Implantable Cardiac Defibrillator (cont.)
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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:
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.