Sunday 3 July 2016

Death and defibrillators


Anyone who is diagnosed with heart failure is bound to think about death.  The heart is vital.  Failing suggests the end is nigh, right?.  Well, we know it is not as bad as that.   Kasper and Knudson in their useful book “Living well with heart failure” subtitle the book: The misnamed, misunderstood condition.”  Unfortunately a more accurate term has not found favour.  But apart from gradual deterioration, sudden death is a possibility for some patients. 

All this is a preamble to my latest visit to a cardiologist, who specialises in ICDs (Implantable cardioverter defibrillators).  My cardiac specialist nurse had suggested it was not necessary in my condition.  So I expected it would be a nice quiet chat.  However I was more than a little shaken to be told, very nicely and considerately in the event, that I was at risk of a serious arrhythmia.  How likely this was he couldn’t say, but I was at risk.  

He discussed the pros and cons of ICDs.  They are inserted in the chest, under local anaesthetic, with a wire attached to the heart.  This can usually be done as a day case.  You are forbidden from driving a car for one month afterwards.  There was a risk of bleeding, puncture of the lung etc, but the risks were rare and usually easily treated.  The ICD contained a clever computer that monitored the heart beat, and in the event of a serious arrhythmia developing, would produce a shock to correct the abnormality.  Just like the “stand clear, charge at 200” episodes in medical soaps on TV.  Except it is done instantly, in your own chest.  It doesn’t treat the heart failure or make you feel better.  The cardiologist used the analogy of an air bag:  “They won’t make you drive better, they can’t prevent accidents, but in an accident they could save your life.”   All good.    The only real snag appeared to be that on occasion the ICD could misinterpret the heart beat and fire off a shock when it wasn’t necessary.  Ouch!  You get a big thump on the chest. 

Having discussed this with my wife, Lorraine, we decided to go ahead with it.  There will be the usual NHS delay, some six weeks or so.  Interestingly, the fact that I am currently feeling well, as well as I was a year ago, before the attack of atrial fibrillation and the diagnosis of heart failure, was a strong point in favour of having an ICD.  If I were in dire straits, miserable, in serious decline, having an ICD would not be indicated.  So the decision is made, and we just have to hope nothing bad happens while we wait.