Defibrillator Implantation

What is an ICD?

An implantable cardiac defibrillator (ICD) is a device that restores a normal heartbeat by sending an electric pulse or shock to the heart. They are used to prevent or correct an arrhythmia, a heartbeat that is uneven or that is too slow or too fast. Defibrillators can also restore the heart’s rhythm if the heart suddenly stops. An ICD — a pager-sized device — is placed in your chest to restore your normal heartbeat should the lower chambers of your heart (ventricles) go into a dangerous rhythm and stop beating effectively (cardiac arrest).

You might need an ICD if you have a dangerously fast heartbeat (ventricular tachycardia) or a chaotic heartbeat that keeps your heart from supplying enough blood to the rest of your body (ventricular fibrillation).

ICDs detect and stop abnormal heartbeats (arrhythmias). The device continuously monitors your heartbeat and delivers electrical pulses to restore a normal heart rhythm when necessary.

Why would I need an ICD?

You are a candidate for an ICD if you have experienced sustained ventricular tachycardia, survived a cardiac arrest, or fainted from a ventricular arrhythmia. You might also benefit from an ICD if you have:

A history of coronary artery disease and heart attack that has weakened your heart.
A heart condition that involves abnormal heart muscle, such as enlarged (dilated cardiomyopathy) or thickened (hypertrophic cardiomyopathy) heart muscle.
An inherited heart defect that makes your heart beat abnormally. These include long QT syndrome, which can cause ventricular fibrillation and death even in young people with no signs or symptoms of heart problems.
Having other rare conditions such as Brugada syndrome and arrhythmogenic right ventricular dysplasia also may mean you need an ICD.

Why would I need an ICD?

ICDs are placed surgically in the chest or abdomen, where it checks for arrhythmias. Arrhythmias can interrupt the flow of blood from your heart to the rest of your body or cause your heart to stop. The ICD sends a shock to correct the arrhythmia.

When you have a rapid heartbeat, the wires from your heart to the device transmit signals to the ICD, which sends electrical pulses to regulate your heartbeat. Depending on the problem with your heartbeat, your ICD could be programmed for the following therapies:

Low-energy pacing (Anti-tachycardia pacing) therapy: You may feel nothing or a painless fluttering in your chest when your ICD responds to mild disruptions in your heartbeat.

Defibrillation therapy: This is the electrical therapy used to restore a normal heartbeat. During this therapy, it may feel as if you’re being kicked in the chest, and it might knock you off your feet. The pain from this therapy usually lasts only a second. There should be no discomfort after the shock ends.

Usually, only one shock is needed to restore a normal heartbeat. Sometimes, however, you might have two or more shocks during a 24-hour period. Frequent shocks in a short time period are known as ICD storms. If you have two ICD shocks, you should seek emergency care to see if your ICD is working properly or if you have a problem that could be making your heart beat abnormally.

If necessary, the ICD can be adjusted to reduce the number and frequency of shocks. You may need additional medications to make your heart beat regularly and decrease the chance of an ICD storm.

An ICD is surgically placed under your skin, usually below your left collarbone. One or more flexible, insulated wires (leads) run from the ICD through your veins to your heart. ICDs have a generator connected to wires to detect your heart’s pulses and deliver a shock when needed. Some models have wires that rest in one or two chambers of the heart.

Like a pacemaker, an ICD can also record the heart’s electrical activity and heart rhythms. The recordings can help your doctor fine-tune the programming of your device to enhance correction of irregular heartbeats. Your device will be programmed to respond to the type of arrhythmia you are most likely to have.

Why is an ICD implanted?

You’ve likely seen TV shows in which hospital workers “shock” an unconscious person out of cardiac arrest with electrified paddles. An ICD does the same thing only internally and automatically when it detects an abnormal heart rhythm.

Because the ICD constantly monitors for abnormal heart rhythms and instantly tries to correct them, it helps treat cardiac arrest, even when you are far from the nearest hospital.

