Implantable Cardioverter-Defibrillator Procedure
Overview
An implantable cardioverter-defibrillator (ICD) is a small heart device that helps manage certain types of arrhythmia. Powered by a battery, doctors usually place it under the skin in the chest area.
The ICD’s main job is to watch the heart’s rhythm and deliver electric shocks to restore a normal heartbeat if a dangerous rhythm change occurs. This device especially helps people with serious heart muscle weakness or those at high risk for life-threatening irregular heartbeats.
An ICD differs from a pacemaker. A pacemaker mainly prevents heartbeats that are too slow, while an ICD delivers electric therapy if the heart beats too fast or unevenly. The pulse generator is the main component and works closely with a lead system that connects it to the heart.
Main Categories
There are two main forms of ICD devices:
| Type | Where Placed | Connections | Key Points |
|---|---|---|---|
| Traditional ICD | Chest | Wires (leads) inside veins connected to heart muscle | Monitors and treats rhythms directly within the heart |
| Subcutaneous ICD (S-ICD) | Side of the chest, below the armpit | Electrode runs along breastbone, no wires inside the heart | Larger in size, does not enter blood vessels or touch heart muscle |
The transvenous ICD uses wires to connect to the heart’s interior, while the S-ICD stays outside the heart and blood vessels. Doctors choose each type based on the patient’s specific heart condition and risk factors. Both devices can stop dangerous heart rhythms and support heart health.
Reasons for Getting an ICD
Doctors use implantable cardioverter defibrillators (ICDs) to help prevent dangerous heart rhythm problems. ICDs can detect and treat conditions including:
- Sudden cardiac arrest
- Ventricular fibrillation
- Ventricular tachycardia
- Life-threatening arrhythmias
These devices are important for people who have survived cardiac arrest or have a higher risk of one in the future. Doctors also recommend them for people with:
| Conditions Where ICDs May Be Needed | Example Risk Factors |
|---|---|
| Abnormal heart rhythm (arrhythmias) | History of acute myocardial infarction |
| Heart failure or weak heart muscle | Enlarged or weakened heart muscle |
| Fast or slow heart rate (tachycardia, bradycardia) | Genetic heart disorders |
Doctors often suggest an ICD when medicine is not enough to control the risk of sudden cardiac death. They may recommend an ICD for people with genetic heart problems or after a serious heart event. The goal is to spot and stop dangerous rhythms before they cause harm.
Potential Complications
An implantable cardioverter-defibrillator (ICD) can cause possible issues, such as:
- Infection at the spot where the doctor places the device.
- Swelling, bruising, or bleeding near the implant site.
- Damage to blood vessels from ICD wires.
- Bleeding around the heart.
- Leaking of blood through the heart valve where the lead goes.
- Collapsed lung.
- Movement or shifting of the device or wires, rarely causing a tear in the heart.
Other concerns may involve electrolyte imbalance, drug toxicity, or electrical problems with the device. The table below shows some risks and possible causes:
| Complication | Possible Cause |
|---|---|
| Infection | Surgery site |
| Electrical problems | Device malfunction |
| Drug toxicity | Improper medication |
| Electrolyte imbalance | Changes in body chemistry |
Getting Ready for the Procedure
Preparing for ICD implantation starts with several tests to assess heart health. These include an electrocardiogram (ECG), an echocardiogram, Holter monitoring, and sometimes an event monitor or electrophysiology study. Each test helps the medical team understand how the heart works and if an ICD is needed.
Common Tests Used Before ICD Placement
| Test Name | Purpose | How It’s Done |
|---|---|---|
| Electrocardiogram (ECG) | Measures electrical signals of the heart. | Electrodes on the chest, arms, and legs. |
| Echocardiogram | Shows images of heart structure and movement. | Uses sound waves through a probe on the chest. |
| Holter Monitor | Tracks heart rhythm over 1-2 days. | Wearable device with sensors stuck to the chest. |
| Event Monitor | Records heart activity during symptoms, up to 30 days. | Portable device, button pressed during symptoms. |
| Electrophysiology Study | Pinpoints irregular heart areas. | Catheter inserted through a blood vessel to the heart. |
Before the day of ICD implantation, the care team provides instructions about eating, drinking, and taking medications. Patients should follow these directions carefully. Often, they should not eat or drink for several hours before the surgery. On the day of the procedure, the team gives a sedative and local anesthesia.
The sedative helps the patient stay calm and relaxed, while the anesthesia numbs the incision area. The healthcare team prepares the upper chest, where a small cut will be made, to insert the ICD. They may use imaging tools like fluoroscopy during the operation to guide the placement of the device and leads through a blood vessel.
