Implantable Cardioverter Defibrillator (ICD)

An ICD is a battery powered device with thin wires connecting from the device to your heart.. This device monitors your heart rhythm (the speed and pattern of your heartbeat). If this rhythm becomes too fast and potentially dangerous, the ICD will send out electrical signals to your heart. These signals could either be multiple and rapid or a single electric shock that will help bring the rhythm back to normal.

The ICD is put inside your body during a minor surgical procedure called implantation. It is usually implanted in the upper part of the chest just below the collar bone. The device is placed under the skin and the wires are threaded (inserted) through veins to your heart. In most cases the procedure takes less than 2 hours.

How to get ready for this procedure

• Do not eat or drink anything after midnight the night before the procedure, or at least 8 hours before the procedure or as directed by your healthcare provider.
• Follow your healthcare provider's instructions on what medicines to take.

What happens during the procedure

The ICD is usually put on the left side of your chest. Putting the ICD in your body (implantation) does not need open heart surgery. This means your chest will not be opened. During the procedure:

• You will be given medicine to help you relax.
• The doctor makes a cut (incision) in the skin below your collarbone. This creates a “pocket” to hold the ICD.
• The doctor threads a wire (lead) through the incision into a vein in the upper chest. With the help of X-ray monitors, the doctor guides the lead into one of the heart’s chambers. Depending on how many leads your ICD has, this process may be repeated to guide leads into other chambers.
• The doctor attaches the leads to the heart muscle so they will stay in place. The leads will be tested to make sure they are placed correctly.
• The battery (generator) is attached to the leads. Then the doctor places the generator in its pocket under the skin.
• The doctor may start (induce) a fast heart rhythm to test the ICD.
• The incision (pocket) may be closed with sutures, medical glue and surgical tape or a combination of the two. A sterile dressing will then be applied over the incision to keep it clean and dry.

Other implantation sites

• In some cases, the ICD can be put elsewhere in the body.
• This could be on the right side of the chest, or on the left side under the muscle.
• If one of these is an option for you, your doctor will explain more.

What happens after the procedure

• You will stay in the hospital overnight.
• While you are in the hospital, your heart’s signals will be monitored to see how the ICD is working. You can go home when your condition is stable.

Once you get home:

• Follow your discharge instructions to care for your incision. Watch for signs of infection (see box).
• Follow any special instructions to care for the side of your body where your ICD was implanted. Your doctor may tell you not to raise that arm above the shoulder for a certain amount of time.
• You will likely have bruising at the incision site. This is normal and will go away as the incision heals.
• You can probably return to your normal routine soon after implantation. Ask your doctor when you can return to work.
• You may be instructed not to drive for a certain amount of time. Generally, you should not drive for about 6 months after having an ICD implanted, or if the device delivers a shock.
• Commercial driving with an ICD is not allowed by most state laws because of the risk of losing consciousness from life threatening heart rhythms that this device is designed to treat.
• See your doctor for follow-up visits as recommended.