Implantable Cardioverter Defibrillator (ICD) for Children

An Implantable cardioverter defibrillator (ICD) is a special type of cardiac device that can recognize abnormal heart rhythms in the bottom part of the heart and deliver therapy if needed to restore the heart to a normal rhythm. 

It has 2 components: lead(s), which is a specialized wire to deliver energy from the ICD to the heart muscle and the generator (battery pack)
ICDs can function in a couple of ways:

  • ICD’s use the lead to analyze heart rates that are too fast and identify if this rhythm may be life threatening, such as ventricular tachycardia (VT) or ventricular fibrillation (VF). 
  • If the ICD identifies an abnormal rhythm (arrhythmia) it attempts to pace the heart into an organized normal rhythm.
  • If unable to convert (normalize) the rhythm by pacing, the ICD will deliver energy by shocking the heart, to convert it into an organized normal rhythm. 
  • If heart rate is too slow, it can function like a pacemaker in certain ICDs.

ICD have become the treatment choice for patients who are at a high risk of sudden cardiac death. In primary prevention, patient has been identified to be at high risk but has not yet experienced a sudden cardiac event compared to secondary prevention for a patient who has experienced a sudden cardiac arrest.

Disorders:

ICD therapy is indicated in patients who are survivors of cardiac arrest due to ventricular fibrillation (VF) or hemodynamically unstable sustained VT after evaluation to define the cause of the event and to exclude any reversible causes. Other reasons to implant an ICD can include:

  • patients with structural heart disease and sustained VT
  • patients who have passed out where the cause is identified to be an abnormal heart rhythm.
  • primary prevention for patients with who are high risk of sudden cardiac death related to a diagnosis of cardiac channelopathies, structural congenital heart disease, hypertrophic cardiomyopathy (HCM), dilated cardiomyopathy (DCM), and severe left ventricular dysfunction in the presence of ventricular arrhythmias and other causes of ventricular arrhythmias.  

The decision to implant an ICD should be discussed with your cardiology team.

On the Inside:

ICDs can be implanted in multiple basic ways in children and adolescents. 

The systems can be:

  • epicardial (leads attached to the outside of the heart)
  • transvenous (leads inside the veins leading to the heart)
  • subcutaneous

With transvenous or epicardial placement, the leads can be attached to the top chamber of the heart (atrium) or the bottom chamber of the heart (ventricle) or both. Sometimes leads are placed on both ventricles.

A subcutaneous ICD is a newer technology where the leads are implanted under your skin instead of inside your veins or attached to the outside of the heart. This allows for easier removal of the leads if this becomes necessary. 

Recovery from implantation of an ICD varies, depending on the child and whether or not other heart surgery was performed at the time. Typically, a child leaves the hospital one to three days after implantation of an ICD if this is the only surgery performed at the time. Restriction of arm movement may be necessary for certain types of procedures. 

The type of ICD used is based on your diagnosis and specific needs of the device.

Lifestyle Changes:

Activity restrictions or precautions may be recommended depending on your child’s heart disease and type of ICD.  Your cardiologist will review these recommendations with you.

Patients with ICDs will require future procedures related to the ICD generator (battery pack) longevity or battery life. The ICD generator (battery pack) typically last 5-10 years. 

The lead(s) only need to be changed if they stop functioning. In some instances, the lead has to be removed and replaced. 

Routine visits with the cardiologist and/or electrophysiologist provide the best care for the ICD. At these appointments the pacemaker/ICD leads and battery are tested. 

Today’s advanced technology provides a way to check an ICD at home (remote monitoring). A monitor will be set up by your child’s doctor or pacemaker clinic if it is part of their plan of care.

The monitor will collect information from the ICD and send it securely over the phone system and internet to the pacemaker clinic. Your child’s doctor will determine how often and when transmissions are to be sent using the monitor versus when you need to come to the hospital to have the ICD checked in person.

Keep Exploring

Heart Rhythm Disorders
Millions of people experience irregular or abnormal heartbeats, called arrhythmias, at some point in their lives. Most of the time, they are harmless and happen in healthy people free of heart disease. However, some abnormal heart rhythms can be serious or even deadly. Having other types of heart disease can also increase the risk of arrhythmias.
Pediatrics and Congenital Heart Disease (CHD)
This section is for pediatric patients and families living with heart rhythm disorders and heart rhythm disorders related to congenital heart disease (CHD).
Early Warning Signs
If you are experiencing a racing, pounding, rumbling or flopping feeling in your chest or if you have been fainting, having repeated dizzy spells, feeling lightheaded or you are extremely fatigued, it's time to see a doctor to discuss your heart health.
Common Treatments
Learning about the underlying cause of any heart rhythm disorder provides the basis for selecting the best treatment plan. Information and knowledge about care options, and their risks and benefits help you work with your health care provider to make the best choices.
Lifestyle
Since other heart disorders increase the risk of developing abnormal heart rhythms, lifestyle changes often are recommended. Living a “heart healthy” lifestyle can ease the symptoms experienced with heart rhythm disorders and other heart disorders, and can be beneficial to overall patient health.
The Normal Heart
The heart is a fist-sized muscle that pumps blood through the body 24 hours a day, 365 days a year, without rest. The normal heart is made up of four parts: two atria on the top of the heart (right atrium and left atrium), and two ventricles (right ventricle and left ventricle) which are the muscular chambers on the bottom of the heart that provide the major power to pump blood.