Cardioverter Defibrillator Implantation

An implantable cardioverter defibrillator (ICD) is a device that identifies and corrects abnormal heart rhythms. Cardioverter defibrillator implantation is a surgery to place an ICD under the skin in the chest or abdomen. An ICD has a battery, a small computer (pulse generator), and wires (leads) that go into the heart. The ICD detects and corrects two types of dangerous irregular heart rhythms (arrhythmias):

  • A rapid heart rhythm in the lower chambers of the heart (ventricles). This is called ventricular tachycardia.

  • The ventricles contracting in an uncoordinated way. This is called ventricular fibrillation.

There are different types of ICDs, and the electrical signals from the ICD can be programmed differently based on the condition being treated. The electrical signals from the ICD can be low-energy pulses, high-energy shocks, or a combination of the two. The low-energy pulses are generally used to restore the heartbeat to normal when it is either too slow (bradycardia) or too fast. These pulses are painless. The high-energy shocks are used to treat abnormal rhythms such as ventricular tachycardia or ventricular fibrillation. This shock may feel like a strong jolt in the chest.

Your healthcare provider may recommend an ICD if you have:

  • Had a ventricular arrhythmia in the past.

  • A damaged heart because of a disease or heart condition.

  • A weakened heart muscle from a heart attack or cardiac arrest.

  • A congenital heart defect.

  • Long QT syndrome, which is a disorder of the heart’s electrical system.

  • Brugada syndrome, which is a condition that causes a disruption of the heart’s normal rhythm.

Tell a healthcare provider about:

  • Any allergies you have.

  • All medicines you are taking, including vitamins, herbal medicines, eye drops, creams and over-the-counter medicines.

  • Any problems you or family members have had with anaesthetics.

  • Any blood disorders you have.

  • Any surgery you have had.

  • Any medical conditions you have.

  • Whether you are pregnant or may be pregnant.

What are the risks?

Generally, this is a safe procedure. However, problems may occur, including:

  • Infection.

  • Bleeding.

  • Allergic reactions to medicines used during the procedure.

  • Blood clots.

  • Swelling or bruising.

  • Damage to nearby structures or organs, such as nerves, lungs, blood vessels, or the heart where the ICD leads or pulse generator is implanted.

What happens before the procedure?

Staying hydrated

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Follow instructions from your healthcare provider about hydration, which may include:

  • Up to 2 hours before the procedure – you may continue to drink clear liquids, such as water, clear fruit juice and tea and coffee without milk or cream.

Eating and drinking restrictions

Follow instructions from your healthcare provider about eating and drinking, which may include:

  • 8 hours before the procedure – stop eating heavy meals or foods, such as meat, fried foods, or fatty foods.

  • 6 hours before the procedure – stop eating light meals or foods, such as toast or cereal.

  • 6 hours before the procedure – stop drinking milk or drinks that contain milk.

  • 2 hours before the procedure – stop drinking clear liquids.

Medicines

Ask your healthcare provider about:

  • Changing or stopping your regular medicines. This is especially important if you are taking diabetes medicines or blood thinners.

  • Taking medicines such as aspirin and NSAIDs. These medicines can thin your blood. Do not take these medicines unless your healthcare provider tells you to take them.

  • Taking over-the-counter medicines, vitamins, herbal medicines and supplements.

Tests

You may have an examination or tests. These may include:

  • Blood tests.

  • A test to check the electrical signals in your heart (electrocardiogram, ECG).

  • Imaging tests, such as a chest X-ray.

  • Echocardiogram. This is an ultrasound of your heart to evaluate your heart structures and function.

  • An event monitor or Holter monitor to wear at home.

General instructions

  • Do not use any products that contain nicotine or tobacco for at least 4 weeks before the procedure. These products include cigarettes, chewing tobacco, and vaping devices, such as e-cigarettes. If you need help quitting, ask your healthcare provider.

  • Ask your healthcare provider:

    • How your procedure site will be marked.

    • What steps will be taken to help prevent infection. These may include:

      • Removing hair at the surgical site.

      • Washing skin with an antibacterial soap.

      • Taking antibiotics.

  • You may be asked to shower with an antibacterial soap.

  • Plan to have a responsible adult take you home from the hospital or clinic.

What happens during the procedure?

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  • Small monitors will be put on your body. They will be used to check your heart rate, blood pressure, and oxygen level.

  • A pair of sticky pads (defibrillator pads) may be placed on your back and chest. These pads are able to pace your heart as needed during the procedure.

  • An IV tube will be inserted into one of your veins.

  • You will be given one or more of the following:

    • A medicine to help you relax (sedative).

    • A medicine to numb the area (local anaesthetic).

    • A medicine to make you fall asleep(general anaesthetic).

  • A small incision will be made to create a deep pocket under the skin of your chest or abdomen.

  • Leads will be guided through a blood vessel into your heart and attached to your heart muscles. Depending on the ICD, the leads may go into one ventricle, or they may go into both ventricles and into an upper chamber of the heart. An X-ray machine (fluoroscope) will be used to help guide the leads. The other end of the leads will be attached to the pulse generator.

  • The pulse generator will be placed into the pocket under the skin.

  • The ICD will be tested, and your healthcare provider will programme the ICD for the condition being treated.

  • The incision will be closed with stitches (sutures), skin glue, adhesive strips, or staples.

  • A bandage (dressing) will be placed over the incision.

The procedure may vary among healthcare providers and hospitals.

What happens after the procedure?

  • Your blood pressure, heart rate, breathing rate and blood oxygen level will be monitored until you leave the hospital or clinic. Your healthcare provider will also monitor your ICD to make sure it is working properly.

  • A chest X-ray will be taken to check that the ICD is in the right place.

  • Do not raise the arm on the side of your procedure higher than your shoulder for as long as instructed by your healthcare provider. This is usually at least 6 weeks.

  • You may be given an identification card explaining that you have an ICD.

  • You will be given a remote home monitoring device to use with your ICD to allow your device to communicate with your clinic.

Summary

  • An implantable cardioverter defibrillator (ICD) is a device that identifies and corrects abnormal heart rhythms. Cardioverter defibrillator implantation is a surgery to place an ICD under the skin in the chest or abdomen.

  • An ICD consists of a battery, a small computer (pulse generator), and wires (leads) that go into the heart.

  • During the procedure, the ICD will be tested, and your healthcare provider will programme the ICD for the condition being treated.

  • After the procedure, a chest X-ray will be taken to check that the ICD is in the right place.

This information is not intended to replace advice given to you by your health care provider. Make sure you discuss any questions you have with your health care provider.