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Implantable Cardiac Defibrillator (ICD) Implantation

An implantable cardiac defibrillator (ICD) is a small battery-powered device that is placed under the skin of your chest to monitor and treat potentially lethal arrhythmias. An ICD detects abnormal heart rhythms from the lower chambers of the heart and delivers an electric shock or pulse to restore a normal heartbeat.

Why Implantable Cardiac Defibrillator Implantation is Performed

An ICD is designed to prevent an at-risk person from dying suddenly from a dangerous heart rhythm. It constantly monitors the heart for abnormal beats. When it senses a dangerous heart rhythm, an ICD gives the heart an electrical shock. It does this to get the heart to beat normally.

Implantable cardiac defibrillators may be recommended for patients who have: 

• Had a ventricular arrhythmia
• Survived a sudden cardiac arrest
• A history of coronary artery disease and heart attack that has weakened the heart
• An enlarged heart muscle
• A genetic heart condition that increases the risk of dangerously fast heart rhythms
• Other rare conditions that may affect the heartbeat

About ICDs

An implantable cardioverter-defibrillator is a small device that’s placed in your chest or abdomen. You will most commonly hear it referred to as an ICD or defibrillator. The ICD is attached to the heart by thin wires and uses electrical pulses or shocks to help control irregular heartbeats. 

Also known as ventricular arrhythmias, these irregular heartbeats can be potentially life-threatening. This is especially true of arrhythmias that could cause the heart to suddenly stop beating, leading to sudden cardiac arrest.

An ICD is made up of several parts:

• Pulse Generator: Contains a battery and electrical circuits that read the electrical activity of your heart. The pulse generator of an ICD is about the size of a stopwatch.
• Electrodes: Wires, also called leads, that go through your veins to the heart. The leads connect the device to the heart. An ICD may have 1, 2, or 3 electrodes.
• Pacemaker: All traditional ICDs (see below) have a pacemaker built into the device, however, they are not always programmed to pace the heart. They can do so in patients that also require it.

Types of ICDs

• Traditional ICD: Implanted in the chest with wires (called leads) that travel through a vein into the heart where they are attached.
• Subcutaneous ICD (S-ICD): Implanted under the skin at the side of the chest below the armpit. It’s attached to an electrode that runs along the breastbone (outside of the veins). An S-ICD is larger than a traditional ICD but doesn’t attach to your heart. This type of ICD does not have a pacemaker function and therefore is not indicated for patients that require intermittent pacing.

What to Expect During ICD Implantation

Cardiac defibrillator implantation typically takes 1-2 hours, followed by a few hours of recovery at the ambulatory surgical center. You’ll need to have someone drive you home from the ASC after the procedure.

Before the Procedure

After checking in to the Cardiovascular ASC, you will be taken to a patient room where a specialist will insert an IV to administer a sedative. The amount of sedation needed for the procedure depends on your specific health conditions. You may be being fully awake or lightly sedated (conscious sedation). Your electrophysiologist most often will insert your ICD when you are awake but comfortable.

During the Procedure

The area of your chest wall below your collarbone will be numbed with local anesthesia, so you will not feel pain. The electrophysiologist will make an incision through your skin and create space under your skin and muscle for the ICD pulse generator. In most cases, this space is made near your left shoulder. However, it can also be done on the right shoulder area if needed.

Your electrophysiologist will place the electrode into a vein, then into your heart. This is done using a special x-ray to see inside your chest. Then the electrophysiologist will connect the electrodes to the pulse generator.

After the Procedure

You will be taken to a recovery room for observation for several hours. Your vital signs will be monitored during this time. You’ll need to have someone drive you home from the ASC after the procedure.

You may need to wear a sling for a day or so following the procedure. Follow the aftercare and recovery instructions provided by your doctor. If at any point after ICD implantation your legs or ankles swell, or if you faint or get dizzy, contact your doctor as soon as possible.

Learn More from ASC, LLC

At Cardiovascular ASC, LLC our board-certified cardiologists and electrophysiologists utilize advanced technologies to deliver the highest quality care in a cost-effective setting. Call Cardiovascular ASC, LLC at 727-449-9891 to learn more about our facility and the services we provide.