ICD- defibrillator and pacemaker

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KOMLAS
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ICD- defibrillator and pacemaker

Post by KOMLAS » August 21st, 2018, 2:20 pm

I am new to the board and I am going to sound very uneducated because I am when it comes to this topic. I am trying to educate myself in a hurry to help my Dad who is 80 years old. My Dad has CHF and Kidney disease. Its a balancing act between the heart and kidneys when it comes to the Lasix's. He has been thru hell and back over the last 2 years and his heart took a big hit last year after a 7 hour surgery on his back. His heart ejection fraction ratio is around 29%. The doctors think anything below 30% needs both a defibrillator and pacemaker. We have been told they have to use Dye to implant the defibrillator which could kill his kidneys. Some of the dr's are saying they use very little dye but its still a chance he has to consider.

The question my family is faced with is the defibrillator worth it or should we just get the pacemaker? I was told the pacemaker would help with this kidney function because it will help his heart better. any information on this topic is greatly appreciated, even if its just to explain the two.

thank you,

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Leah
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Re: ICD- defibrillator and pacemaker

Post by Leah » August 21st, 2018, 2:25 pm

Hi-
Welcome to the group. My HF is 25% and I just got upgraded to a CRT-D in June. I used to have just a regular pacemaker/defibrillator since 2001.

KOMLAS
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Re: ICD- defibrillator and pacemaker

Post by KOMLAS » August 21st, 2018, 3:13 pm

What is a CRT-D and how is that different? you say you upgraded?

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ROBO Pop
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Re: ICD- defibrillator and pacemaker

Post by ROBO Pop » August 21st, 2018, 3:53 pm

Welcome to the island of misfits, glad you found us. Hopefully we can help you on this journey.

So as the Dr said, once your EF hits 30% or below, a defibrillator is called for because the patient is at increased risk of SCA (Sudden Cardiac Arrest). Few people who experience an SCA survive without immediate help from a defibrillator to restart the heart. This is the condition we frequently hear of athletes suddenly dying from. As for the decision between a defibrillator or pacemaker, it's really not a choice. Most defibrillators have a pacemaker built in and you can lay them next to a plain pacemaker and can't tell the difference.

So there are pacemakers, which are strictly a pacemaker. There's ICD's (Implantable Cardioversion Defibrillator) which is a defibrillator and pacemaker combination, and finally a CRT-D (also known as a bi-ventricular Defibrillator) which is a special ICD used for a condition that causes the two sides of the heart to beat out of sync causing a low EF. Most likely your dad would be prescribed a ICD for his condition.

For clarity the defibrillator can perform multiple functions from restarting the heart (Defibrillation) to pacing the heart, to Anti_Tachycardia Pacing (ATP) which helps stop out of control fast heart rates (Ventricular Tachycardia) which can lead to Fibrillation.

Hope this helps
Broken Heart
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KOMLAS
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Re: ICD- defibrillator and pacemaker

Post by KOMLAS » August 21st, 2018, 4:04 pm

yes that does help, thank you. Keep it coming guys.. :)

my late husband died 6 yrs ago from colon cancer and I joined a board almost exactly like this one and I can not tell you how much I learned more from people themselves opposed to the actual Dr's during our appointments.

the support group board was exactly like this one too.

InSync
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Re: ICD- defibrillator and pacemaker

Post by InSync » August 21st, 2018, 11:06 pm

Welcome Komlas!

Do you have any idea what his heart rate is running? A pacemaker is used when the heart is beating too slow. It is programmed to emit a little electrical charge at the 60 bpm interval if the heart doesn't do so on its own. The heart would be pumping more effectively, perfusing the body and the vital organs better. Dye would still be used because the lead from the device to the heart is inserted through a blood vessel into the right atrium, where it is implanted. The dye helps the doc guide the lead in.

An ICD has the pacemaker function and one lead goes to the right atrium, just as in the pacemaker. There is also a second lead that goes into the atrium with the pacemaker lead, but it goes through the tricuspid valve into the right ventricle. This is the lead that shocks. So you would now have a device that can act as pacemaker and also defibrillator, in case of SCA. The device will also watch your rhythm and if tachycardia starts, the device will emit small electrical charges to try to interrupt the abnormal rhythm.

The third kind of device is CRT-D. Robo described its function. It has the pacemaker function, the shock lead, and a third lead. That lead is threaded through a vessel around the back of the heart. This kind of device makes the ventricles beat together, so heart function is better, the beat more effective, and the body perfused more effectively......perfusing the kidney better, so hopefully it will work better. In addition, better circulation means less fluid retention.


All of these require dye. I would want to know how much more is used with the additional leads. An EF of 29 is definitely abnormal, but not scary low range. You might want to ask about the likelihood of recovery for the kidney with pacemaker vs. ICD.
Dilated Cardiomyopathy, LBBB, CHF
St. Jude CRT-D 5/12
The beat goes on.....

InSync
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Re: ICD- defibrillator and pacemaker

Post by InSync » August 21st, 2018, 11:07 pm

Welcome Komlas!

Do you have any idea what his heart rate is running? A pacemaker is used when the heart is beating too slow. It is programmed to emit a little electrical charge at the 60 bpm interval if the heart doesn't do so on its own. The heart would be pumping more effectively, perfusing the body and the vital organs better. Dye would still be used because the lead from the device to the heart is inserted through a blood vessel into the right atrium, where it is implanted. The dye helps the doc guide the lead in.

