ICD vs. Pacemaker

On my second ICD as the battery was about to expire.. Have noticed a few posts here where considering changing out Pacemaker for an ICD. I have to wonder why not get an ICD to start with.....since they also have pacing feature? Both treat similar arrhythmia issues which got us here to start with. Seems this would be preferred as you might be better protected and save the need to switch. Sure there must be a good reason and I would be curious to know..


5 Comments

"Similar arrhythmia issues"

by AgentX86 - 2021-08-18 23:01:17

That's the differnce. The arrhythmias aren't similar at all. Most of us have atrial arrythmias which are almost always, by themselves, benign. Pacemakers, in general, only treat one sort of arryhmia - Bradycarda. Other atrial arrhythmiasare are treated in some other way, or often not at all. Pacemakers do allow different and higher doses of drugs to surpress these arrhythmia but their side effect is often a decreased heart rate so the PM acts like a floor on the heart rate.

OTOH, ICDs are used for very serious (deadly) ventricular arrhythmias. Vtach can very easily turn into Vfib, which is often the fish hook (end of the line). The ICD does a <cntl><alt><del>, which terminates the arrhythmia allowing the heart to restart in normal rhythm.

This isn't 100% effective and can even cause Vfib for someone not in Vtach/Vfib. For someone in Vfib, there isn't a downside to the shock. For some who isn't, there is an unnecessary risk. For this reason the AEDs (automatic electronic defibrillators) you see in public places are smart enough to detect rhythms they're not designed to treat and won't allow the discharge.

There is a similar procedure that many of us with atrial arrhythmias have gone though called the DCCV (Direct Current CardioVersion) or "cardioversion" for short. The idea of this is the same as an ICD discharge but is done under medial supervision (and in a safe cozy place devoid of automobiles), in case something goes wrong.

The short answer is that an ICD poses a risk to those who don't need it. For those who do, it can be a life-saver so the risk is not having it.

PM vs ICD explanation

by Old male - 2021-08-18 23:24:55

Thanks AgentX86 for the explanation.  As for Cardioversions I've had 3 for Afib issues.  First one lasted about 4 months and the next two only a short time.  Just take Xarelto and go on with life.  Have considered Ablation but as a last resort.  Seems a low or short term success rate from what I've read.

ICD vs pacer

by Tracey_E - 2021-08-20 10:42:56

ICD's are larger, have a shorter battery life, and require an extra lead. It's a great insurance policy if you are at risk but completely unnecessary for those of us who just need our heart to beat faster. 

ICD vs Pacer - Tracey....

by BOBTHOM - 2021-08-22 01:21:46


I think your talking about the CRT combo units.  The stand alone basic single lead ICD is actually smaller with a longer battery life dependent on the number of times it discharges.  Mine started in Jan 2017 with 12 year estimate and now in Aug 2021 still has 7 years after delivering 8 full out shocks.  Although it can pace, my heart has not needed it as of yet. Also slightly lower risk as only one lead is placed.

Just sayin....

cant drive

by dwelch - 2021-08-25 23:35:12

Depending on where you live you get an ICD and you cant drive anymore.   Some only limit you if the icd has gone off in the las 6 months...

In general though dont mess with an ICD unless you need one.  Get the device that is right for you.   One leg is broken so put a cast on both?

 

You know you're wired when...

You always have something close to your heart.

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