What Is an EV-ICD?
When someone has a heart condition that puts them at high risk for dangerous or life-threatening heart rhythms, their care team may recommend an implantable cardioverter-defibrillator (ICD).
Think of an ICD as a personal 24/7 seatbelt for your heart, always ready in the event of an emergency. Its job is to monitor for unsafe heart rhythms. If one is detected, the ICD can deliver pacing or an electrical shock to restore a normal rhythm.
Understanding the EV-ICD
When considering which ICD is right for you, your provider may discuss a specific device called an extravascular ICD, or EV-ICD.
In a traditional, or transvenous, ICD, the battery is placed under the skin below the collarbone and connected to a wire that travels through a vein into the heart.
An EV-ICD is different. The battery is placed under the skin on the left side of the chest, below the armpit. It connects to a wire that is positioned just beneath the breastbone, above the heart.
Because the wire does not enter the heart or blood vessels, those structures remain untouched.
Who May Benefit from an EV-ICD?
An EV-ICD may be a good option for patients who have a higher risk of infection or difficult-to-access veins, including some people with diabetes or kidney disease.
It may also be beneficial for people with active lifestyles. Compared with traditional ICDs, EV-ICD systems may be less affected by the wear and tear associated with heavy lifting or frequent arm movement.
Who May Not Be a Candidate?
An EV-ICD is not the right choice for everyone. Your care team will use imaging studies to determine whether your anatomy is suitable for this type of device placement.
The device is also not currently approved for people who have previously undergone open-heart surgery or for patients with slow heart rhythms who require ongoing pacing support.
The Procedure
During the implantation procedure, you will be asleep under general anesthesia to ensure your comfort.
Your doctor will make a small incision on your left side, just below the underarm, to place the device, which is about the size of a large stopwatch. A second incision near the center of the chest is used to position the wire beneath the breastbone.
Recovery and Follow-Up
Before the procedure, you will typically need to fast and avoid food or drink the night before.
After implantation, your care team will monitor you to ensure the device is functioning properly. Some patients stay overnight in the hospital, while many are able to return home the same day.
It is common to experience some soreness and bruising around the incision sites, but medication can help manage discomfort.
You may also have temporary restrictions on arm movement and lifting for several weeks to allow proper healing.
Living with an EV-ICD
Once you have recovered, your device clinic will stay connected to your EV-ICD through remote monitoring. This allows your care team to check on the device and your heart rhythm on an ongoing basis.
While the EV-ICD quietly monitors your heart in the background, you can have peace of mind knowing it is there when you need it, allowing you to continue doing the things you love.
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