Implantable Cardioverter Defibrillator

What is an Implantable Cardioverter Defibrillator:
Implantable Cardioverter Defibrillator (ICD). An implantable cardioverter defibrillator is used in patients at risk for recurrent, sustained ventricular tachycardia or ventricular fibrillation. It consists of two parts; a generator or battery and electrodes or wires. You may have one or two electrodes placed depending on your needs.

Patient preparation:
Your doctor may advise you to stop taking certain medications before your ICD instertion. If you have any questions about any other medications be sure to ask. ICD insertions require that you have an empty stomach. In most cases you will not be permitted to eat or drink anything after midnight. It's important to get a good night's sleep.

Hospital admission usually occurs the same day as your test. You will be asked to remove all clothing and jewelry and to put on a hospital gown. The nurse will need to start an intravenous (IV) line for fluids and medications. Staff members present for the procedure are a scrub nurse, a nurse to monitor and care for your needs and often a representative from the device company. The Electrophysiologist, Cardiologist, or Surgeon will perform the procedure. 

Some suggestions to help you prepare:

  • Pack a small bag of overnight clothing and for the next day.
  • Do not bring any valuables.
  • Bring a list of your medications (with exact names and dosages).
  • Arrange for someone to drive you home.
  • Empty your bladder for your own comfort.
  • You may wear your socks, dentures, hearing aids, or glasses.

During the examination
When it is time for your procedure your will be taken to the Eletrophysiology or Cardiac Catheterization Lab. The staff members will explain the procedure to you and answer any questions you may have. The area of your chest where the implantable cardioverter defibrillator is to be implanted will be shaved and cleansed to prevent infection. You will be connected to a cardiac and blood pressure monitor. This will monitor your heart rate constantly and your blood pressure frequently. You will be given a sedative and a local anesthetic ( numbing medication) will be injected into the skin at the area that was shaved and cleansed. The doctor will make a 3 to 4 inch incision and make a small pocket under the skin to hold the ICD. 

The device is connected to leads positioned inside the heart or on its surface. These leads are used to deliver electrical shocks, sense the cardiac rhythm and sometimes pace the heart, as needed. The various leads are tunnelled to a pulse generator, which is implanted in a pouch beneath the skin of the chest or abdomen. These generators are typically a little larger than a wallet and have electronics that automatically monitor and treat heart rhythms recognized as abnormal. Newer devices are smaller and have simpler lead systems. They can be installed through blood vessels, eliminating the need for open chest surgery.

When an implantable cardioverter defibrillator detects ventricular tachycardia or fibrillation, it shocks the heart to restore the normal rhythm. New devices also provide overdrive pacing to electrically convert a sustained ventricular tachycardia, and "backup" pacing if bradycardia occurs. They also offer many other sophisticated functions (such as storage of detected arrhythmic events and the ability to do "noninvasive" electrophysiologic testing).

Implantable cardioverter defibrillators have been very useful in preventing sudden death in patients with known, sustained ventricular tachycardia or fibrillation. Studies are now being done to find out how best to use them and whether they may have a role in preventing cardiac arrest in high-risk patients who haven't had, but are at risk for, life-threatening ventricular arrhythmias.

The incision will be closed with sutures and/or apply Steri-strips directly over the incision, followed by a dressing. A sling will be placed on your arm as a reminder to keep your arm at your side.

Post Procedure Information:
After the procedure is complete, you will be moved to a room where you can rest and recover while your heart is monitored continously. You will be on bed rest typically until the next morning until after a chest x-ray is taken to verify lead placement. Discharge will occur typically the day after the procedure. Before you go home, you will be given instructions explaining how to care for the insertion site as well as restrictions to be followed.

What can I do when I return home?
In 7 to 10 days you will be seen by your doctor and the sutures and Steri-strips will be removed. Only tub or sponge baths are recommended until that time. Call the office immediately if you have any of the following: redness, pain, swelling or drainage at the incision site, or fever with no other symptoms.

It will take a few weeks for the pacemaker to become firmly attached to the heart. Therefore, you will need to limit exertion movement on the side and arm where your implantable cardioverter defibrillator is located. If the patient is right handed the implantable cardioverter defibrillator is typically implanted on the left side of the chest. If the patient is left-handed the implantable cardioverter defibrillator is typically implanted on the right side of the chest. Avoid reaching over your head or heavy lifting for approximately one month. You may resume other normal activities the day after surgery. Unless instructed otherwise, you may begin driving one week after surgery.

You may use any appliance in your home, including electric blankets, microwave ovens and other home appliances. These appliances will NOT harm your implantable cardioverter defibrillator .

There will be no travel restrictions. However, your implantable cardioverter defibrillator may set off security devices in airports. If this happens, simply show airport personnel your implantable cardioverter defibrillator card. You will receive a temporary card before you leave the hospital. In the next few weeks you will receive a permanent implantable cardioverter defibrillator ID card in the mail. CARRY THIS CARD WITH YOU AT ALL TIMES! Other restrictions: your implantable cardioverter defibrillator may be reset by strong electrical currents. You are advised to avoid: electrical arc welding, observation towers with television transmitters, very close inspection of running combustion engines. The implantable cardioverter defibrillator is also sensitive to shock and shotgun shooting: recoil against the implantable cardioverter defibrillator must be avoided! 

Call your doctor or clinic if you have any further questions or concerns regarding your pacemaker.