Definition and Overview

A defibrillator checkup refers to a series of routine follow-up visits to a cardiac physiologist to have an implantable cardiac defibrillator (ICD) device checked. The visits are required for all patients who have had the device implanted.

A defibrillator is a small electronic device that sends electric shocks to the heart to restore normal heart rhythms in case the heart’s internal electrical system malfunctions. An ICD implantation is part of the treatment for heart disease and can help protect a patient from the dangers of arrhythmias and the risk of sudden cardiac arrest. An ICD is usually implanted in the chest, but may also be placed in the abdomen; in both cases, the implantation requires a major surgical procedure.

Who Should Undergo and Expected Results

A defibrillator checkup is a crucial part of long-term care prescribed for patients who have had the device implanted. These may include patients who are suffering from the following conditions:

  • Coronary artery disease
  • History of heart attack/s
  • Dilated cardiomyopathy, in which the heart muscle is abnormally enlarged
  • Hypertrophic cardiomyopathy, in which the heart muscle is thickened
  • Long QT syndrome, an inherited heart condition characterized by abnormal heart rhythms
  • Brugada syndrome
  • Arrhythmogenic right ventricular dysplasia
    These patients may experience the symptoms commonly associated with heart disease; these include:

  • Discomfort

  • Chest pain
  • Arm pain
  • Pain below the breastbone
  • Chest pressure
  • Pain or discomfort that radiates from the chest towards the back, throat, jaw, or arm
  • Indigestion
  • Heartburn, or a similar sensation
  • Nausea
  • Vomiting
  • Dizziness
  • Sweating
  • Shortness of breath
  • Palpitations
  • Rapid heart rate

How Does the Procedure Work

A defibrillator checkup is performed by a cardiac physiologist who is familiar with the patient’s case history. It takes place in an ICD or pacemaker clinic or a cardiac catheter suite in a hospital. The recommended schedule for each patient may vary, but patients are generally asked to come back for their (1) first checkup 24 hours after implantation, (2) second checkup six weeks after implantation, and (3) third checkup three months after. The next checkup is performed six months after the 3rd-month checkup, and succeeding visits are scheduled every six months thereafter.

During the follow-up visit, the patient will be asked to remove his upper clothes and lie down on an examination couch. The checkup begins with the physiologist checking the patient’s scar, then proceeds to inspect the device itself to check whether it is properly functioning and whether the battery still has an adequate charge. To do so, the cardiologist or technician will attach electrodes to the patient’s chest, as well as a magnet, which will be placed over the spot where the ICD was implanted. The magnet and the electrodes will connect the ICD to the computer to access the device’s record of heart rates. The procedure is painless and comfortable for most patients, and usually only takes up to 40 minutes.

The most important part of the checkup is when the activity recorded by the device since the last checkup is analyzed. This will determine whether the device detected abnormal heart rhythms and how it responded or resolved the situation. The activity will then be plotted on an ICD chart so that future records can be compared with it.

Once the device is checked, the cardiologist will assess the patient’s state of health and general condition and will ask the patient about any changes or new symptoms he may have observed or experienced since his last visit. The doctor will also evaluate the patient’s medications and check for side effects. Thus, patients are advised to bring a list of their medications to their defibrillator checkup.

At the end of the appointment, the doctor will provide his recommendations and advice on how to ensure the patient’s health and safety until his next checkup. If necessary, he may also reset the defibrillator before sending the patient home.

Aside from the regular defibrillator checkups, a patient with an ICD implanted will also need to go back to the doctor for a minor procedure after six to eight years to have the battery changed.

Possible Risks and Complications

A defibrillator checkup is a routine visit that poses little to no risks to the patient. In fact, the follow-up checks can help protect a patient from the risks and complications associated with the use of these devices. These include:

  • Infection
  • Allergic reactions or sensitivity to any of the materials used in the device
  • Swelling
  • Bleeding
  • Bruising
  • Vein damage
  • Bleeding around the heart
  • Blood leakage from the heart valve
    Regular checkups also help by reminding patients of the limitations the ICD imposes on them, such as staying away from magnetic and electromagnetic materials and appliances, to ensure their long-term health and safety.

Most importantly, the checkups ensure that the defibrillator is in good working condition and will not suddenly run out of battery charge, so that if and when arrhythmias occur, the device will be able to respond as it is supposed to.

Reference:

  • Swerdlow CD, Hayes DL, Zipes DP. Pacemakers and cardioverter-defibrillators. In: Mann DL, Zipes DP, Libby P, et al, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 10th ed. Philadelphia, PA: Elsevier Saunders; 2014:chap 36.
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