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 tracks the heart’s rhythm and delivers appropriate treatment. Most ICDs have both pacemaker and defibrillator functions. If the heart beats too slowly, the ICD can help the heart beat at a normal pace. If the heart starts to beat in a disorganized way, it delivers a shock to restore a normal rhythm. ICD implantation is the surgical placement of an ICD.

Implanted Cardioverter Defibrillator

Reasons for Procedure

Certain heart rhythms are very dangerous and can lead to cardiac arrest or sudden cardiac death. Some irregular rhythms that may need an ICD implant:

Bradycardia —heart beating too slowly
Ventricular tachycardia —heart beating too rapidly
Ventricular fibrillation —heart muscle not pumping, but just quivering

ICDs are implanted in those who:

Have had 1 or more episodes of serious irregular heart rhythms
Have had a heart attack and are at high risk for arrhythmias
Have a high risk of dangerous arrhythmias
Have a weakened heart muscle
Have hypertrophic cardiomyopathy —an enlarged heart muscle that does not work properly

Possible Complications

Problems from the procedure are rare, but all procedures have some risk. Your doctor will review possible problems such as:

Damage to nearby structures
Infection
Bleeding
Bruising
Inappropriate shocks
Device malfunction

Your chances of problems are higher for:

Obesity
Smoking
Excess alcohol use
Bleeding problems
Use of certain medicines
Diabetes

What to Expect

Prior to Procedure

You may have:

Blood tests
Imaging tests:
- Chest x-ray
- Echocardiogram
To test the heart's electrical activity with:
- ECG
- Implantable loop recorders (ILR)
- Electrophysiology study (EPS)
To test for coronary artery disease with:
- Stress testing
- Cardiac catheterization

Leading up to your procedure:

Talk to your doctor about your medicines. You may need to stop some up to 1 week in advance.
The night before, eat a light meal. Don't eat or drink anything after midnight.

Anesthesia

To implant the ICD, light sedation and local anesthesia are usually used.

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

Description of the Procedure

The area where the ICD is to be implanted will be cleaned. A small cut will be made below the collarbone on the left or right side.

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 where the skin was cut. The ICD will be implanted into the pocket.

When the ICD is in place, the sedation will be increased. The ICD will be tested to make sure that it shocks the heart properly. Every precaution will be taken to ensure that this is a safe process. The cut will be stitched when the ICD is working properly and in the right place.

Immediately After Procedure

You will be taken to a recovery room. Your pulse, blood pressure, and wound will be checked regularly. Chest x-rays will ensure the ICD and leads are in the proper place.

How Long Will It Take?

About 1-3 hours

How Much Will It Hurt?

You may feel some pushing and tugging on the skin. The anesthesia will keep pain to a minimum. You may notice some pain or stiffness around the wound. Pain medicines will ease pain afterward.

Average Hospital Stay

1-3 days

Postoperative Care

At the Hospital

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

At Home

To help with healing:

You may need to avoid:
- MRI scans
- Heat therapy—often used in physical therapy
- High-voltage or radar machinery, such as electric arc welders, high-tension wires, radar installations, or smelting furnaces
- Contact with radio or television transmitters
- Prolonged contact with household appliances, such as microwave ovens
Do not carry a cell phone in a pocket directly over the device. Keep your phone on the side away from the device. Also, headphones worn with MP3 players may cause interference.
Turn off car or boat motors when working on them. They may temporarily confuse your device.
Tell your doctor or dentist that you have a device before a surgical procedure.
Check with your doctor about the safety of going through airport security detectors with your device.

You will get an ID card that has important information about your ICD. It’s important that you show this card to any doctor, nurse, dentist, or other healthcare staff at the beginning of an office visit or hospital admission.

If your heart needs a shock from your ICD, you may be able to feel it. You may feel lightheaded before the shock. This is from the heart rhythm. The shock given by the ICD may feel like a light thump or a strong kick in the chest. If you feel a shock, try to stay calm. Sit or lie down. If someone is with you, ask them to stay. If you feel okay after the shock, call your doctor’s office to let them know. This is not an emergency. Your doctor may want you to come in for a visit, especially if this is the first shock you’ve had. If you get multiple shocks in a row or multiple shocks in a day, go to the emergency room.

Call Your Doctor

Contact your doctor if your recovery is not progressing as expected or you develop complications such as:

You feel a shock
Fever or chills
Redness, swelling, pain, excess bleeding, or pus from the wound
Pain that you cannot control with the medicines you were given
Coughing
Nausea or vomiting

Call emergency medical services for:

Chest pain
Breathing problems
Feel lightheaded and do not feel a shock
You are still feeling symptoms after a shock
You feel 3 or more shocks in a row

If you think you have an emergency, call for emergency medical services 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://www.hrsonline.org/Patient-Resources/Treatment/Implantable-Cardioverter-Defibrillator. Accessed July 3, 2018.

Implantable cardioverter defibrillator (ICD). EBSCO DynaMed Plus website. Available at:http://www.dynamed.com/topics/dmp~AN~T116558/Implantable-cardioverter-defibrillator-ICD. Updated June 29, 2018. Accessed July 3, 2018.

Implantable cardioverter-defibrillators (ICD). Stanford Health Care website. Available at: https://stanfordhealthcare.org/medical-treatments/i/icd.html. Accessed July 3, 2018.

Pacemakers. EBSCO DynaMed Plus website. Available at:http://www.dynamed.com/topics/dmp~AN~T906162/Pacemakers. Updated January 11, 2018. Accessed July 3, 2018.

Last reviewed May 2018 by EBSCO Medical Review Board Michael J. Fucci, DO, FACC Last Updated: 7/3/2018

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