Implantable Cardioverter Defibrillator (ICD) Insertion (2023)

What is an implantable cardioverter defibrillator?

An implantable cardioverter defibrillator (ICD) is a small electronicdevice connected to the heart. It is used to continuously monitor and helpregulate potentially fast and life-threatening electrical problems with theheart.

A transvenous or “traditional” ICD, about the size of a stopwatch, isimplanted under the skin just below the collarbone. It consists of a pulsegenerator and wires, called leads. The pulse generator contains the batteryand a tiny computer. One or more lead wires connect the pulse generator tospecific locations in the heart.

The ICD responds to irregular life-threatening heart rhythms from the lowerchambers of the heart with pacing that corrects a fast rhythm and promotesa normal heartbeat, or a shock (defibrillation) that resets the heartrhythm to prevent sudden cardiac arrest. An ICD also records and storesinformation about your heart rhythm and therapies delivered by the ICD foryour doctor to review.

Most people are unaware when the ICD is pacing the heart. But, adefibrillation shock is described by many as feeling like a "kick in thechest."

An ICD can also be programmed to work as a basic pacemaker as needed.Sometimes after a shock is delivered, the heart may beat too slowly. TheICD has a "back-up" pacemaker, which can stimulate the heart to beat fasteruntil the normal heart rhythm returns. The ICD can act as a pacemaker anytime the heart rate drops below a preset rate.

For those patients who do not require either “back-up” pacing orAnti-Tachycardia Pacing (ATP), a Subcutaneous Implantable Defibrillator(S-ICD) is available. It allows for the delivery of high-energy shockswhile avoiding the potential risks and complications associated with leadsthat traverse the veins leading to the heart.

Why might I need an implantable cardioverter defibrillator?

You may need an ICD if you have survived sudden cardiac arrest due toventricular fibrillation, or have fainted due to ventricular arrhythmia, orif you have certain inherited heart conditions.

An ICD is generally needed for those at high risk of cardiac arrest due toa ventricular arrhythmia. This includes people with heart failure who haveproblems with the contraction of the heart, such as abnormal leftventricular ejection fraction.

There may be other reasons for your doctor to recommend an ICD.

What are the risks of an implantable cardioverter defibrillator?

Possible risks of ICD insertion include:

  • Bleeding from the incision or catheter insertion site

  • Damage to the blood vessel at the catheter insertion site

  • Infection of the incision or catheter site

  • Tearing of the heart muscle

  • Collapsed lung

  • Dislodging of the leads requiring another procedure to reposition the leads

If you are pregnant or think that you could be, or are currentlybreastfeeding, tell your healthcare provider.

If you are allergic to or sensitive to any medicines or latex, tell yourhealthcare provider.

Lying still on the procedure table for the length of the procedure maycause some discomfort or pain.

There may be other risks depending on your specific medical condition. Besure to discuss any concerns with your healthcare provider before theprocedure.

How do I get ready for an implantable cardioverter defibrillator?

  • Your doctor will explain the procedure to you and ask if you have any questions.

  • You will be asked to sign a consent form that gives your permission to do the test. Read the form carefully and ask questions if something is not clear.

    (Video) Implantable Cardioverter-Defibrillator (ICD)

  • Tell your doctor if you are sensitive to or are allergic to any medicines, iodine, latex, tape, or anesthetic agents (local and general).

  • You will need to fast for a certain period before the procedure. Your doctor will tell you how long to fast, usually overnight.

  • If you are pregnant or think that you could be, tell your doctor.

  • Tell your doctor of all medicines (prescription and over-the-counter) and herbal or other supplements that you are taking.

  • Tell your doctor if you have heart valve disease, as you may need to take an antibiotic before the procedure.

  • Tell your doctor if you have a history of bleeding disorders or if you are taking any blood-thinning medicines (anticoagulants), aspirin, or other medicine that affect blood clotting. You may be told to stop some of these medicines before the procedure.

  • Your doctor may request a blood test before the procedure to see how long it takes your blood to clot. Other blood tests and chest X-ray may be done as well.