Patients should bring a list of any medications they take and share information about allergies. They should remove any jewelry or metal objects before the procedure. Comfortable clothing is recommended, and a responsible adult should accompany the patient to help them get home after the procedure.
What You Can Expect
Steps to Take Before the Procedure
Before the procedure starts, most people are told not to eat or drink for a few hours. This prepares the body for surgery and reduces possible risks. Patients should share a full list of their medications with the healthcare team. Some medicines might need to be paused or adjusted before the operation.
A friend or family member should drive the patient home. Planning for help at home during the first part of recovery is also a good idea. Wearing comfortable clothing and leaving jewelry or electronics at home makes things easier on the day of the procedure.
What Happens During Surgery
The medical team first inserts an intravenous (IV) line into the hand or arm for medicines and fluids. Sedatives help the patient relax. Some people receive general anesthesia and sleep through the operation, while others stay relaxed but awake. The choice depends on the procedure and the patient’s health.
Sticky patches called electrodes are placed on the chest, and sometimes the legs. These connect to monitors that watch heart rate and rhythm during the entire process. The surgical area is cleaned and prepared to lower the risk of infection.
The surgeon makes a small cut under the collarbone. One or more thin wires, called leads, are inserted through a blood vessel and guided into the heart. One end of each wire attaches to the heart muscle, while the other connects to the ICD device—also called the shock generator. The surgeon places this generator just under the skin near the collarbone.
Placing the ICD usually takes a few hours. After the leads and generator are in place, the surgeon tests the system. Sometimes the heart is briefly sped up to see if the ICD detects and fixes abnormal rhythms. The ICD can restore a regular beat in two major ways:
- Gentle Pacing Pulses: The ICD may send quick, mild electrical signals to fix fast heart rates. These are usually not felt or may cause a fluttering in the chest.
- Stronger Shock: If the heart rhythm is very dangerous, the device delivers a stronger shock. This can feel like a sudden force to the chest. The feeling is sharp but extremely brief and should not cause pain afterward.
In rare cases, someone may have several shocks within a short time, called an electrical storm. This is a medical emergency. Once the team programs the device for the patient’s needs, the surgery ends. Sometimes, the team gives extra medications to reduce the chance of rhythm problems after surgery.
Key Details During Surgery
| Step | What to Expect |
|---|---|
| IV insertion | Medication and fluids |
| Monitoring electrodes | Tracking heart activity |
| Sedation or anesthesia | Relaxation or sleep during procedure |
| Small incision | Below collarbone |
| Lead placement | Guided into heart by physician |
| Generator placement | Under skin near collarbone |
| Device testing | Ensures it detects and treats arrhythmias |
| Initial programming | Device tuned to individual needs |
What Happens After the Operation
Most patients go home the day following the procedure. Some swelling or soreness is common around where the ICD was placed. Healthcare providers often give pain medication, but usually recommend avoiding drugs like aspirin and ibuprofen for a while, since these can increase bleeding risk.
Patients should limit moving the arm on the side of the ICD for about eight weeks. Raising the left arm above shoulder height, lifting heavy objects, or making sudden movements could dislodge the wires (leads). Following these rules helps the area heal. There are also restrictions on some physical activities for about four weeks after the operation:
- Do not do any energetic sports or exercises that use the left arm above the shoulder—examples include golf, tennis, swimming, and certain household chores like vacuuming.
- Avoid heavy lifting or other strenuous workouts.
- Contact sports such as football or hockey are not recommended. A hit to the area where the device sits could harm the ICD or move the leads.
Recovery Timeline and Care
| Time After Surgery | Restrictions |
|---|---|
| First 24 hours | Rest, bandage care, watch for swelling |
| 1-4 weeks | Avoid heavy lifting, sports, and raising arm above shoulder |
| First 8 weeks | Keep the left arm below shoulder height |
| As advised | Follow up with remote monitoring or office visits |
The healthcare team gives personalized advice about when to return to normal routines. Monitoring—sometimes done remotely—allows the team to keep checking the ICD and heart rhythms after the patient leaves the hospital.
If several strong shocks occur at once, this can signal an “electrical storm” or severe arrhythmia episode. This is not normal and needs emergency care. Sometimes, changing the ICD settings or adding medication can help reduce these warning episodes.
