AICD

Question 1

What types of patients typically have AICDs placed?

Answer 1

AICDs may be used in patients ranging from otherwise healthy
young patients with supraventricular dysrhythmias such as
Wolff-Parkinson-White syndrome to elderly patients with
significant coronary artery disease or congestive heart failure
who have survived a previous life-threatening arrhythmia such
as ventricular tachycardia or ventricular fibrillation.
Longnecker DE, Newman MF, Brown DL, Zapol WM.
Anesthesiology. 2nd ed. New York: McGraw-Hill; 2012: 1271.

Question 2

What type of anesthesia is typically utilized for the

implantation of an AICD?

Answer 2

AICDs are typically implanted under sedation in an
electrophysiology lab rather than the operating room. The
procedure itself is not very painful, but ventricular fibrillation is
induced during the procedure in order to test the device and this
is distressing to the patient.
Nagelhout JJ, Plaus KL. Nurse Anesthesia. 5th ed. St. Louis,
MO: Elsevier Saunders Company; 2014: 1268.

Question 3

How long after sensing ventricular tachycardia or
ventricular fibrillation will an AICD discharge an
electric shock?

Answer 3

An AICD usually discharges about 10-15 seconds after
detecting VT or VF. Most of the time, delay is attributed to the
charging of the capacitor.
Nagelhout JJ, Plaus KL. Nurse Anesthesia. 5th ed. St. Louis,
MO: Elsevier Saunders Company; 2014: 1269

Question 4

How long will the battery of an AICD last?

Answer 4

The battery of most AICDs is designed to deliver 120 shocks
and typically lasts 3-6 years.
Nagelhout JJ, Plaus KL. Nurse Anesthesia. 5th ed. St. Louis,
MO: Elsevier Saunders Company; 2014: 1268.

Question 5

Can a healthcare provider be shocked by a patient’s

AICD?

Answer 5

If in physical contact with a patient who has an AICD that is
discharging, a healthcare provider can receive a mild shock that
is not capable of causing fibrillation in the caregiver, but can be
distressing while attempting to administer care to the patient. If
a patient is experiencing ‘electrical storm’ from the defibrillator
(numerous shocks are being discharged in a short period of
time) it is recommended to place the patient on an ECG monitor
and watch for periods of VT or VF that last about 4 seconds.
This will give the caregiver several seconds warning before a
shock is discharged to cease physical contact with the patient.
Davis, C. (2007). Electrical Storm and Implanted Defibrillators.
Southern Medical Journal, 100, 547-548.

Question 6

Is the presence of an AICD of special concern in
patients undergoing extracorporeal shock wave
lithotripsy (ESWL)?

Answer 6

Pacemakers and AICDs are no longer considered
contraindications to ESWL. AICD and lithotripter manufacturing
companies generally state that AICDs are a contraindication to
lithotripsy, but patients with AICDs have been shown to
complete the procedure successfully. Older abdominallyimplanted
AICDs present a greater hazard than transvenous
pacemakers. The AICD should be shut off prior to treatment
and then reactivated immediately after the procedure.
Miller RD. Miller’s Anesthesia. 7th ed. Philadelphia: Churchill
Livingstone; 2010: 2126.