Automatic Cardioverter Defibrillator Implantation

(Implantable Cardioverter Defibrillators [ICD]; Automatic Implantable Cardioverter Defibrillator [AICD])

Definition

An implantable cardioverter defibrillator (ICD) is a small, battery-operated device. It helps the heart beat normally. ICD implantation is surgery to put an ICD into the chest.

Implanted Cardioverter Defibrillator

Reasons for Procedure

This procedure is done to correct certain abnormal heartbeats such as:

Bradycardia—heart beating too slowly
Ventricular tachycardia—heart beating too fast
Ventricular fibrillation—heart muscle not pumping, just shaking

In some people, abnormal heartbeats can raise the risk of cardiac arrest or sudden death. An implanted ICD can help prevent this.

Possible Complications

Problems are rare, but all procedures have some risk. The doctor will talk about problems that could happen, such as:

Bleeding
Damage to nearby structures
Infection
Unwanted shocks
Problems with the device

Things that may raise the risk of problems are:

Smoking
Excess alcohol use
Long term diseases such as diabetes or obesity

What to Expect

Prior to Procedure

The surgical team may meet with you to talk about:

Anesthesia options
Any allergies you may have
Current medicines, herbs, and supplements that you take and whether you need to stop taking them before surgery
Fasting before surgery, such as avoiding food or drink after midnight the night before
Whether you need a ride to and from surgery
Tests that will need to be done before surgery

Anesthesia

The doctor will give:

Local anesthesia—the area will be numb
Medicine to help you relax

After the ICD is in place, it will need to be tested. General anesthesia will be used for this step. You will be asleep.

Description of the Procedure

The area where the ICD is to be implanted will be cleaned. A small incision will be made below the collarbone.

A wire, called a lead, will be threaded through a vein in the upper chest to the heart. X-rays will be used to watch the lead move through the vein to the heart. The signals between the heart and the ICD will be carried on this lead.

A pocket is made in the incision area. The ICD will be implanted into the pocket.

Once in place, the ICD will be tested. This is to make sure it shocks the heart properly. Precautions will be taken to make sure this is a safe process. When the ICD is working properly and in the right place, the incision will be stitched up. A bandage will be placed over the site.

How Long Will It Take?

About 1 to 3 hours

Will It Hurt?

Some pain and stiffness around the area is common for a while.. Medicines and home care help.

Average Hospital Stay

1 to 3 days

Postoperative Care

At the Hospital

The day after the implant, you will have an ECG and blood tests. The ICD function may be checked again. You may be sedated.

During your stay, the hospital staff will take steps to lower your risk of infection, such as:

Washing their hands
Wearing gloves or masks
Keeping your incision covered

There are also steps you can take to lower your risk of infection, such as:

Washing your hands often and reminding visitors and staff to do the same
Reminding staff to wear gloves or masks
Not letting others touch your incisions

At Home

It usually takes a week or so to recover.

Call Your Doctor

Call your doctor if you are not getting better or you have:

Signs of infection, such as fever or chills
Redness, swelling, excess bleeding, or discharge from the incision
A shock from the device
Pain that you cannot control with the medicine
Coughing
Lasting nausea or vomiting

Call for medical help right away for:

Chest pain
Breathing problems
Lightheadedness— and there is no shock
Symptoms that do not go away after a shock
3 or more shocks in a row

If you think you have an emergency, call for medical help right away.

RESOURCES:

American Heart Association
http://www.heart.org

Heart Rhythm Society
https://www.hrsonline.org

CANADIAN RESOURCES:

Canadian Cardiovascular Society
http://www.ccs.ca

Heart and Stroke Foundation
http://www.heartandstroke.ca

REFERENCES:

Implantable cardioverter defibrillator. Heart Rhythm Society website. Available at: https://upbeat.org/common-treatments/implantable-cardioverter-defibrillator. Accessed August 30, 2021.

Implantable cardioverter defibrillator (ICD). EBSCO DynaMed website. Available at: https://www.dynamed.com/device/implantable-cardioverter-defibrillator-icd-16. Accessed August 30, 2021.

Implantable cardioverter-defibrillators (ICD). Stanford Health Care website. Available at: https://stanfordhealthcare.org/medical-treatments/i/icd.html. Accessed August 30, 2021.

Kamp NJ, Al-Khatib SM. The subcutaneous implantable cardioverter-defibrillator in review. Am Heart J. 2019;217:131-139.

Pacemakers. EBSCO DynaMed website. Available at: https://www.dynamed.com/device/pacemakers. Accessed August 30, 2021.

Last reviewed July 2021 by EBSCO Medical Review Board Nicole Meregian, PA Last Updated: 8/30/2021

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