  • You may get a sedative before the procedure to help you relax.

  • Based on your medical condition, your doctor may request other specific preparation.

How is a cardioverter defibrillator implanted?

Having an ICD implanted may be done on an outpatient basis or as part ofyour stay in a hospital. Procedures may vary depending on your conditionand your doctor’s practices.

Generally, an ICD insertion follows this process:

  • You will be asked to remove any jewelry or other objects that may interfere with the procedure.

  • You will be asked to remove your clothing and will be given a gown to wear.

  • You will be asked to empty your bladder before the procedure.

  • An intravenous (IV) line will be started in your hand or arm for injection of medicine and fluids, if needed.

  • You will be placed on your back on the procedure table.

  • You will be connected to an electrocardiogram (ECG) monitor that records the electrical activity of the heart during the procedure using. Your vital signs (heart rate, blood pressure, breathing rate, and oxygenation level) will be monitored during the procedure.

  • The surgical site is cleaned. In some cases, hair may be shaved or clipped.

  • Large electrode pads will be placed on the front and back of the chest.

  • You will receive a sedative in your IV before the procedure to help you relax. However, you will likely remain awake during the procedure.

  • The ICD insertion site will be cleansed with antiseptic soap.

  • Sterile towels and a sheet will be placed around this area.

    (Video) Implantable Cardioverter-Defibrillator (ICD)

  • A local anesthetic will be injected into the skin at the insertion site.

  • Once the anesthetic has taken effect, the doctor will make a small incision at the insertion site.

  • A sheath, or introducer, is inserted into a blood vessel, usually under the collarbone. The sheath is a plastic tube through which the ICD lead wire will be inserted into the blood vessel and advanced into the heart.

  • It will be very important for you to remain still during the procedure so that the catheter does not move out of place and to prevent damage to the insertion site.

  • The lead wire will be inserted through the introducer into the blood vessel. The doctor will advance the lead wire through the blood vessel into the heart.

  • Once the lead wire is inside the heart, it will be tested to verify proper location and that it works. There may be 1, 2, or 3 lead wires inserted, depending on the type of device your doctor has chosen for your condition. Fluoroscopy, (a special type of X-ray that will be displayed on a TV monitor), will be used to position the lead.

  • For subcutaneous ICDs, one or two small incisions are made near the top and bottom of the sternum or breast bone. The lead wire is then tunneled underneath the skin next to the sternum and from the sternum to the incision on the left side of the chest.

  • The ICD generator will be slipped under the skin through the incision (just below the collarbone for traditional ICDs and on the left side of the chest for S-ICDs) after the lead wire is attached to the generator. Generally, if you are right-handed, the device will be placed in your upper left chest. S-ICDs are implanted on the left side of the chest near the heart. If you are left-handed, or have a contraindication to a left-sided device a traditional ICD can be placed in your upper right chest.

  • The ECG will be observed to monitor ICD function. Certain tests may then be done to assess the device function.

  • The skin incision will be closed with sutures, adhesive strips, or special glue.

  • A sterile bandage or dressing will be applied.

What happens after an implantable cardioverter defibrillator?

In the hospital

After the procedure, you may be taken to the recovery room for observationor returned to your hospital room. A nurse will monitor your vital signs.

Tell your nurse right away if you feel any chest pain or tightness, or anyother pain at the incision site.

After the period of bed rest has been completed, you may get out of bedwith help. The nurse will help you the first time you get up, and willcheck your blood pressure while you are lying in bed, sitting, andstanding. Move slowly when getting up from the bed to avoid any dizzinessfrom the period of bed rest. You will be able to eat or drink once you arecompletely awake.

Your arm may be in a sling for a day or so. How long you will need to weara sling will depend on your provider. Some people are asked to wear it atnight while they sleep after the first couple of days but can take it offduring the day.

The insertion site may be sore or painful, and pain medicine may be givenif needed.

After the procedure, a chest X-ray is often done to check the lung and makesure the systems are stable.

