Defibrillator

[Circuit Rider]

Gentlemen, and ladies, I had open heart triple by-pass surgery. My heart is operating at approx 25%. My cardio rehab said they could raise my heart function % with rehab. My surgeon wants to install a Defib. I would like responses from anyone who has had one installed or that knows someone and the results. I hesitate having wires implanted that I understand can't be removed. I also understand I will have to alter or modify my way of doing some things, such as wearing a leather jacket to weld, not having any electrical device close to the defib. I'm 82 and normally very active. Any and all opinions are welcome. Thanks, James C.

[chuck40219]

I have one integrated with my pacemaker. I am on my 3rd pacemaker. I would not be here without one.

It's true you will not want to get near someone welding. At least that is what I have been told. I have a friend that takes care of any welding I need.

If you are still very active, good for you. But if you go against your Dr's recommendation you may not be active in the future. Reorganize how you do things, ask for help on a thing or two.

With whatever decision you make the wish of good health and happiness come from my family.

Chuck40219

[Finster101]

Oddly enough I just came from visiting my cardiologist this morning. I specifically asked about using a welder with my defibrillator. He said I should be fine as long as I don't stand right over the generator/transformer (don't know the correct terminology). He said todays devices are well shielded and using a little extra care would be okay. I have had my device for three years now due to low EF after a heart attack. I'm 63 and can do pretty much whatever I wish. I just can't do it for long anymore.

Ask the surgeon specific questions about the device being used. Too much conflicting and misinformation on the net.

[popper]

Defib usually goes with pace maker. It stops the heart and P.M. restarts it if nature doesn't. Surgery for it is usually pretty simple. Restrictions on lifting & heavy exercise for a while.

[atfsux]

Oddly enough I just came from visiting my cardiologist this morning. I specifically asked about using a welder with my defibrillator. He said I should be fine as long as I don't stand right over the generator/transformer (don't know the correct terminology). He said todays devices are well shielded and using a little extra care would be okay.


Wow. That's really good news. I've had my pacer/defibrillator for 12 years now. (On my 2nd one. Due for a 3rd in about a year.) I'll have to specifically ask about the welding, because back 12 years ago when I got my first one, they specifically said MIG and TIG and ARC were a no-no. I've been wanting to learn to TIG so I could do some gunsmithing projects, but have stayed away because of what my cardiologist told me back then. I've actually been excited about the new laser welding apparatuses because, although they are expensive, at least they seem to be safe for the cardiac electrical implants.

My first one literally saved my life and brought me back from the dead. I would have expired 6 years ago if it hadn't have been in me. I was all alone just sitting on the couch when my heart unexpectedly stopped. No one would have found me in time to have helped me. It was hours before anyone else showed up. So yeah,...I'm a big proponent for these implantable defibrillators. I thought my cardiologist was being overly cautious and that it was probably not actually warranted. But I trusted his judgement and went along with it, and was actually THE BEST DECISION I EVER MADE.

[phantom22]

I do not have one, but I have experience with them being a paramedic. They are saying 25% functionality which I assume them to mean your heart's ejection fraction which is the percent of blood that is able to be pumped out of your left ventricle on contraction. Normal is around 80% if I recall correctly. 25% is from what I remember is in what is called a cardiac cripple. This means that your heart function is so poor that you will likely become winded and exhausted with minimal physical exertion.

You also likely have heart blocks due to your history. These are different than blocked arteries. Heart blocks are electrical problems where the atrium (top part) has difficulty or is not able to communicate with the ventricles (bottom part). Damage to the heart via infarctions (heart attacks) damages the heart muscle by starving it of oxygen. The damage is permanent. The electrical pathways of the heart run through these muscles and are damaged along with them. The heart can sometimes re-route the signals, but it takes longer. These delays can be seen on an EKG and are how heart blocks are diagnosed. There are varying degrees of heart block, but third degree or complete heart block is the most common for pacemaker insertion. Your situation may not be that severe, but is probably close to it if they are recommending a pacemaker.

Most, but not all cases I have seen are due to 3rd degree heart block which means that the atrium and ventricles are basically working at their own pace and not in conjunction with each other. The problem is, the AV node, which is supposed to fire when signaled by the SA node, has a very slow intrinsic rate. It is not uncommon to find people with it to have pulses of 25 beats per minute.
TOO SLOW!

The pacemaker forces the heart to contract at a normal rate. Usually around 70 beats per minute. As a result, you blood pressure will be more normal and perfusion to organs, especially the lungs will be more normal. The higher oxygenation of your body should allow you increased stamina as well as overall better health as everything is being supplied at a better rate.

