ICD IMPLANTATION
How is a ICD implanted?
HOW IS A TRADITIONAL IMPLANTABLE DEFIBRILLATOR (ICD) SYSTEM IMPLANTED? A small incision, approximately two to four inches long, will be made in your upper chest area, just below your collarbone. One or two leads will be guided through a vein into your heart, and the leads will be connected to the defibrillator.
How long does it take to put in a pacemaker and defibrillator?
Inserting a pacemaker or defibrillator takes about 3 hours. If the doctor only has to change the generator battery, the procedure may only take 1 to 2 hours.
An arrhythmia is any disorder of your heart rate or rhythm. It means that your heart beats too quickly, too slowly, or with an irregular pattern. Most arrhythmias result from problems in the electrical system of the heart. If your arrhythmia is serious, you may need a cardiac pacemaker or an implantable cardioverter defibrillator (ICD). They are devices that are implanted in your chest or abdomen.
A pacemaker helps control abnormal heart rhythms. It uses electrical pulses to prompt the heart to beat at a normal rate. It can speed up a slow heart rhythm, control a fast heart rhythm, and coordinate the chambers of the heart.
An ICD monitors heart rhythms. If it senses dangerous rhythms, it delivers shocks. This treatment is called defibrillation. An ICD can help control life-threatening arrhythmias, especially those that can cause sudden cardiac arrest (SCA). Most new ICDs can act as both a pacemaker and a defibrillator. Many ICDs also record the heart’s electrical patterns when there is an abnormal heartbeat. This can help the doctor plan future treatment.
Getting a pacemaker or ICD requires minor surgery. You usually need to stay in the hospital for a day or two, so your doctor can make sure that the device is working well. You will probably be back to your normal activities within a few days.
Why it's done
You’ve likely seen TV shows in which hospital workers “shock” an unconscious person out of cardiac arrest with electrified paddles. An ICD does the same thing only internally and automatically when it detects an abnormal heart rhythm.
An ICD is surgically placed under your skin, usually below your left collarbone. One or more flexible, insulated wires (leads) run from the ICD through your veins to your heart.
Because the ICD constantly monitors for abnormal heart rhythms and instantly tries to correct them, it helps when your heart stops beating (cardiac arrest), even when you are far from the nearest hospital.
How an ICD works
When you have a rapid heartbeat, the wires from your heart to the device transmit signals to the ICD, which sends electrical pulses to regulate your heartbeat. Depending on the problem with your heartbeat, your ICD could be programmed for:
- Low-energy pacing: You may feel nothing or a painless fluttering in your chest when your ICD responds to mild disruptions in your heartbeat.
- A higher-energy shock: For more-serious heart rhythm problems, the ICD may deliver a higher-energy shock. This shock can be painful, possibly making you feel as if you’ve been kicked in the chest. The pain usually lasts only a second, and there shouldn’t be discomfort after the shock ends.
Usually, only one shock is needed to restore a normal heartbeat. Sometimes, however, you might have two or more shocks during a 24-hour period.
Having three or more shocks in a short time period is known as an electrical or arrhythmia storm. If you have an electrical storm, you should seek emergency care to see if your ICD is working properly or if you have a problem that’s making your heart beat abnormally.
Who needs an ICD
You’re a candidate for an ICD if you’ve had sustained ventricular tachycardia, survived a cardiac arrest or fainted from a ventricular arrhythmia. You might also benefit from an ICD if you have
- A history of coronary artery disease and heart attack that has weakened your heart.
- A heart condition that involves abnormal heart muscle, such as enlarged or thickened heart muscle.
- An inherited heart defect that makes your heart beat abnormally. These include long QT syndrome, which can cause ventricular fibrillation and death even in young people with no signs or symptoms of heart problems.
- Other rare conditions that may affect your heart rhythm.
What you can expect
During the procedure
Usually, the procedure to implant an ICD can be performed with numbing medication and a sedative that relaxes you but allows you to remain aware of your surroundings. In some cases, general anesthesia may be used so that you’re unconscious for the procedure.
During surgery, one or more flexible, insulated wires (leads) are inserted into veins near your collarbone and guided, with the help of X-ray images, to your heart. The ends of the leads are secured to your heart, while the other ends are attached to the generator, which is usually implanted under the skin beneath your collarbone. The procedure usually takes a few hours.
After the procedure
You’ll usually be released on the day of your surgery, once the anesthesia has worn off. You’ll need to arrange for a ride home because you won’t be able to drive right away.
Because some defibrillators have leads placed through the veins into the heart, you’ll need to avoid abrupt movements that raise your left arm above shoulder-height for two to three weeks. This is so the leads don’t move until the area has had time to heal. That also means no driving during that time.
If you got a subcutaneous defibrillator, there are no leads placed through the veins, so there aren’t any restrictions on driving or lifting your arm above your shoulder.
