ICD Combo Device Surgery Treatment Cost in India

Implantable Cardioverter Defibrillator or an ICD is a battery-powered device that has been placed underneath the skin that can keep track of the heart rate. There are very thin wires that connect the ICD to the heart of the patient. When any abnormal heart rhythm is detected the device will generate an electric shock for the restoration. When the heartbeat grows too chaotic and beats too fast this device is helpful.

ICDs have been particularly helpful in the prevention of sudden death among patients who have earlier sustained fibrillation or ventricular tachycardia. Some studies show that the device plays a role in preventing sudden cardiac arrest among high-risk patients who probably never suffered life-threatening outcomes from arrhythmias.

The device gets to detect when the heartbeat is not normal and tries to return it back to normal.

This device has features similar to the pacemaker and when the heartbeat is very slow it sends a tiny electrical impulse to the heart like the pacemaker.

And when the heartbeat is too quick it gives defibrillation shocks and stops the abnormal rhythm

New features like “overdrive” where a sustained ventricular tachycardia (fast heart rhythm) is converted electrically and backup pacing when bradycardia (slow heartbeat) occurs. They also provide other functions like storage of detected arrhythmic events and later perform electrophysiologic testing. The stored information can allow the doctor to reset the ICD as per the need of the patient.

An ICD device is recommended by the American Heart Association after a patient has been diagnosed with arrhythmia that can be life-threatening and all other correctable causes of arrhythmia have been ruled out or not applicable and they are:

•           Acute myocardial infarction (heart attack)
•           Drug toxicity and electrolyte imbalance
•           Myocardial ischemia or inadequate flow of blood to the muscles of the heart.

Most people are unable to understand the consequences of underlying conditions such as heart failure or genetic predisposition to face a risk of sudden cardiac arrest, and since ICDs are generally used to avoid sudden cardiac death, the benefits versus the disadvantages of having an ICD implanted may not be clear. The reasons why the doctor can prescribe an ICD are the following life-threatening ventricular arrhythmia:

•           Had suffered a heart attack
•           A ventricular arrhythmia
•           Survived a sudden cardiac arrest
•           Brugada Syndrome
•           Long QT Syndrome

A congenital heart disease or any other hidden conditions that may trigger a sudden cardiac arrest.

Some of the symptoms of such patients are:

•           Chest pain
•           Shortness of breath
•           Profuse sweating
•           Tachycardia or bradycardia
•           Fluttering sensation in heart
•           Fainting and lightheadedness

The implantation of ICD can be done on an inpatient or outpatient basis. It can vary depending on the selection of the surgery team based on the conditions of the patient. An IV (intravenous line) is introduced on arm or hand followed by emptying of the urinary bladder of the patient.

The implantation procedure can have the following approach:

Thoracotomy: In this situation, the chest is uncovered, and delicate, thin, oval-shaped patches made of rubber along with wire mesh are sewn on the outer side of the heart or epicardium.

Transvenous approach: From the name we understand that we need to access this through a vein. A small incision near the collarbone of the patient is made in this technique and through these the leads make their way into the heart of the patient. The lead tip is positioned right inside the endocardium or the inner wall of the heart.

Subxiphoid approach: This technique is somewhat similar to the thoracotomy procedure but here the incision is made close to the breastbone or sternum making the incision slightly towards the left.

Sternotomy: This technique is also close to thoracotomy where the chest is opened. Here the incision is made on the sternum itself or the breast bone and the leads are then directed into the heart. A sternotomy can be combined with coronary artery bypass surgery or heart-valve surgery.

The patient is placed on the back over the operating table and an ECG or EKG lead is placed to monitor the electrical activities of the heart. Large electrode pads are placed on both the front and backside of the chest.

Through the IV-line, a sedative is injected to allow the patient to relax and the patient will be in their senses during the defibrillator procedure.  Insertion site is cleaned, and sterile towels and sheets are placed around the area.

Under the collarbone, a sheath or it may be referred to as an introducer is moved into the blood vessel. The ICD lead wire in also made to move through this plastic tube and reach the heart. The surgeon shall conduct tests like fluoroscopy to find out whether the leads are being placed in the best locations and the connection with the ICD is proper.

Once the ICD is properly implanted (usually under the collarbone or below the waistline), some additional testing is done to ensure that the system is working properly or not and whether it shall be effective in correcting the patient’s arrhythmia problem.

There can be cases where multiple lead wires are inserted into the blood vessels and all their positions will be checked via a fluoroscopy test.

For some time, the ECG will keep monitoring the function of the ICD while the incision in the skin is closed with a special adhesive strips or glue and sterile bandage dressing is done for the incision site.

The patient is expected to inform the doctor of any medical history or medication that they are taking. It must be clearly understood that if they are pregnant or planning pregnancy (female candidates) then they must be notified to the health care provider. Apart from that, if they are allergic to latex or any other dye, they must be informed.

One can be on any antibiotic course before surgery and is expected to be on fasting. They should remain in touch with their healthcare provider so that any change in patterns can be well taken care of.

After the surgery, the vital signs of patient are observed, and they may be given easily digestible food to eat. Immediate improvement in health can be seen after implantation. Patient is also given an ID card which should always be carried by them so that during any security screening they are considered. Certain things that must be considered or avoided by patients are:

•           Anti-theft systems
•           Security metal detectors
•           Cell phones, MP3 Players, headphones
•           Welding equipment, jumper cables or any power generating devices
•           Radios depending on watts should be kept away by 2 feet.
•           Gasoline ignition systems
•           Ab stimulators and electronic boy fat scales
•           Portable car battery chargers
•           Electric fences

One must also take care of the medical procedures that pose a threat to the patient like MRI scans or any kind of radiation-oriented procedure like radio frequency ablation, electrolysis, electrocauterization, X-rays and CT scans.

ICD implantation procedure costs around $14000 in India. Best class medical care can be expected at a very reasonable cost.