Your doctor will visit with you in your room while you are recovering. Thedoctor will give you specific instructions and answer any questions you mayhave.

Once your blood pressure, pulse, and breathing are stable and you arealert, you will be taken to your hospital room.

If the procedure is done on an outpatient basis, you may be able to leaveafter you have completed the recovery process. However, it is common tospend at least 1 night in the hospital after ICD implantation forobservation.

Arrange to have someone drive you home from the hospital after yourrelease.

At home

You should be able to return to your daily routine within a few days. Yourdoctor will tell you if you need to take more time in returning to yournormal activities.

(Video) ICDS (Implantable Cardioverter-Defibrillators): PACE CARDIOLOGY

Avoid lifting or pulling on anything for a few weeks. You may be told tolimit movement of the arm on the side that the ICD was placed, based onyour doctor's preferences.

You will most likely be able to resume your usual diet, unless your doctortells you differently.

Keep the insertion site clean and dry. You will be given instructions aboutbathing and showering.

Your doctor will give you specific instructions about driving. You will notbe able to drive until your doctor says it's OK. These limitations will beexplained to you, if they are applicable to your situation.

You will be given specific instructions about what to do the first timeyour ICD delivers a shock. For example, you may be told to dial 911 or goto the nearest emergency room in the event of a shock from the ICD. Calmingyourself with slow deep breaths can be helpful if you are anxious after ashock.

Ask your doctor when you will be able to return to work. The nature of yourjob, your overall health, and your progress will determine how soon you mayreturn to work.

After implantation, your ICD will require regular evaluation (called aninterrogation) to evaluate its function and battery status, and to checkfor any significant events stored by the device. Your doctor will tell youwhen and how this is done.

A home monitor may be provided to you that can communicate with your ICDwirelessly. Information about ICD function can then be related to yourdoctor over the internet.

Tell your doctor right away if you have any of the following:

  • Fever or chills

  • Increased pain, redness, swelling, or bleeding or other drainage from the insertion site

  • Chest pain or pressure, nausea or vomiting, profuse sweating, dizziness or fainting

  • Palpitations

  • ICD shock

  • If your device generator feels loose or like it is wiggling in the pocket under the skin

Your doctor may give you other instructions after the procedure, dependingon your particular situation.

Living with an ICD

Take the following precautions when you have an ICD implanted. Discuss thefollowing in detail with your doctor, or call the company that made yourdevice:

  • Always carry an ID card that states you have an ICD. In addition, you may want to wear a medical ID bracelet showing that you have an ICD.

  • If you travel by air, inform security screeners that you have an ICD before going through the metal detector. (It may help to say you have a pacemaker – which is true as pacemaker functions are built into ICDs – because security may not know what an ICD is.) In general, airport security detectors are safe for pacemakers and ICDs, but the small amount of metal in the device and leads may trigger the alarm. If you are selected for additional screening, politely remind the screener that the security wand contains a magnet, which may interfere with the programming or function of the ICD (pacemaker) if it is held over the device for more than a few seconds.

  • Anti-theft systems or electronic article surveillance (EAS) used in department stores may interact with an ICD. Do not lean on or stand in this equipment. But it is OK to pass quickly through the detection system.

  • Avoid large magnetic fields such as power generation sites and industrial sites, such as automobile junkyards that use large magnets.

    (Video) Intermuscular Implant 2IT Technique for S-ICD

  • If an MRI has been recommended for you, contact your doctor. Some newer ICDs are compatible with MRI scanners with some restrictions.

  • Do not use diathermy (the use of heat in physical therapy to treat muscles). Do not use a heating pad directly over your ICD.

  • Avoid transcutaneous electrical nerve stimulation (TENS) therapy. Talk to your doctor if you are considering this treatment.

  • Turn off large motors, such as cars or boats, when working on them as they may create a magnetic field.

  • Avoid high-voltage and radar machinery, such as radio or television transmitters, electric arc welders, high-tension wires, radar installations, or smelting furnaces.

