Il Implantable Defibrillator (ICD) is the most effective life-saving device capable of preventing sudden cardiac death in patients with cardiomyopathy. Its function is to continuously analyze the rhythm of the heart, automatically recognize any rapid cardiac arrhythmias (usually Tachycardia or ventricular fibrillation with a frequency greater than 200 beats per minute), and stop them by means of electrical therapy (generally a high voltage shock) .
It is a small box with an electrical pulse generator and one or more leads.
In patients with cardiomyopathy, the ICD has shown that sudden death can be avoided in most patients. The ICD modern are effective, safe and compatible with a lifestyle that involves few precautions and limitations and the possibility of performing an MRI.
Almost all of these devices are equipped with a system that allows the remote transmission of information on the rhythm of the heart and on the integrity of the system. This function, commonly known as "home monitoring”, Allows a closer contact between doctor and patient.
Trans-venous ICD (TV ICD) It is the traditional ICD that is implanted by introducing the leads into the heart through a vein in the chest and placing the generator under the skin, under the left collarbone. The surgery is performed under local anesthesia and mild sedation with a short hospital stay; it requires neither opening the chest nor direct access to the heart.
This ICD it also has a pacemaker function, that is, it can stimulate the heart, if necessary, to prevent the heart rate from being too low. The pacing rate should be determined based on the type of cardiomyopathy (for example, higher in the case of Restrictive Cardiomyopathy).
However, ICD therapy is not without risk: Complications can occur during implantation or as a result of long-standing leads within the heart, with lead infections and fractures. Younger patients, while benefiting most fromICD, they are more prone to long-term complications, due to their long life expectancy and the increased mechanical stress that the ICD undergoes with their active lifestyle. These potential complications, not negligible, more frequent in subjects with diabetes, renal insufficiency or immunosuppressed, must always be considered when evaluating the implantation of a ICD. There is in fact a growing awareness that complex devices, especially when equipped with multiple leads that reside within the heart for decades, can lead to complications without necessarily adding significant clinical benefits.
Subcutaneous ICD (S ICD) It is a relatively new device, an alternative to the traditional one ICD TV, which is implanted by placing the defibrillation catheter under the skin, parallel to the breastbone, and the generator in a deep “pocket” on the left side, near the armpit. It maintains the functions of the traditional ICD, but without the pacemaker function. The plant of S-ICD minimizes operative risks and long-term complications of the ICD TV, related to the placement of the leads within the veins and heart and their possible infections. Its effectiveness in the prevention of sudden death in patients with cardiomyopathy has already been demonstrated. However, the possibility of implanting it depends on the characteristics of the patient, so it is necessary to make an accurate preventive evaluation.