How does my heart device protect me? It’s pretty amazing!

I initially had a pacemaker but now an implantable cardioverter defibrillator (ICD_ resides in my body.  The first pacemaker was made in 1958.  The first ICD was implanted in February 1980.  It is pretty amazing when you look at those initial cardiac devices and consider how they evolved and became much smaller in the last 60 years, to the benefit of me and my fellow heart failure patients. 

An ICD is a small electronic device that I suspect will reside in my body in some form for the rest of my life.   It is like the pacemaker I had but with some extra features to address additional heart issues.  The ICD monitors my heart rhythm, to include the speed and the pattern of the heartbeat.  If the rhythm becomes to slow (my initial problem in 2013), the ICD sends out electrical signals to bring it back up to a normal level.  This is referred to as “pacing” the heart.  If the rhythm becomes dangerously fast, the ICD may send impulses to slow it down, or it may briefly shock the heart, to return the heart to a normal rhythm.  (Happily, my ICD has never shocked my heart).
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The ICD is made up of a generator and leads.  The generator holds a tiny computer and battery.  The leads are wires that carry information about the heart rhythm to the generator, and also carry the impulses or shocks that were discussed in the previous paragraph.  My device has 3 leads.

I believe that I mentioned in previous blog posts that there is a device by my bedside that monitors my ICD.  A variety of information is transmitted to a heart monitoring center.  (The device also transmits my weight to the heart monitoring center on a daily basis).  In addition to this constant monitoring, once a year, I am required to go into the doctor’s office for an in-person check by a representative from the company that manufactured my ICD. 

I had my annual in-person device check recently.  I'll give you the verdict first - everything was fine.  It was an informative check-up because I took the opportunity to ask the company representative numerous questions to find out what the in-person and remote checks cover.  

I asked her how often the monitor beside my bed checks on the defibrillator.  She says it usually checks it once every 24 - 48 hours to see if there are any loose connections, damages to the wire, unusual amount of battery being used, etc.  The monitor also interrogates the device once a week and compiles data.  Once every three months, the heart monitoring center downloads a report that contains all this data.  I told her that I usually get an e-mail from the monitoring center at each three month point telling me that a doctor looked at the report and the numbers were fine.

The representative performed a check which basically powers down the pacing function of the defibrillator.  I really felt this, so much so that I held up my hand and said something like "Whoa!"  The representative looked at me and said, “Sorry, I saw the initial numbers and I stopped the check for now."  

I told her that the check, while intense, was a good reminder of how bad my heart pacing was before I got a cardiac device.  The representative examined a few more things and then came back and did a gentler version of the test.  I told her that when she powered down the pacing function, I felt like the bunny with the drum in the energizer battery commercial, shutting down when the battery charge dies.  She said she was making a note on my file so that the people who check it in the future will know that this is a test that needs to be done with care so I don't feel like someone unplugged me.

The representative was also able to see my heart rate throughout each day.  I told her that one of my doctors wanted me to record my heart rate during exercise and after exercise for 6 months.   I use an app on my smartphone, but wonder how accurate it is because occasionally my heart rate jumps all over the place in one reading.  She said that the highest reading she saw was maybe 110.  From what she reported to me, I think I can feel comfortable that my heart rate does what it is supposed to do - increases when exercising, but immediately recovers to a normal rate when I am finished.

The representative looked through all the data - I'm not sure if it was from the entire year or just the last time the center monitored it.  She saw two instances where I had fast heart beats.  One was 8 beats in a row, the other was 16 beats in a row.  She said it was not anything to be concerned about - if there were a lot of instances, she would bring it to the doctor's attention.  But again - two instances is no big deal.  She just wondered if I could recall the instance on September 6 when I had 16 fast heart beats in a row.   (When I got home, I checked my calendar.  I had a medical test on that day.  Maybe the performance of the test caused my heart to beat faster?)

The final thing she told me before the appointment ended was that I still have six years left on my battery.  So when the battery life is nearing an end, I believe the entire generator will have to be replaced.  Allegedly this is an easier and shorter procedure than implanting the ICD.  If the leads wear out, then the procedure to replace them is similar to an ICD implantation.  But my understanding is that this is a rare occurrence.

My ICD has been good for me.  In turn, there are some things I have to do to make sure that the ICD is not adversely impacted.  I have a card called a medical device ID and I need to carry it with me at all times.  It contains formation about my device generator and the leads as well as the name and the phone number of my electrophysiologist.  Additionally, the card advises security personnel that magnetic security wands may affect the ICD, and not to hold the wand over the device.  So I keep this card in my hand whenever I go through airport or any other type of security checkpoint.

Usually the card works well.  I motion to it and say to the screener, I have a defibrillator and they pull me aside for special screening.  But sometimes the card doesn’t always work.  When I was flying to Europe this year, I presented the card to the screener and said “I have a defibrillator”.  She looked at me and said “you can just put it in the bin”.  In other words, she thought I had something that I could just toss in the bins where you put your purse and your jacket and other personal devices for screening by the metal detector.  I pointed to my collar bone area and said “No, I actually have the defibrillator inside me.”  At that point, she realized that I would have to go through a special screening.

Why does someone with a pacemaker or ICD need a special screening?  Is it because the walk through metal detector will harm the ICD?  Actually, the metal detector itself probably will not harm the ICD.  However, if something that you are wearing sets off the metal detector, then the screener will want to wand you.  It is the magnetic wand that can set off the ICD.  So this is why I need a special screening to assure both that I am a good security risk, but that my ICD and heart withstand the screening.  

A special screening, depending on the resources of the airport, can be one of two things.  You can go through one of the new airport body scanners advanced screening technology.  I believe I used one of these scanners once, and had no problems.  But I am not sure every airport has the scanners.  

The second type of special screening can be a pat down search.  The pat down is conducted by a TSA officer of the same gender.  I think some people do not like the pat down search because it does involve touching some sensitive areas.  But the officer will explain to you exactly what she is doing and why.  It has always been very straightforward and quickly performed, and I have no problem with the pat-down.  Sometimes the only issue is waiting for a female officer to become available to do the search.   

​To recap, when you look at what the ICD does, and how many ways it can be monitored in real time to check on your heart health, it’s pretty amazing.  And when you look what the security screeners do to protect us from a terrorist threat, well that is pretty important too.  So I’ll take a little device inside me and a little inconvenience at the airport in order to have a heart that works and the ability to fly without fear.