Definition

An implantable cardioverter defibrillator (ICD) is a small battery-operated device that monitors the heart’s rhythm and provides appropriate treatment. Most ICDs have both pacemaker and defibrillator functions. If the heart beats too slowly, the ICD can help the heart beat at a normal pace. If the heart begins to beat in a disorganized way, the device provides a shock to restore a normal rhythm. ICD implantation is the surgical insertion of an ICD.

Defibrillator Implantation

Reasons for Procedure

Certain heart rhythms are extremely dangerous and can lead to sudden cardiac death or cardiac arrest. Some irregular rhythms that may require an ICD implant include:

  • Bradycardia —heart beating too slowly
  • Ventricular tachycardia —heart beating too rapidly
  • Ventricular fibrillation —heart muscle not pumping, but just quivering

ICDs are implanted in patients who:

  • Have had one or more episodes of serious arrhythmias (irregular heart rhythms)
  • Have had a heart attack and at high risk for arrhythmias
  • Have a high risk of dangerous arrhythmias
  • Have a weakened heart muscle (high risk for dangerous arrhythmias)
  • Have a high likelihood of developing an arrhythmia
  • Have the condition known as hypertrophic cardiomyopathy (an enlarged heart muscle that does not function properly)

Possible Complications

If you are planning to have a defibrillator implanted, your doctor will review a list of possible complications, which may include:

  • Damage to the heart or lungs
  • Damage to blood vessels
  • Infection
  • Bleeding
  • Bruising
  • Inappropriate shocks or device malfunction

Some factors that may increase the risk of complications include:

  • Obesity
  • History of smoking
  • History of excess alcohol consumption
  • Bleeding or blood-clotting problems
  • Use of some medicines

What to Expect

Prior to Procedure

The following test may be conducted prior to your procedure:

  • Blood tests
  • Chest x-ray —a test that uses radiation to take a picture of structures inside the body
  • Electrocardiogram (ECG), implantable loop recorders (ILR), electrophysiology study (EPS)—tests that record the heart’s activity by measuring electrical currents through the heart muscle
  • Echocardiogram —ultrasound test to evaluate heart structure and function
  • Stress testing or cardiac catheterization —to evaluate for coronary artery disease

Leading up to your procedure:

  • Talk to your doctor about your medicines. You may be asked to stop taking some medicines up to one week before the procedure, like:
    • Aspirin or other anti-inflammatory drugs
    • Blood thinners, such as clopidogrel (Plavix) or warfarin (Coumadin)
  • The night before, eat a light meal. Do not eat or drink anything after midnight.
  • Ask your doctor if you should take your daily medicines the day of the procedure with a sip of water.

Anesthesia

For the implantation of the ICD, light sedation and a local anesthesia will usually be used.

Once the ICD is in place, it will need to be tested. General anesthesia will be used for this step.

Description of the Procedure

A sedative will be given by IV to help you relax. The area where the ICD is to be implanted will be washed with antiseptic. Local anesthesia will be injected to numb the area. A small incision will be made below the collarbone on the left or right side.

A wire, called a lead, will be threaded through a vein in the upper chest to the heart. An x-ray monitor will be used to watch the lead move through the vein to the heart. The signals between the heart and the ICD will be carried on this lead.

The doctor will then create a pocket under the skin at the incision site. The ICD will be implanted into the pocket.

When the ICD is in place, the sedation will be increased. The ICD will be tested to make sure that it shocks the heart appropriately. Every precaution will be taken to ensure that this is a safe process. Once it is determined the ICD is working properly and in the right place, the incision will be closed with stitches.

Immediately After Procedure

You will be taken to a recovery room after the procedure. Your pulse, blood pressure, and incision site will be checked regularly. Chest x-rays will ensure the ICD and leads are in the proper place.

How Long Will It Take?

About 1-3 hours

How Much Will It Hurt?

You may feel some pushing and tugging on the skin during the procedure. The anesthesia should minimize any pain. After the procedure, you may experience some pain or stiffness at the incision site. Your doctor can prescribe pain medicine for this.

Average Hospital Stay

1-3 days

Postoperative Care

At the Hospital

The day after your implant, you will have an ECG and blood tests. The ICD function may be checked again. This will require sedation.

At Home

After this procedure, you will gradually be able to return to normal life, with a few exceptions. Do the following to help ensure a smooth recovery:

  • Keep the bandage over the incision are clean and dry. Follow your doctor’s instructions to clean the area.
  • Ask your doctor about when it is safe to shower, bathe, or soak in water.
  • Do not drive for up to six months. Talk with your doctor to determine how long you should wait to drive.
  • Avoid lifting objects over 10 pounds until six weeks after surgery.
  • Avoid vigorous activity for 4-6 weeks following surgery. This especially applies to upper body activities. Be very careful of your arm and shoulder on the side where the device was implanted. You want to avoid dislodging the device’s leads.
  • Avoid any activity that involves rough contact to your chest or abdomen, such as contact sports.
  • Return to work and regular daily activities as soon as you are ready. Sexual relations may resume as soon as you are able.
  • Make and keep all postoperative appointments.
  • You may need to avoid:
    • Magnetic resonance imaging ( MRI scan)
    • Heat therapy (often used in physical therapy)
    • High-voltage or radar machinery, such as electric arc welders, high-tension wires, radar installations, or smelting furnaces
    • Contact with radio or television transmitters
  • Do not carry a cell phone in a pocket directly over the device. Keep your phone on the side away from the device. Also, headphones worn with MP3 players (eg, iPods) may cause interference.
  • Turn off car or boat motors when working on them. They may temporarily confuse your device.
  • Tell your doctor or dentist that you have a device before a surgical procedure.
  • Check with your doctor about the safety of going through airport security detectors with your particular device. Do not linger in security devices.
  • Be sure to follow your doctor’s instructions .

You will get an ID card that contains important information about your ICD. It is important that you show this card to any doctor, nurse, dentist, or other healthcare professional at the beginning of an office visit or hospital admission.

If your heart requires a shock from your ICD, you may be able to feel it. You may feel dizzy or lightheaded before the shock. This is from the heart rhythm. The shock administered by the ICD may feel like a light thump or a strong kick in the chest. If you feel a shock, try to stay calm and sit or lie down. If someone is with you, ask them to stay. If you feel okay after the shock, contact your doctor’s office to let them know. This is not an emergency. Your doctor may want you to come in for a check-up, particularly if this is the first shock you have received. If you receive multiple shocks in a row or multiple shocks in a day, you should go to the emergency room.

Call Your Doctor

After you leave the hospital, contact your doctor if any of the following occurs:

  • You feel a shock
  • Signs of infection, including fever and chills
  • Redness, swelling, increasing pain, excessive bleeding, or discharge from the incision site
  • Pain that you cannot control with the medicines you have been given
  • Cough or severe nausea or vomiting

These symptoms are medical emergencies. Call for medical help right away if:

  • You have chest pain or shortness of breath
  • You feel lightheaded or dizzy and do not feel a shock
  • You are still feeling symptoms after a shock
  • You feel three or more shocks in a row

In case of an emergency, call for medical help right away.

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