  • If you are scheduled for surgery, let the surgeon know well ahead of the operation that you have an ICD. Also, consult with your cardiologist before the procedure to find out if you need any special preparation.

  • When involved in a physical, recreational, or sporting activity, protect yourself from trauma to the ICD. A blow to the chest near the ICD can affect its functioning. If you are hit in that area, you may want to see your doctor.

  • Cell phones are generally safe to use, but keep them at least 6 inches away from your ICD. Avoid carrying a cell phone in your breast pocket over your ICD.

  • Always see your doctor when you feel ill after an activity, or when you have questions about beginning a new activity.

  • Always talk to your doctor if you have any questions concerning the use of equipment near your ICD.

Next steps

Before you agree to the test or the procedure make sure you know:

  • The name of the test or procedure

  • The reason you are having the test or procedure

  • What results to expect and what they mean

  • The risks and benefits of the test or procedure

  • What the possible side effects or complications are

  • When and where you are to have the test or procedure

  • Who will do the test or procedure and what that person’s qualifications are

  • What would happen if you did not have the test or procedure

  • Any alternative tests or procedures to think about

  • When and how will you get the results

  • Who to call after the test or procedure if you have questions or problems

    (Video) My life with an Implantable Cardioverter Defibrillator (ICD)

  • How much will you have to pay for the test or procedure

FAQs

When should an ICD be implanted? ›

You may need an ICD if you have survived sudden cardiac arrest due to ventricular fibrillation, or have fainted due to ventricular arrhythmia, or if you have certain inherited heart conditions. An ICD is generally needed for those at high risk of cardiac arrest due to a ventricular arrhythmia.

Is ICD placement a major surgery? ›

An ICD is a type of cardiac therapy device. There are two basic types: A traditional ICD is implanted in the chest, and the wires (leads) attach to the heart. The implant procedure requires invasive surgery.

How long can't I drive after having ICD implanted? ›

Importance. Although guidelines recommend driving restrictions for 3 to 6 months after appropriate implantable cardioverter-defibrillator (ICD) shocks, contemporary data to support these recommendations are lacking.

Is getting an ICD serious? ›

There is a risk of bleeding and bruising, damage to the artery, nerves, and veins requiring surgery or transfusions, blood clots and swelling and infection. There is also a risk of pneumothorax, a condition in which air becomes trapped in the pleural space, causing the lung to collapse.

What is the success rate of ICD? ›

One- and 5-year implantable cardioverter-defibrillator survival rates are 92% and 68%, respectively, and are 88% and 54% for cardiac resynchronization therapy defibrillators.

Can you live a normal life with ICD? ›

Pacemakers and ICDs generally last 5 to 7 years or longer, depending on usage and the type of device. In most cases, you can lead a normal life with an ICD. Advances in technology have reduced the chances that machines, such as microwaves, could interfere with your device.

What to avoid if you have an ICD? ›

Don't dangle headphones round your neck or within 3cm (1in) of your ICD. Don't put mobile or cordless phones, or MP3 players within 15cm (6in) of your ICD. Don't wear magnetic fasteners near your ICD. Don't use a TENS machine for pain relief, and keep electric-pulse body-toning tools below your stomach.

How painful is an ICD implant? ›

Do shocks from an ICD hurt? Most patients who have received shocks from their ICDs describe them as startling, jolting and unsettling, but not painful. It's easy to understand why. The ICD delivers a shock to prevent a dangerously fast heart rhythm.

How soon can you shower after ICD implant? ›

You may shower 24 to 48 hours after surgery. Pat the incision dry. Don't swim or take a bath for the first 2 weeks, or until your doctor tells you it is okay. You will have a dressing over the incision.

How long does it take to heal from ICD placement? ›

Most people who have an ICD implanted are able to go home from the hospital in 1 day. Most quickly return to their normal activity level. Full recovery takes about 4 to 6 weeks. Ask your provider how much you can use the arm on the side of your body where the ICD was placed.

