Definition

Automatic cardioverter defibrillator implantation is the surgical insertion of an implantable cardioverter defibrillator (ICD). An ICD is a small battery-operated device that is implanted in the chest and continuously monitors the heart’s rhythm. These days, implantable defibrillators combine the function of a pacemaker with the function of an external defibrillator. The mechanism monitors the heart’s rate and rhythm. If the heart slows or speeds up too much, the pacemaker element provides pacing to restore a normal heart rate. If the heart begins to beat in a disorganized fashion, the device provides a shock to restore normal rhythm.

Implanted Cardioverter Defibrillator

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Parts of the Body Involved

  • Heart
  • Upper chest area

Reasons for Procedure

An ICD is inserted when the lower chambers of the heart (ventricles) are at risk for rhythm disturbances, specifically beating too slowly (bradycardia), too rapidly (ventricular tachycardia), or in an unsynchronized fashion (ventricular fibrillation). If a disturbance in the heart’s rhythm keeps the heart from delivering blood to the brain and other vital organs, sudden cardiac death (SCD) or cardiac arrest can occur.

ICDs are implanted in patients who:

  • Have survived one or more episodes of ventricular tachycardia, ventricular fibrillation, or sudden cardiac death
  • Heart attack survivors at high risk for future cardiac arrest
  • Individuals with the condition known as hypertrophic cardiomyopathy (an enlarged heart muscle that doesn’t function properly)
  • Have a high likelihood of developing sustained ventricular fibrillation or ventricular fibrillation

Risk Factors for Complications During the Procedure

  • Obesity
  • History of smoking
  • History of excess alcohol consumption
  • Bleeding or blood-clotting irregularities
  • Regular use of the following prescription medications: high blood pressure medicine, muscle relaxants, tranquilizers or sedatives, insulin, beta-adrenergic blockers, blood thinners, or cortisone
  • Regular use of mind-altering medications

What to Expect

Prior to Procedure

The following test may be conducted prior to your procedure:

  • Blood tests
  • Chest x-ray—a test that uses radiation to take a picture of structures inside the body, especially bones
  • Electrocardiogram (ECG, EKG)—a test that records the heart’s activity by measuring electrical currents through the heart muscle
  • Electrophysiology study (EPS)—a test that measures the condition of the heart’s electrical system by electrodes placed on the heart through blood vessels

In the days leading up to your procedure:

  • Do not take aspirin or other anti-inflammatory drugs for one week before surgery, unless told otherwise by your doctor.

The day before and the day of your procedure:

  • The night before, eat a light meal and do not eat or drink anything after midnight.
  • If you must take medications (which have been approved by your doctor), do so only with small sips of water.

Anesthesia

For the implantation of the ICD, light sedation and local anesthesia are used. For testing the ICD once in place, general anesthesia is used.

Description of the Procedure

An intravenous line is inserted into the arm to administer a sedative to help with relaxation. The area where the ICD is to be implanted is washed with antiseptic and if necessary, shaved. A local anesthesia is injected at the insertion site to numb the area.

The surgeon makes a small incision below the collarbone on the left or right side. The ICD lead, which carries signals between the heart and the ICD, is threaded through a vein in the upper chest to the heart with the assistance of an x-ray monitor. The physician creates a pocket under the skin at the incision site and implants the ICD.

With the ICD in place, sedation is increased. The surgeon will test the ICD function by initiating cardiac arrest and allowing the ICD to shock the heart back into a normal rhythm. Every precaution is taken to ensure this is a safe process. Once it is determined the ICD is working properly and in the right place, the incision is closed with stitches.

After Procedure

The day after your implant, you will have an ECG, blood tests, and chest x-ray to ensure the ICD and leads are in the proper position. The ICD function may be checked again, which will require sedation. Your pulse, blood pressure, and incision site will be checked regularly.

How Long Will It Take?

About 1-3 hours

Will It Hurt?

You may feel some pushing and tugging on the skin during the procedure, but the anesthesia should minimize any pain. After the procedure, you may experience some pain or stiffness at the incision site. Your doctor can prescribe pain medication for this.

Possible Complications

  • Puncture of the heart or lung tissue
  • Damage to the vein
  • Infection
  • Bleeding
  • Bruising

Average Hospital Stay

1-3 days

Postoperative Care

When you return home, do the following to help ensure a smooth recovery:

  • Clean incision area every day with lukewarm water and mild soap like Cetaphil. Do not scrub the incision area.
  • Do not take a shower for five days after the procedure.
  • Do not drive for up to six months. Talk with your doctor to determine how long you should wait to drive.
  • Avoid lifting objects over 10 lb until six weeks after surgery.
  • Avoid vigorous activity, especially those involving the upper body, for 4-6 weeks following surgery.
  • Avoid any activity that involves rough contact to your chest or abdomen, such as contact sports.
  • Return to work and regular daily activities as soon as you are ready; sexual relations may resume as soon as you are able.
  • Make and keep all postoperative appointments.

Outcome

After this procedure, you will gradually be able to return to normal life with a few exceptions.

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

Because strong magnets can interfere with your ICD functioning, you must avoid strong electric or magnetic fields. Examples include:

  • Large magnets (like those used in junk yards)
  • Arc or resistance welders
  • Magnetic resonance imaging (MRI)
  • Airport security wands (show your ICD card and request a hand search)
  • Ham or CB radio antennae
  • Heavy-duty electrical equipment
  • Powerful stereo speakers

Keep cellular phones at least six inches from your ICD. Do not carry phone in the “on” position in a pocket over or within six inches of the ISD, and hold the phone to the ear on the opposite side of the ICD.

If your heart requires a shock from your ICD, you may be able to feel it. You may feel dizzy or lightheaded prior to the shock—this is from the tachycardia or fibrillation. The shock administered 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 and sit or lie down. If someone is with you, ask them to stay. If you feel okay after the shock, contact your doctor’s office to let them know you felt a shock. This is not an emergency, but your doctor may want you to come in for a check-up.

These following symptoms are medical emergencies. Call 911 if:

  • You feel lightheaded or dizzy and do not feel a shock
  • You are still feeling symptoms after a shock
  • You feel three or more shocks in a row

Call Your Doctor If Any of the Following Occurs

  • Signs of infection, including fever and chills
  • Redness, swelling, increasing pain, excessive bleeding, or discharge from the incision site
  • Coughing, chest pain, shortness of breath, or severe nausea or vomiting