Implantable Cardiac Defibrillator (cont.)
How are ICDs implanted?
Implantation of an ICD is similar to that of a permanent
pacemaker. The procedure, which lasts 2-3 hours, is
considered minor in that it does not involve major heart
surgery. Patients are typically sedated during the
procedure. A local anesthetic is injected under the skin
over the area where the ICD will be placed, usually in the
right or left upper chest near the collarbone. The lead is
then inserted into a vein located in the upper chest near
the collarbone. The tip of the lead is placed on the inner
wall of the heart with the visual guidance of x-rays. If
there is more than one lead, the process is repeated. The
other end of the lead (or leads) is connected to the
defibrillator unit, which is then inserted under the skin
at the incision site. Because there are no nerve endings
inside the blood vessels and the heart, the patient usually
does not feel the placement of the lead(s).
Heavy sedation is used during the procedure when the
defibrillator is tested for proper functioning. Testing an
ICD involves inducing a rapid heart rhythm and allowing the
defibrillator to detect the abnormal rhythm and then
terminate it with a shock (just as the device would be
expected to operate in a real-life tachycardia episode).
What happens after implantation of an ICD?
While in the hospital, the patient's heart rhythms,
pulse, and blood pressures are routinely monitored. The
doctor may check or adjust the settings on the
defibrillator (done from outside the body). The nurses also
periodically examine the incision over the implantation
site for bleeding, redness, or other signs of infection. It
is normal to feel some pain over the incision for 1-2
weeks. Medications are usually given to alleviate pain.
Patients are typically discharged from the hospital in 1-
2 days after the procedure. Once home, the patient can
usually return to most activities. Instructions are given
to avoid raising the arm over the shoulder on the side of
the ICD implantation for several weeks. This precaution is
to avoid dislodging the leads before they become secure
inside the veins and the heart. Patients are also asked to
avoid contact sports, vigorous exercises, and heavy lifting
for several weeks.
In a week, the sutures over the incision are removed in
the doctor's office. This is a good opportunity to discuss
the following issues with the doctor:
- Level of physical activity;
- Return to work;
- Permission to drive automobiles;
- How frequently should the ICD and battery level be checked?
- What are the signs of device failure?
- When to replace the ICD (most ICD batteries last 3-7 years)?
- Precautions regarding interference with the device by outside power sources; and
- What to do when tachycardias occur.
Call the doctor if there is bleeding from the incision site, increasing pain over the
incision site, fever, heat, swelling, or fluid draining from the incision site.
Also call if the arm becomes swollen on the side of the implantation or if there
is twitching of chest muscles, persistent hiccups, dizziness, fainting, chest pain, or
shortness of breath.
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