How long does ICD implant surgery take? ›

The procedure usually takes about an hour. You may stay in the hospital for 1 or 2 days. You can likely return to many of your normal activities after you get an ICD. But to stay safe, you may need to make some changes to your normal routine.

Which is more serious ICD or pacemaker? ›

The larger shocks ICDs deliver are intended to restore a normal heart rate and rhythm when the heart falls too far out of beat for regular artificial pacemaker pulses. ICDs are deemed necessary when the arrhythmia present is considered more immediately life-threatening or not fixable with surgery.

Is an ICD better than a pacemaker? ›

An implantable cardioverter defibrillator (ICD) looks similar to a pacemaker, though slightly larger. It works very much like a pacemaker. But the ICD can send an energy shock that resets an abnormal heartbeat back to normal. Many devices combine a pacemaker and ICD in one unit for people who need both functions.

Does ICD improve quality of life? ›

Two RCTs reported improved QoL for patients with an ICD compared to patients with medical treatment. The remaining four studies noted no QoL differences among the groups.

Does an ICD improve heart function? ›

What are the benefits? An ICD may lower the risk of sudden death in some people who have heart failure. An ICD can fix a heart rate that is too fast or too slow without using a shock.

Can ICD prevent sudden death? ›

Sudden cardiac death (SCD) is a leading cause of death. The advent of the implantable cardioverter‑defibrillator (ICD) has revolutionized prevention of SCD in high‑risk patients with underlying cardiac diseases.

Does an ICD cure heart failure? ›

Your doctor may suggest an ICD if you are at risk of having an abnormal heart rhythm that could cause sudden death. Tests can show if you are at risk. An ICD does not treat heart failure. It does not help you feel better.

Can ICD prevent heart failure? ›

Implantable cardioverter defibrillators (ICDs) represent the only available tool in our treatment armamentarium proven to prevent arrhythmic sudden cardiac death. In addition, cardiac resynchronization therapy (CRT) is an established treatment option significantly improving both quality of life as well as mortality.

How do you sleep with a defibrillator? ›

If you have an implanted defibrillator, sleep on the opposite side. Most defibrillators are implanted on the left side, so sleeping on the right side may feel more comfortable.

Is having an ICD a disability? ›

Having a pacemaker or implanted cardiac defibrillator (ICD) doesn't automatically qualify you for Social Security disability, especially if the device is controlling your symptoms well.

What do I do if my defibrillator shocked me? ›

Call your doctor's office and let them know you received a shock. If you received multiple shocks, you should go straight to the emergency room. Interrogation — using a device connected to your phone line to remotely monitor your device — will let your doctor know what happened.

Can you use a cell phone with an ICD? ›

Mobile phones could potentially interfere with an ICD or pacemaker, because they often contain magnets, as well as other elements that also produce electromagnetic fields. Electromagnetic fields may interfere with the ability of your ICD or pacemaker to detect the electrical activity of your heart.

Are you allowed to drive with an ICD? ›

You can drive with an arrhythmia as long as it doesn't cause symptoms that make it dangerous for you to drive. If you have an arrhythmia or an ICD (implantable cardioverter-defibrillator) that makes it dangerous for you to drive, your doctor might suggest that you stop driving, at least for a short time.

Can you go through a metal detector with an ICD? ›

Don't stand near the metal detector any longer than is necessary. Don't lean against the structure of the system. If scanning with a handheld metal detector is necessary, tell the security personnel that you have an ICD or pacemaker, and request an alternative form of inspection, such as a pat down.

Can I drive a car with ICD implant? ›

The person should not drive for at least 6 months after the ICD is implanted.

What happens if you get shocked by a defibrillator while awake? ›

Answer: A defibrillator shock, if you're wide awake, will indeed hurt. The description is that it's like being kicked by a mule in the chest.

Can you drink after ICD implant? ›

Although you may not be aware of it, sedation can remain in your system for up to 24 hours and can cause you to be less alert then normal. It is important that you do not drive, drink alcohol, operate machinery or sign legally binding documents within 24 hours of the procedure.

