An implantable cardioverter defibrillator (ICD) is a small, pager-sized device that continually monitors the heart rate, ever ready to deliver a jolt of electricity.

“It is like having a built-in paramedic with me every place I go,” says Joe Higgins of Oregon about his ICD. “Knowing it is there is a tremendous comfort. I know I do not have to worry about sudden death. I expect the machine to do the job.”

Higgins, 69, has a long history of heart disease. He received an ICD after passing out due to an irregular heart rhythm.

Rachel Smith of North Carolina received her first ICD after experiencing sudden cardiac arrest at age 33.

Most people with ICDs, like Smith and Higgins, have survived a cardiac arrest or suffer from irregular heart rates that increase their risk of sudden death. But people with other conditions, like a weakened heart muscle or hypertrophic cadiomyopathy may also eligible for the devices.

What Does an ICD Do?

An ICD monitors the heart rate. If it detects a dangerous rhythm, it sends a shock of electricity to return the heartbeat to a normal pattern. Most units also function as pacemakers. Some include special features to strengthen the heartbeat.

An ICD is placed under the skin near the collarbone. Wires from the device are attached to the heart during the short procedure.

“The procedure is very straightforward and simple,” says Dr. Liem. “Former Vice President Dick Cheney went home the same afternoon. There is no significant time for recovery.”

Patients typically resume their normal activities. They must make some changes, though, like avoiding MRI scans, heat therapy (used in physical therapy), high-voltage or radar machinery, or contact with radio or TV transmitters. Carrying a cell phone close to the ICD also should be avoided.

“An ICD needs careful consideration,” says Lisa Salberg, 34. The New Jersey woman has hypertrophic cardiomyopathy, a genetic condition that increases her risk of sudden cardiac death. She received an ICD five years ago and trusts it more than her own heart. “It is going to be part of your life from here on out. Make sure all your questions are answered before the implant.”

Adjusting to the Technology

It takes most people time to psychologically adjust to the device. Anxiety is common. “The first couple of months I was very aware,” says Salberg. Her device has not gone off.

“I do not do anything that is going to get my heart rate way up there where I am going to test the boundaries of the device,” she says. “But I have a normal life and do not let it get in the way.”

Higgins’ ICD has jolted his heart twice. After the first shock, while walking up a steep grade, his doctor adjusted the device’s parameters. A second shock occurred four years later.

“It felt like the kick of a mule in my chest,” Higgins says. “I do not limit my activities at all. It might go off. I have had two experiences. But it is an instantaneous thing, and it goes away. I am fine afterward.”

Higgins has walked 5-6 miles during a relay race. He scuba dives, walks four miles daily, exercises with weights, and does push-ups and sit-ups. “Before scuba diving, I called Medtronic (the manufacturer) to find out whether my ICD was capable of taking depths,” Higgins says. He also contacted the company before traveling abroad to obtain a list of the medical facilities familiar with ICDs.

Seeking Support

Smith has not been so lucky. She has felt the kick 57 times. She exercises regularly and at first blamed that activity for triggering the ICD to deliver its jolt. But then shocks occurred while watching television, in a restaurant, and during a speaking engagement.

“It got to the point I was afraid to go out of the house,” Smith says. “I had to push through that by connecting with other people, going to support groups. Taking a step at a time, you do it.”

Smith has worked through her anger, anxiety, and depression. She described it as a grieving process for her former self. Some people seek help with emotional aspects from a mental health counselor. Even with the multiple shocks, Smith knows her ICD has saved her life and has no regrets.

“Without this defibrillator, I would not be where I am today,” she concludes. “It has given me some of the best years of my life.”