Q.1 What do you mean by Device Therapy for Heart failure?
A. Heart Failure is a condition which predisposes for sudden cardiac death due to abnormal ventricular rhythms in conditions like ventricular tachycardia (VT) or ventricular fibrillation (VF). Device therapy means implanting an ICD (Implantable Cardioverter Defibrillator) or CRT (Cardiac Resynchronisation Therapy). These devices help you to overcome these life threatening variations in your heart rhythms.
Q.2 What is an ICD? What does it do?
A. ICD is a small shock box like a pacemaker, which is implanted very much like a pacemaker. It is like a CPU of the computer and gets signals from a lead implanted in the heart. It looks at your rhythm 24X7, 365 days a year, and whenever your heart rhythm goes berserk it brings it fixes it by either pacing it out or giving a shock.
Q.3 How do I know whether I need it?
A. If you have been diagnosed with any condition like low heart functions, a sudden unconsciousness with or without documented bad heart rhythm, or in case of a family history of sudden demise with no obvious reason, you should meet your cardiologist to decide whether you need an ICD or not.
Q.4 I have had heart failure with a heart function of 30%. I am doing very well on medicines. Do I still need an ICD device?
A. Yes, all studies show that a person with heart functions less than 30-35%, have high chances of having sudden deaths and should have an ICD. If you ever had a documented VT or VF then ideally you should not be discharged from the hospital without an ICD device.
Q.5 Does ICD improve heart functions or symptoms of a heart condition?
A. No, an ICD does nothing to improve the symptoms or heart functions. It is a device which prevents sudden death due to VT or VF. However, in few selected cases a CRT might improve your heart function as well.
Q.6 What is a CRT?
A. CRT means Cardiac Resynchronisation Therapy. In this device three leads are put in the heart; one in the upper chamber and two on either side of the left lower chamber of the heart. It helps in improving synchronised contraction of the heart and thereby betters the heart function. If there is an ICD function also it is called a Combo Device.
Q.7 How do I know whether I am a candidate for CRT?
A. Your ECG holds the key to answer this. It should have very broad complexes that signify desynchronised heart contractions. Consult your cardiologist to make this decision.
Q.8 How good is this therapy?
A. In ideal candidates it has 70% chances of improving the heart function and sometimes also leads to almost total withdrawal of medicines. It has been the biggest leap in managing heart failure patients.
Q.9 How much will my life be restricted after these devices are inside me?
A. Not much except in the initial few weeks when you would be asked to restrict movement. You can do all your activities like walking, exercising, playing, sexual intercourse etc. However, you should always consult your cardiologist for a full update on the activities that you can do.
Q.10 How is it checked whether these devices are working well?
A. These devices can be checked with their programmers available with your cardiologist. They have a memory and all this can be checked to see if you received a shock or in case of any other problem with the device. There should be a dedicated periodic check up of the device as per your cardiologist.
Q.11 How long does the battery last?
It varies depending on how much your heart uses it. On an average it lasts 8-9 years for ICD and 5-6 years for a CRT.
Device therapy is a big leap in preventing sudden deaths and improving general status of the patient’s health, especially with the Combo Device. One should always discuss the need for the same in their patients if they suffer from heart failure. Though there are other conditions also for which ICD may be indicated and one should discuss it with their cardiologist.