How do I live with my ICD?

Your doctor will check your ICD every three to six months. The battery in your ICD should last five to seven years or longer. When the battery runs down, you will need surgery to replace it. Carry an ID card with you so others know you have an ICD. Tell your other doctors and your dentist that you have an ICD. Certain types of medical equipment may affect how an ICD works. It is necessary to inform airport security that you have a pacemaker.

What are the risks of the procedure?

Risks associated with ICD implantation are uncommon but may include:

Infection at the implant site
Allergic reaction to the medications used during the procedure
Swelling, bleeding or bruising where your ICD was implanted
Damage to the vein where your ICD leads are placed
Bleeding around your heart, which can be life-threatening
Blood leaking through the heart valve where the ICD lead is placed
Collapsed lung (pneumothorax)

What is the process of implanting an ICD?

Usually, the procedure to implant an ICD can be performed with numbing medication and a sedative that relaxes you but allows you to remain aware of your surroundings. In some cases, general anesthesia, which puts you to sleep, may be used.

The procedure usually takes a few minutes but may take up an hour. During surgery, one or more flexible, insulated wires (leads) are inserted into veins near your collarbone and guided, with the help of X-ray images, to your heart. The ends of the leads are secured to your heart, while the other ends are attached to the generator, which is usually implanted under the skin beneath your collarbone.

Once the ICD is in place, your doctor will test it and program it for your heart rhythm problem. Testing the ICD might require speeding up your heart and then shocking it back into normal rhythm.

How long will I stay in the hospital after the procedure?

You may be discharged home the same day or may stay in the hospital up to one day after the procedure.

How do I treat my pain after the procedure?

After surgery, you may have some pain in the incision area, which can remain swollen and tender for a few days or weeks. Your doctor might prescribe pain medication. As your pain lessens, you can take non-aspirin pain relievers, such as acetaminophen (Tylenol) or ibuprofen (Advil, Motrin IB, or others).

When you’re released from the hospital, you will need to arrange for a ride home.

What are the results?

ICDs have become standard treatment for anyone who has survived cardiac arrest, and they are increasingly used in people at high risk of sudden cardiac arrest. An ICD lowers your risk of sudden death from cardiac arrest more than medication alone.

Although the electrical shocks can be unsettling, there is evidence that the ICD is effectively treating your heart rhythm problem and protecting you from sudden death. Talk to your doctor about how to best care for your ICD.

What are the long-term precautions following the procedure?

Problems with your ICD due to electrical interference are rare. Still, take precautions with the following:

Cellular phones and other mobile devices: It’s safe to talk on a cellphone, but avoid placing your cellphone within 6 inches (about 15 centimeters) of your ICD implantation site when the phone is turned on. Although unlikely, your ICD could mistake a cellphone’s signal for a heartbeat and slow your heartbeat, causing symptoms such as sudden fatigue. Avoid keeping your cellphone in the front pocket of your shirt.

Security systems: After surgery, you’ll receive a card that says you have an ICD. Show your card to airport personnel because the ICD may set off airport security alarms. Also, hand-held metal detectors often contain a magnet that can interfere with your ICD. Limit scanning with a hand-held detector to less than 30 seconds over the site of your ICD or make a request for a manual search.

Medical equipment: Let doctors, medical technicians, and dentists know that you have an ICD. Some procedures, such as magnetic resonance imaging (MRI), magnetic resonance angiography (MRA), and radiofrequency or microwave ablation are not recommended if you have an ICD.

Power generators: Stand at least 2 feet (0.6 meters) from welding equipment, high-voltage transformers or motor-generator systems. If you work around such equipment, your doctor can arrange a test in your workplace to see if the equipment affects your ICD.

Magnets: These might affect your ICD, so it’s a good idea to keep magnets at least 6 inches (15 centimeters) from your ICD site.