An ICD has the pacemaker function and one lead goes to the right atrium, just as in the pacemaker. There is also a second lead that goes into the atrium with the pacemaker lead, but it goes through the tricuspid valve into the right ventricle. This is the lead that shocks. So you would now have a device that can act as pacemaker and also defibrillator, in case of SCA. The device will also watch your rhythm and if tachycardia starts, the device will emit small electrical charges to try to interrupt the abnormal rhythm.

The third kind of device is CRT-D. Robo described its function. It has the pacemaker function, the shock lead, and a third lead. That lead is threaded through a vessel around the back of the heart. This kind of device makes the ventricles beat together, so heart function is better, the beat more effective, and the body perfused more effectively......perfusing the kidney better, so hopefully it will work better. In addition, better circulation means less fluid retention.


All of these require dye. I would want to know how much more is used with the additional leads. An EF of 29 is definitely abnormal, but not scary low range. You might want to ask about the likelihood of recovery for the kidney with pacemaker vs. ICD.
Dilated Cardiomyopathy, LBBB, CHF
St. Jude CRT-D 5/12
The beat goes on.....

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luvmydogs
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Re: ICD- defibrillator and pacemaker

Post by luvmydogs » August 22nd, 2018, 8:09 am

Komlas,

Sorry, but I have to ask the question... what does your 80 year old Dad want? Is he all for having an ICD (or something) implanted? You will also find other discussions on here regarding the defibrillator choice. It is a very personal choice on how you want to go when your times up. A lot of people would rather go from an SCA (sudden cardiac arrest) when their time comes, so may not want the defibrillator part.

I will say though, that you can have the ICD or CRT-D implanted and they can turn off the defib part at any time.
Joanne (aka Jo)

KOMLAS
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Re: ICD- defibrillator and pacemaker

Post by KOMLAS » August 22nd, 2018, 3:28 pm

thank you both for the continued information. you know I have never asked my Dad how he wants to go, as its obviously a topic I hate to discuss but yo have a very good point. I will bring this up to my Dad. They are doing a heart Cath today to see if there is any blockage anywhere because he keeps retaining fluid and the creatinine level is going back up. :(

KOMLAS
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Re: ICD- defibrillator and pacemaker

Post by KOMLAS » August 22nd, 2018, 8:44 pm

When you say an EF OF 29 is not scary low , why with this EF does the heart have problems pumping the fluid out of the body ?
They did a right heart catherization on my dad today and from what I was told it came out good , no blockages and all. Why does the right side keep retaining fluid ?
I am probably missing a piece to the puzzle here .

My dad wore a life vest for 3 months and according to the report it never once detected anything bad so why would he need a pace maker ?

Leedur
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Re: ICD- defibrillator and pacemaker

Post by Leedur » August 23rd, 2018, 6:41 am

@KOMLAS................ I had my defibrillator/pacemaker for 15 months in 2015 and had convinced myself I had not needed it. Then while driving...suddenly started to pass out...then ZAPP. Saved me from crash and possible SCD.

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TruckerRon
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Re: ICD- defibrillator and pacemaker

Post by TruckerRon » August 23rd, 2018, 9:28 am

KOMLAS wrote:
August 22nd, 2018, 8:44 pm
When you say an EF OF 29 is not scary low , why with this EF does the heart have problems pumping the fluid out of the body ?
They did a right heart catherization on my dad today and from what I was told it came out good , no blockages and all. Why does the right side keep retaining fluid ?
I am probably missing a piece to the puzzle here .

My dad wore a life vest for 3 months and according to the report it never once detected anything bad so why would he need a pace maker ?
Some thoughts:
  • An EF of 29% is low enough that insurance companies allow the insertion of an ICD. To me, that says it's serious enough.
  • He may not have a detectable arrhythmia, but something has decreased his EF and is contributing to the CHF.
  • It may be that the weakened heart is the result of a virus they don't recognize. That happened to a neighbor of mine.
If it's none of the above, then doctors have a lovely word to describe his CHF: idiopathic, which means "we're idiots, and this is pathetic, but we don't have a clue."
TruckerRon -- Received Minion I on 17 Sep 2009, Minion II on 26 Jan 2015

Non-ischemic cardiomyopathy
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No shocks yet...
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abas
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Re: ICD- defibrillator and pacemaker

Post by abas » August 23rd, 2018, 2:28 pm

Leedur wrote:Saved me from crash and possible SCD.
So what do you get instead if you do not get the SCD?

Leedur
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Re: ICD- defibrillator and pacemaker

Post by Leedur » August 23rd, 2018, 6:06 pm

Leedur wrote: "Saved me from crash and possible SCD."

abas asked: "So what do you get instead if you do not get the SCD?"


Response: Assuming SCD = Sudden Cardiac Death, there could be many answers to your question. First thing that comes to mind is I get to keep living.

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ROBO Pop
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Re: ICD- defibrillator and pacemaker

Post by ROBO Pop » August 24th, 2018, 10:17 am

TruckerRon wrote:
August 23rd, 2018, 9:28 am
if it's none of the above, then doctors have a lovely word to describe his CHF: idiopathic, which means "we're idiots, and this is pathetic, but we don't have a clue."
lmao4dx :lamo: as you may have noticed Ron likes to demonstrate his Latin skills
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http://www.icdsupportgroup.org/board/vi ... 97&p=91375

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