shocks

Good Afternoon, All!
I am curious for those with ICDs how many times you have been shocked, and how frequently so. I have been delivered therapies more than once, but it is always multiple shocks. The most recent time was over 20 shocks within a 1/2 hour. The first time ever was 7 shocks within one minute. I suppose I should research more on this, and I will ask my doctor next time, but do you all know of any temporary or permanent damage done physically or mentally from the shocks? I live 2.5 hours from the closest facility that can treat my condition, and the last time it took over 30 minutes to be "life-flighted" to this hospital. I know the shocks save my life, but does it come with risk?

~Jo

1 Comments

ICD shocks

by golden_snitch - 2014-05-17 03:05:52

Hi!

I don't have an ICD, so no personal experience. But there has been a discussion going on for quite a while about ICD shocks and increased mortality. If you google this, you'll find a lot of articles. I must admit that it's not that easy to understand. I copied the following from an article published in October 2013, it sums the debate up quite well:

"Additionally, data from clinical trials have consistently shown an association between ICD shocks and subsequent cardiovascular events. In MADIT II (Multicenter Automatic Defibrillator Trial II), the risk of death over an average of 21 months of follow-up in those who survived appropriate ICD therapy was more than 3-fold greater than in those who survived without receiving ICD therapy 7. The excess mortality was driven by an abundance of heart failure and nonsudden cardiac death events in the group that received successful ICD therapy, suggesting the possibility that ICD therapy may be a marker of a more severe cardiomyopathic process. In the SCD-HeFT (Sudden Cardiac Death in Heart Failure Trial), the risk of mortality for those who survived >24 h after a first appropriate ICD shock was 3 times that of those who did not receive a shock over a median 45.5 months of follow-up (5). Certainly, patients who develop ventricular arrhythmias necessitating an ICD shock may be a priori at higher risk for cardiovascular events, which would explain a large part of this association. Additionally, these patients, having survived what could have been a terminal arrhythmic event without the ICD, are subsequently at risk for competing causes of both cardiovascular and noncardiovascular mortality. However, in the SCD-HeFT trial, a first inappropriate shock was also associated with a 1.6-fold increase in mortality (5). In the MADIT II study, there was a 2.3-fold increased risk of mortality with an inappropriate shock (4). These findings have fueled a debate as to whether the adverse cardiovascular outcomes after an ICD shock are related to the underlying cardiac arrhythmia or are a harmful effect of the shock itself."
(Source: http://content.onlinejacc.org/article.aspx?articleid=1709460)

If all the shocks you received were appropriate/necessary, I think it does not make sense to worry about possible damage done; you could have died without them. However, and it sounds a bit like it, if you received lots of inappropriate shocks due to bad programming or a faulty lead or things like that, I'd certainly talk to the cardio about how to reduce these inappropriate shocks.

Best wishes

Inga

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