Devices that pose little or no risk to your ICD include microwave ovens, televisions and remote controls, AM/FM radios, toasters, electric blankets, electric shavers and electric drills, computers, scanners, printers, and GPS devices.

Are there any driving restrictions?

If you have an ICD to treat ventricular arrhythmia, driving a vehicle presents a challenge. The combination of arrhythmia and shocks from your ICD can cause fainting, which would be dangerous while you’re driving.

The American Heart Association’s guidelines advise avoiding driving for one week after ICD placement, but talk to your doctor for specific recommendations. The guidelines discourage driving during the first six months after your procedure if your ICD was implanted due to a previous cardiac arrest or ventricular arrhythmia.

If you have no shocks during this period, you’ll likely be able to drive again. But if you then have a shock, with or without fainting, tell your doctor and follow his or her recommendations. In most cases, you’ll need to stop driving until you’ve been shock-free for another six months.

If you have an ICD but have no history of life-threatening arrhythmias, you can usually resume driving within a week after your procedure if you’ve had no shocks. Discuss your situation with your doctor.

You cannot obtain a commercial driver’s license if you have an ICD.

What is the battery life of my ICD?

The lithium battery in your ICD can last up to 7 years. The battery will be checked during regular checkups, which should occur every three to six months. When the battery is nearly out of power, your old shock generator is replaced with a new one during a minor outpatient procedure.

ICD Discharge Instructions

Wound care instructions:

Keep the area where the ICD was inserted clean and dry.
Do not get the ICD incision wet for at least 7 days.
If you have aquacel (skin colored) dressing over the incision site, it is waterproof. You can take shower with the dressing on. The dressing needs to be removed after 1 week.
If you have steristrips (small white paper tapes) over the incision site, the incision site must be kept dry for 1 week. Either you can use wet towel or you can use large piece of Saran/plastic wrap over the incision site while you take shower. Remove Saran/plastic wrap after shower so that the incision site is dry and leave it uncovered at all other times. You can start taking shower regularly after 1 week. The steristrips will fall off on their own or the doctor will remove them at your follow up visit.
Do not submerge the wound under water during the healing period for 6 weeks.

Notify your physician if:

You notice unusual redness or swelling at the site,
Drainage from the wound,
A fever of greater that 100.5 or chills.

Avoid extreme pulling, pushing or lifting motions for 6 weeks from the date of the procedure, (such as placing your arm over your head without bending at the elbow).
No heavy weight lifting greater than 10 lbs.
No golf or swimming for 6 weeks.
You will need to be seen in 1-2 weeks to for a wound check.
If you do not have an appointment scheduled, call 602-698-5820 to schedule an appointment for a wound check.

Things you cannot do:

Arc welding can adversely interact with your device and cause an inappropriate shock.
Do not lean over a running car engine with the hood up. The electrical signal can be misinterpreted by the device. Being next to a running car should not adversely affect your ICD.

Things you can do:

You can have X-rays and CT scans
Normal household items such as microwave, TVs, refrigerators, ovens, saws, dryers, washers, electric blankets and computers DO NOT adversely affect your ICD.
Cellular phones do not, in general affect your ICD. It is recommended you use the ear opposite the device. Bluetooth is OK.

MRI Safe Pacemaker:

Most new ICD implants are now MRI compatible. If you need an MRI, please obtain clearance through your EP physician prior to ordering the MRI.

Traveling with your device:

Immediately following your surgery, you will receive a temporary identification card. A permanent identification card will be sent to you by mail in 8 weeks. Keep this card with you at all times.
Tell the airport personnel that you have a pacemaker-defibrillator, show them your ID card and they will wand everything but the device. X-ray will not harm your device.

What if I get shocked at home?

If you receive 1 shock and you feel fine, remain calm and call 602-698-5820 to be seen in the next 48 hours. Your device will store the information, so we will be able to review what caused the shock.
If you receive more than one shock, please call 911 to seek emergency medical attention.

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