If your heart function is that low there is really no reason not to get one. You mentioned you are very active, a pacemaker will help you continue your activity to some extent.


Another option might be a left ventricular assist device or LVAD. If your not keen on the pacemaker wires you are likely not going to like what the LVAD entails. I have had a few patient's with them, and they all seemed to do very well on them, but there are some special considerations such as having no palpable pulse rate which can throw medical personnel off if they are unaware you have one. The other very much less likely option is a heart transplant. At 82, that will probably not happen and it probably isn't the best option anyway.

[phantom22]

I just re-read the part about the defibrillator. Someone already mentioned that they usually go along with the pacemaker, though you can have one without the other. In your case, I would expect that you would have both. (They are all in one device).

These monitor your heart's rhythm. If it detects ventricular fibrillation (I think it also detects ventricular tachycardia) the former being 100% a fatal rhythm and the latter being a fatal rhythm, although in some cases you can maintain sufficient perfusion to not die for a short period of time, basically dying slower.

The device detects these rhythms and delivers a defibrillating electrical shock directly to the heart. You WILL know when this happens. This actually stops the heart momentarily. The hope being that the disorganized rhythm, will reset into a normal rhythm or back into your normal paced rhythm. This is the short version of how this works or I should say sometimes works.

The benefit of this is actually monumental and will likely be the difference in you surviving or not. Early defibrillation is vital to survival. The sooner your heart rhythm goes back to its normal state the higher the likelihood of survival without major repercussions.

Do not rely on EMT's to revive you. It can happen, but is very rare and the circumstances have to be perfect. In 13 years and hundreds if not well over a thousand cardiac arrest calls, I can honestly say that I have only had 3 with a positive outcome. One went into cardiac arrest in front of me after I had him hooked to everything. (He was having a heart attack) I was able to defibrillate him within 10 seconds. Another, was when we happened to be right next to the place where the call was originated. Trained CPR personnel were already on scene and started immediately. He was defibrillated withing 3-4 minutes while receiving quality CPR.

The 3rd was at a jobsite where co-workers defibrillated him with an AED that they had in their building.

You have about 4-7 minutes with no pulse before significant brain damage occurs. After 7 minutes or so you are brain dead. Even before, 7 minutes you are likely going to have severe brain damage.

Let's give a perfect scenario:

Someone witnesses you go unresponsive. They are quick acting. They see you collapse, see you are not breathing right and have no pulse. 30 seconds
They get their phone and call 911. 15-30 seconds.
The 911 telecommunicator asks questions to figure out what's going on and who to send. By the time I am dispatched at least another minute goes by.
EMT's get the call and have to get to the truck and figure out routing to the location 1 minute, maybe 30 seconds if we are already in the ambulance.
Drive time to the call varies, but is generally at least 5 minutes and in rural areas or when call volume is high, up to 15-25 minutes.
Arrive on scene, gather equipment, get to the patient - 30 seconds to 1 minute under normal circumstances, longer if in apartments or usually much longer if a corporate or industrial setting.

So you can see how long it takes for help to get there and put hands on the patient. It takes another 30 seconds or so to hook up the cardiac monitor and actually deliver a defibrillation.

If you've been adding up the times, you'll see that it is already much too late. No add to that time if your collapse is unwitnessed. Add the time it takes for you to go into cardiac arrest until someone finds you.

The chances of survival with all of your mental acuity is virtually nil. The time you have is increased if high quality CPR being performed as soon as possible. Performing CPR correctly is physically demanding. Add to this that the patient has to be on a rigid surface and the candidates for performing quality CPR dwindles. Most cases are elderly couples. They do not have the strength to move a body from a bed or recliner to the floor, nor do they generally have the strength or stamina to do quality CPR until help arrives. To help mitigate this you can take a CPR class which are normally offered for free if you look for them, or just watch a youtube video on it to see how it is done. The concept is simple, the physical demand is high.

Most times, the only chance you have is the implanted defibrillator.

[Circuit Rider]

Phantom22, you described pretty much what my Dr. said. I was reading an article from the Cleveland Clinic that was interesting. A newer device called Subcutaneous ICD. It is an implant but there is just one wire and it is not in the veins. Apparently it has good results. To each of you, thanks for the comments. James C.

[MrWolf]

Nice write-up / explanation Phantom22. Thanks for the information.

[phantom22]

You're welcome. I hope it all works out. They are common so I would imagine the risk/benefit ratio is favorable.