A decision aid for patients considering ICD therapy for primary prevention.


A decision aid for patients considering ICD therapy for primary prevention.


This site is for patients with heart failure considering an ICD who are at risk for sudden cardiac death (primary prevention). This website will lead you step-by-step through some information on ICDs that may be helpful. We also hope this will make talking to your doctor easier.

What is an Implantable Cardioverter Defibrillator (ICD)?

An ICD is a small device that is placed under the skin of the chest. Wires (called “leads”) connect the ICD to the heart. An ICD is designed to prevent an at-risk person from dying suddenly from a dangerous heart rhythm. When it senses a dangerous heart rhythm, an ICD gives the heart an electrical shock. It does this in order to get the heart to beat normally.

Is an ICD right for me?

The ICD does not stop an advancing illness like heart failure. The only purpose of the ICD is to try to get a dangerous heart rhythm to beat normally.

While the future is always unpredictable, there is an important trade-off to consider when deciding whether to get an ICD.

Consider two possible paths:

Path 1

You may choose to get an ICD. You may be feeling like you usually do, then a dangerous heart rhythm could happen. The ICD may help you live longer by treating a dangerous heart rhythm. You will continue to live with heart failure that may get worse over time.

“I’m not ready to die. I have so much I’m trying to stay alive for. Even if it means getting shocked, I’m willing to do anything that can help me live longer.”

Path 2

You may choose to not get an ICD. You may be feeling like you usually do and then a dangerous heart rhythm could happen.  You may die quickly from the dangerous heart rhythm.  Some people are okay with this.

“I’ve lived a good life. The idea of dying quickly sounds like a painless way to go. I’ve always said I hope to die in my sleep. Going through surgery and getting shocked is not the kind of thing I want.”

VIDEO: Consider the two possible paths.

Fred Masoudi, MD
Heart Doctor

VIDEO: Is an ICD the right choice for you?

Paul Varosy, MD
Electrophysiologist

Benefits and Risks


How does it feel to receive a shock?

Patients say that getting shocked is like “being kicked in the chest.” Some patients pass out before they are shocked and do not remember being shocked. Before a shock is delivered, the ICD will try to correct your dangerous heart rhythm.

Over 5 years, about 20 out of 100 patients get shocked by their ICDs. About 80 out of every 100 will not get shocked. Most shocks happen because of dangerous heart rhythms but some happen when they are not needed.

Video: Fred Masoudi, MD
Heart Doctor

Video: Tyler, Patient

Video: Velma, Patient

Video: Caroline, Patient

Video: Deborah, Patient

Video: Fred Masoudi, MD
Heart Doctor

Will an ICD make me feel better?

ICDs do not make you feel better. Some patients might get devices with other features that can make them feel better. You should talk with your doctor about these devices.

What are the risks of getting an ICD?

Problems do occur:

  • 4 out of every 100 patients will experience some bleeding after surgery.
  • 2 out of every 100 patients will have a serious problem like damage to the lung, or heart.
  • About 1 out of every 100 patients will develop an infection.
  • Some patients develop anxiety or depression from being shocked.

Will I live longer with an ICD?

With an ICD: Patients with an ICD are less likely to die suddenly of a dangerous heart rhythm. With an ICD, 29 out of every 100 patients with heart failure will die over a 5 year period. This means, over a 5-year period, 7 more patients would live with an ICD.

Without an ICD: Patients without an ICD are more likely to die suddenly from a dangerous heart rhythm.  Without an ICD, 36 out of every 100 patients with heart failure will die over a 5 year period.

Individual situations may vary. You should discuss this with your doctor.

Would I survive a dangerous heart rhythm without an ICD?

You can survive a dangerous heart rhythm only if you are treated within a few minutes with an external shock. However, many patients die before emergency help can reach them.

Is there anything else I should be aware of?

People with an ICD should avoid strong magnetic fields and some industrial equipment. If you work with industrial equipment, discuss this with your doctor. Normal appliances like a microwave are okay.

