Implantable Cardioverter Defibrillator Surgery

What is an implantable cardioverter defibrillator (ICD)?

An implantable cardioverter defibrillator (ICD) is a device that can prevent sudden death by shocking the heart from an abnormal rhythm back to a normal rhythm. The device is put under the skin in the chest.

The ICD system consists of:

• a pacemaker
• a pulse generator that can send a powerful shock to the heart
• electrodes to sense the rhythm of the heart and to carry the shock to the heart muscle
• batteries that last 5 to 9 years, depending on how often the device has to give a shock
• software to tell the ICD when to send a shock to the heart.

When the heart is beating normally, the ICD does nothing. If the ICD detects an abnormally fast heart rate, called ventricular tachycardia, the pacemaker first tries to control the heart rhythm. If this doesn't work, or the rhythm gets worse and becomes ventricular fibrillation, the ICD sends electric shock signals to the heart. The electric shock changes the abnormal rhythm to a normal rhythm.

When is it used?

ICDs may be life-saving if you have a fast heart rhythm (arrhythmia) that can cause sudden death. They may also be used if you have not had dangerous heart rhythms but are at high risk of having them. You may be at high risk if you have had a heart attack or have a problem in the heart muscle.

How do I prepare for ICD surgery?

If you need a minor pain reliever in the week before surgery, choose acetaminophen rather than aspirin, ibuprofen, or naproxen. This helps avoid extra bleeding during surgery. If you are taking daily aspirin for a medical condition, ask your provider if you need to stop taking it before your surgery.

Follow any instructions your healthcare provider may give you. If you are to have general anesthesia, eat a light meal, such as soup or salad the night before the procedure. Do not eat or drink anything after midnight and the morning before the procedure. Do not even drink coffee, tea, or water. Your healthcare provider will tell you which medicines to take that morning.

Follow your provider's instructions about not smoking before and after the procedure. Smokers heal more slowly after surgery. They are also more likely to have breathing problems during surgery. For this reason, if you are a smoker, you should quit at least 2 weeks before the procedure. It is best to quit 6 to 8 weeks before surgery.

Your provider will discuss with you the best site for the ICD implant. Usually, ICDs are implanted below the collar bone on the right or left side of the chest. The implant area will be shaved and cleaned before the procedure. An IV will be started the morning of your procedure. Blood work, chest X-ray, and EKG may be done if they have not already been done.

What happens during the procedure?

Your healthcare provider will give you a shot of local anesthetic to numb the site where the device will be placed. Your provider will make a small cut (incision) in the skin. Small wires are passed through a vein to your heart and then tested to check their position in your heart. A little pocket is made under your skin for the pulse generator. The wires are connected to the pulse generator and tested. The provider then closes the incision and programs the device.

What happens after the procedure?

Recovery time after the surgery is quite short. Hospital stays are usually no more than overnight, and you will soon be able to return to your normal activities.

When you go home after ICD surgery, you should:

• Limit the use of your arm on the side of the device for the next 2 days.
• Avoid sudden, jerky movements with your arms or stretching or reaching over your head for a couple of days.
• Keep the surgical incision clean and dry for 1 week.
• Avoid putting lotions or oils on the incision.
• Wear loose clothes over the incision.
• Avoid getting overly tired.

You may bathe right away, and you can shower in 1 week.

Your provider will tell you how soon you may go back to work. It depends on your age and health condition. Your provider will also discuss driving. There is a chance that when you have an attack of arrhythmia, you may faint before the device corrects the rhythm. Serious injury could occur if you faint while driving. This also makes it risky for you to swim alone.

Follow your provider's advice about medicine, diet, and exercise.

How can I take care of myself when I have an ICD?

When you have an ICD, you need to be aware of things that may interfere with ICDs:

• Keep your cell phone at least 6 inches away from your ICD. When your phone is turned on but not in use, do not carry it in your breast pocket.
• ICDs may not work properly near power-generating equipment, arc welding equipment, and powerful magnets. For example, if you were to need an MRI, a powerful magnet would be used to produce images of your organs. The magnet could interrupt the pacing of your ICD.
• X-rays generally appear to have no effect on ICDs, but radiation used to treat cancer may damage the ICD circuits.

Tell all your healthcare providers and dentists that you have an ICD.

Devices that generally do not damage ICDs include:

• electric drills
• electric blankets and heating pads
• electric shavers
• metal detectors
• microwave ovens
• televisions and remote controls.

Passing through the metal detector at airports will not damage an ICD, but the metal in it may sound the alarm. Be sure to carry an ID card with you showing that you have an ICD.

You will need regular follow-up visits to your healthcare provider so the device can be monitored. Monitoring shows whether the device is sensing the heartbeat properly, how many shocks have been delivered, and how much power is left in the batteries.

When the batteries have run down, the pulse generator must be replaced. Replacement of the pulse generator requires only minor surgery.

What are the benefits?

An implantable cardioverter defibrillator (ICD) can prevent sudden death from an abnormal heart rhythm. The ICD does not fix existing heart problems, but it lowers the risk of dying from an abnormal heart rhythm. The ICD can provide peace of mind and help you live longer.

What are the risks?

There is risk with every treatment or procedure. Talk to your healthcare provider about how the risks apply to you.

The most common problem with the device is that it sometimes gives shocks when you do not need them. You can feel each shock, even though it lasts only a very short time. Tell your provider about every shock you feel.

Another possible risk, although uncommon, is infection of the leads or the pocket where the device is placed.

When should I call my healthcare provider?

Call your healthcare provider right away if:

• Your pulse becomes abnormally slow, fast, or irregular.
• Your original symptoms return.

Call during office hours if:

• You have questions about the procedure or its result.
• You want to make another appointment.