaker or it may also able to deliver a shock (cardioversion or defibrillation) in a life-threatening situation as well. It is called a CRT-D if defibrillation is part of the function of the device. Further information for people with CRT is available online at Arrhythmia Alliance.
Information about why an implantable device is required and the risks and benefits of such a treatment are usually given to the patient by the cardiologist involved in the implanting or by specialist nurses - called ICD nurses (See ‘Specialist heart failure nurses’). The Arrhythmia Alliance website also has lots of useful information about implantable devices.
People we talked to generally had no concerns about having a medical device fitted but did worry about things such as having the procedure under local anaesthetic or told they should not drive for six weeks after the procedure.
Implantable devices are inserted under local anaesthetic and are positioned under the collarbone with flexible electrode leads coming from it that are positioned in the heart (for more information see the Arrhythmia Alliance website).
Usually people stay in hospital overnight but in some cases – for example where people are on anticoagulant medication such as warfarin - they need to be in hospital before and after the medical device is fitted, first to stop the anticoagulant medication and be put on heparin and, afterwards to be monitored when re-starting anticoagulant medication.
An aftercare instruction leaflet stating what to avoid is given to people before they leave hospital. For instance, people should avoid stretching their arms upwards for six weeks following the procedure; people with medical devices should avoid contact with devices with magnetic force, for example alarm systems in shops and in airports. People are also given instructions about electrical equipment in the home.

A few weeks after the device is implanted the patient has a follow-up appointment to make sure all is well. The person continues to be monitored over-time. Medical devices sometime need to be regulated and the speed may need to be put up or down depending on the individual. People also talked about feelings of discomfort and the emotional impact of living with an implantable device.
Sometimes it took people time to get used to having an implantable device or notice an improvement in their condition. Bruce indicated that he was pleasantly surprised to be discomfort-free shortly after his treatment.
People with ICD/CRTs need to attend regular hospital appointments to make sure that all is well. The device is checked using a short-range radio signal to communicate with it through the skin. This procedure is painless and discomfort free and visits are usually needed between one and four times a year. People we talked with found it reassuring to be so well monitored.
Generally people with CRT-D, CRT-P, ICD and permanent pacemakers are not able to safely have an MRI scan. 

Medical devices may need to be disabled during surgical procedures which use diathermy equipment – for sealing blood vessels. The diathermy generates electrical interference that the medical device might interpret as a life threatening arrhythmia and therfore deliver a shock. The device is disabled by a technician with a programmer or it could be disabled by placing a magnet over the device. The pacemaker function continues but the defibrillator is disabled. After the procedure the device needs to be checked to ensure that all the settings are back to normal.
Implantable devices can also be checked remotely using telemonitoring via a telephone line or a wireless connection. In this way, many implantable devices are able to send clinical data to health professionals without the need for a visit to the hospital. (See ‘Heart failure monitoring at home’)
People living with heart failure might have access to Helplines and email run by heart failure nurses for support and advice but such services vary across the UK (also see our section on ‘Specialist heart failure nurses’).

ICDs are designed to deliver an electric shock if the heart rate becomes very fast and the pacing function of the device is unable to correct the rhythm. People said that these shocks from an ICD feel like being suddenly kicked or punched in the chest. People might have warning signs before an ICD shock like palpitations, light-headedness or feeling dizzy. People are given specific advice of what to do in the event of an ICD shock, for example to sit or lie down on the ground, to tell someone they are feeling unwell and not to drive. For more information on ICD shocks see CRT/ICD Patient Information leaflet from the Arrhythmia Alliance website.
See also our ‘Living with heart failure’ section.

Left ventricular assist devices (LVADs)

LVADs are most commonly used to support a failing heart until a donor heart becomes available for transplantation. This is known as a ‘bridge to transplantation’, where the device is only used for a short time and is removed when a donor heart is transplanted. It is a mechanical pump designed to help the left ventricle do its job. It is inserted surgically – either into the left ventricle itself, or into the aorta to help boost the pumping action of the heart (for more information see the British Heart Foundation’s website). We have been unable to interview anyone who has had a LVAD. If you have had a LVAD and would like to be interviewed please contact us.

Last reviewed April 2016.
Last updated April 2016.


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