Interference from Electrical Devices and Gadgets
Manufacturers design ICDs to be safe around most household appliances. Electrical signals from other devices rarely cause issues, but certain precautions are important:
- Mobile Phones: Do not keep a working cellphone near the ICD pocket. It is best to keep phones at least 6 inches (about 15 cm) away when turned on. Using headphones or wireless chargers should also follow this distance rule, as magnets can cause unwanted effects on the device’s operation.
- Security Systems: ICDs can trigger security alarms. There can sometimes be a risk if handheld metal detectors are held over the ICD for too long. A manual search can be requested at airports or other security lanes.
- Medical Equipment: Some types of scanners (such as MRI) and treatments that use heat or strong magnetic fields might not be safe. Always inform doctors and dentist offices about the ICD, as some equipment can affect how the device works. The healthcare team can recommend safe alternatives if needed.
- Large Electrical Machines: Stay at least two feet away from strong power generators, high-voltage transformers, or welding machines. If someone works with strong machinery, tests can be done to check if they are safe near the workplace equipment.
- Magnets: Magnets may interfere with ICDs. It is wise to keep magnet-containing items, like some headphones, speakers, or fridge magnets, at least 6 inches (15 cm) away from the device site.
Common home devices such as microwaves, electric blankets, small power tools, televisions, radios, GPS, and computers do not cause problems for an ICD. If in doubt, a patient should ask the healthcare team for advice.
Helpful Tips About Interference
- Show an identification card about the ICD if asked, especially at airports.
- Use the opposite ear when using a cellphone.
- Avoid carrying electronic devices or magnets in the shirt pocket over the ICD.
- If odd symptoms occur (like random fatigue, fast heartbeat, or dizziness), report these to the doctor.
| Device Type | Risk and Recommendations |
|---|---|
| Microwave ovens | Safe |
| Cellphones | Keep 6 in (15 cm) away from device site |
| MRI scanners | Often not recommended unless device is labeled MRI-safe |
| Metal detectors | Avoid direct scanning over ICD for more than 30 seconds |
| Power generators | Keep 2 feet (0.6 m) away |
| Household electronics | Generally no issue |
Vehicle Operation and Driving Rules
Driving after getting an ICD depends on the heart problem being treated and whether the person has a history of fainting or dangerous heart rhythms. A vehicle crash could happen if someone faints from a shock, so many places have special rules.
If doctors place an ICD because of a life-threatening rhythm problem (like ventricular arrhythmia or prior cardiac arrest), they often limit driving after surgery. Healthcare professionals usually advise patients not to drive for several months. If an ICD delivers a shock—especially one with fainting—doctors will likely require the patient to stop driving for a period. In some cases, patients can resume driving after remaining shock-free for several months.
For those who have an ICD due to risk factors but no history of heart rhythm events, patients might be able to drive again after about a week—if no shocks have happened. The healthcare team reviews the patient’s health and sets any special limits. Commercial drivers (such as bus or truck drivers) usually cannot drive professionally with an ICD.
Driving Restriction Table
| Situation | Typical Restriction |
|---|---|
| ICD for serious rhythm problem | No driving for months or until cleared. |
| Shock with symptoms (like fainting) | No driving until shock-free for several months. |
| ICD placed but no arrhythmia, and no shock | Possible driving after 1 week, if cleared. |
| Commercial driving (bus, truck, professional) | Not permitted with an ICD. |
Stay in close touch with the healthcare team to ensure safe recovery, and ask about any symptoms or restrictions. Remote monitoring systems can track the ICD’s function, heart rhythm patterns, and possible warning signs, allowing doctors to adjust care as needed.
Outcomes
ICD Therapy and Terminal Illness Choices
People with an implantable cardioverter-defibrillator (ICD) need follow-up appointments every few months to check both their heart and the device. The device has a lithium battery that typically lasts between 5 and 7 years. Patients and their healthcare team monitor battery life, as the ICD’s generator will need replacement with a short, usually same-day, surgery when the battery gets low.
If the ICD delivers a shock, it can be stressful or frightening, but the device is responding to an abnormal heart rhythm and working as designed. Patients should notify their healthcare provider if this happens. Some people wear a medical ID bracelet to let others know they have an ICD, which can help during emergencies.
Managing Device Activity During Advanced Illness
When a patient becomes very sick or reaches the end of life, the ICD can still deliver shocks unless someone turns it off. If desired, a healthcare professional can quickly deactivate the device. Turning off the ICD does not make the heart stop instantly, but it prevents further shocks, which may lessen discomfort or distress.
Discuss preferences about ICD therapy well in advance. Include family members or anyone chosen to make healthcare decisions in these conversations. Making these choices early helps ensure that the patient’s wishes are respected regarding their care.