Is ICD surgery painful? ›

Your chest may be sore where the doctor made the cut (incision) and put in the ICD. You also may have a bruise and mild swelling. These symptoms usually get better in 1 to 2 weeks. You may feel a hard ridge along the incision.

How long is bed rest after pacemaker? ›

As a precaution, it is normally recommended that you avoid strenuous activities for around 3 to 4 weeks after having your pacemaker fitted.

Does an ICD improve ejection fraction? ›

Heart failure patients with primary prevention implantable cardioverter-defibrillators (ICD) may experience an improvement in left ventricular ejection fraction (LVEF) over time. However, it is unclear how LVEF improvement affects subsequent risk for mortality and sudden cardiac death (SCD).

When should a pacemaker be implanted? ›

Your doctor may recommend a temporary pacemaker when you have a slow heartbeat (bradycardia) after a heart attack, surgery or medication overdose but your heartbeat is otherwise expected to recover. A pacemaker may be implanted permanently to correct a chronic slow or irregular heartbeat or to help treat heart failure.

Do they stop your heart to put in an ICD? ›

Getting an ICD Implanted

The procedure to implant a defibrillator does not require open heart surgery, and most people go home within 24 hours. Before the surgery, medication may be given to make you sleepy and comfortable. Generally, the procedure is performed under local anesthesia.

Can you exercise with an ICD? ›

Moderate leisure-time physical exercise is safe and clinically recommended for most individuals with ICDs [5]. The benefits of physical activity for secondary prevention are also well known [6], and, for ICD patients in particular, participation in exercise training programmes may reduce their risk of ICD shocks [7].

What drugs increase ejection fraction? ›

The mainstay of medical treatment for patients with heart failure with reduced ejection fraction (HFrEF) are beta blockers (BB), angiotensin converting enzyme inhibitors (ACEi)/angiotensin receptor blockers (ARB), and mineralocorticoid receptor antagonists (MRA).

What ejection fraction qualifies for ICD? ›

An ICD may be considered in patients with non-ischemic cardiomyopathy present for at least nine months, New York Heart Association (NYHA) functional class II to III heart failure, and an LV ejection fraction of ≤ to 30% or an LV ejection fraction of 31% to 35%.

Can WIFI affect pacemakers? ›

In general, consumer appliances and electronics don't affect the performance of ICDs and pacemakers.

When can I lift my arm after pacemaker surgery? ›

For 2 to 4 weeks, don't raise the arm on the pacemaker side above shoulder level. Avoid heavy lifting - no more than 10 to 15 pounds. Keep the incision clean and dry for one week. Avoid putting lotions or oils on the incision.

Is ICD insertion painful? ›

The implant of an ICD or any CIED can be associated with severe acute pain. The pain is most intense immediately after the implant procedure and diminished gradually over the next few days as the implant site heals. Postoperative pain should be managed with preoperative, perioperative, and postoperative strategies.

Does an ICD shorten life expectancy? ›

In an analysis of these clinical trials, the risk of death for patients at least 75 years of age was approximately 35 percent among those receiving an ICD, compared with 22 percent in the current study, in which 75 percent of the population was at least 75 years old.

Does ICD prolong life? ›

Implantable cardioverter-defibrillators (ICDs) significantly extend survival in patients who are at high risk for sudden cardiac death due to the severity of their underlying heart disease.

Videos

1. Implantable Cardioverter Defibrillator ICD Dr Taymour Abdelhaleem
(Cardiology Department Ain Shams)
2. Getting an ICD? Watch an implant procedure!
(JamesKnellerMD)
3. Preparing for Your Implantable Cardioverter Defibrillator Implantation
(Cardiac Sciences)
4. Implantable Cardioverter Defibrillators and Sudden Cardiac Death - Health Matters
(University of California Television (UCTV))
5. Living with an implantable cardioverter defibrillator (ICD)
(Arrhythmia Alliance)
6. What is an implantable cardioverter defibrillator (ICD)?
(British Heart Foundation)
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