You should not walk through the metal detector at the airport. Instead, you should ask to be hand searched. It is okay to walk through security systems at department stores.

Many doctors recommend that a patient not drive for up to 6 months after getting a shock from their ICD. Some states and countries have even stricter laws. Talk to your doctor about the driving laws in your area.

It is possible to exercise with an ICD. Talk to your doctor to learn which exercises are safe for you.

It is okay to have sex when you have an ICD.

You may use a cell phone but you should keep the phone at least 6 inches away from the ICD.

Values


There are no right or wrong answers.

This information will help you decide whether or not an ICD is right for you. Before making your decision, think about what is most important to you – and how you would like to live the rest of your life.

What is important to you?

While no-one can predict the future, if you were able to choose, how would you like to live out the rest of your life?

Things to consider

  • What benefits do you think you might experience?
  • What losses do you think you might experience?
  • How might your life change?
  • What frightens you about living with or without an ICD?

Next Steps


You are the expert on what is important for you

What else do you need to help you make your decision?

Many people have questions or concerns. It may be helpful for you to talk with your family and friends. You may want to share the information in this decision aid with them. You should also share with your doctor your questions and concerns before making a final decision. It’s important that you have all of the information you need to make a decision that is right for you.

Next Steps


You are the expert on what is important for you

What else do you need to help you make your decision?

Many people have questions or concerns. It may be helpful for you to talk with your family and friends. You may want to share the information in this decision aid with them. You should also share with your doctor your questions and concerns before making a final decision. It’s important that you have all of the information you need to make a decision that is right for you.

You have the right to make your own choices!

Video: Caroline, Patient

Video: Danny, Patient

Video: Jim, Patient

Video: Danny, Patient

Video: Donna, Patient

Video: Caroline, Patient

Now we’d like you to ask yourself...

  • Do you know enough about the benefits and side effects of each option?
  • Are you clear about which benefits and side effects matter most to you?
  • Do you have enough support and advice from others to make a choice?
  • Do you feel sure about the best choice for you?

Adjusting to life with an ICD.


Some places that implant ICDs also offer support groups for patients with heart failure that have ICDs. They may have a list of support groups in your community.

Most people with ICDs adjust to living life with an ICD. Their lives may not be the same but they find ways to do the things they like to do. Be sure to ask your doctor about how the important things in your life may change.

Hear What Patients Have to Say

Video: Danny, Patient

Video: Velma, Patient

Video: Tyler, Patient

Replacement of the ICD

Your clinician may have discussed with you the “battery life” of an ICD. When the battery runs out (in about 5 to 10 years) it must be replaced. Replacing the battery requires replacing the entire device. At the time of replacement, it is important to evaluate if the ICD is still the right thing for your life.

Deactivating the ICD

You may be wondering, “What do I do when I no longer want the ICD?” It is important for you to know that the ICD can be turned off at any time. Some patients may decide that living as long as possible is no longer important to them. Turning the ICD off does not require surgery. Instead, it can be done with a computer.

Frequently Asked Questions

Due to your heart failure, you are at higher risk for developing a dangerous heart rhythm.  A dangerous heart rhythm can cause you to die within minutes if not treated.

Heart failure is when a heart is too weak to pump enough blood for the body. People with heart failure sometimes have breathing problems, leg swelling, and feel tired. Some people with heart failure may have no symptoms.

It is best not to remove the ICD unless you have an infection or are having the ICD replaced.

Yes. The ICD is put under the skin and one or more wires (called “leads”) are put into the heart. The surgery takes a few hours. You may stay in the hospital overnight.

Yes, it is possible to turn off the ICD without surgery. This is even recommended when a person is close to dying of another cause.

In the future, people may reach a point where living as long as possible is not what they want anymore. This could be because of worsening heart failure or another illness. When this happens the ICD can be turned off to avoid shocks.

Supporting Evidence

Here is a document outlining all evidence for practice decision aids, to help you in your decision.

View Supporting Evidence