Living with an implantable defibrillator

Ask the doctor

Q. My 79-year-old father recently received an implantable cardioverter defibrillator. While he seems to be doing okay, he and my mother are both very anxious about what will happen if he ends up needing a shock. I live nearby and want to support them, so can you offer any advice? I'd also like to be aware of the general advice for people who have these devices.

A. You can reassure your parents that feeling anxious about a shock from an implantable cardioverter defibrillator (ICD) is both understandable and fairly common. An ICD continuously monitors the heart's rhythm and rate, checking for abnormalities. If it senses a minor glitch, the device emits a low-energy electrical correction that might go unnoticed. But correcting a potentially life-threatening rhythm problem requires a significant jolt. Some patients have told me it feels as though they've been kicked in the chest by a horse. It may help to know that many people with ICDs never receive a shock. In fact, recent improvements allow doctors to program the devices to have a longer period of "watching" to allow the errant rhythm to terminate on its own before delivering a shock.

I'd suggest that your father ask his primary care doctor for a referral to a therapist, as there are specific treatments — such as relaxation therapy, cognitive behavioral therapy, and support groups — that may help ease his anxiety.

If a shock does occur, he should call his physician right away, or 911 if he cannot reach the office, experiences more than one shock, or has other symptoms such as chest pain. Sometimes people lose consciousness after a shock, but that's uncommon. After a shock, most experts recommend that the person avoid driving for six months, although if there was no loss of consciousness, this restriction may be reduced to three months or possibly less.

People with ICDs need to be monitored for the rest of their lives, usually about every three to six months. But newer wireless technology now allows some of these evaluations to be done from home. A special wand that communicates wirelessly with the device sends information from the ICD to a computer.

Your father should always wear a medical alert bracelet or carry a wallet identification card to let others know about his ICD in the event of an accident. Finally, the American Heart Association has information about other devices that may (and those that probably will not) interfere with ICDs and pacemakers; see /pacemaker.

Illustration by Scott Leighton