What is it?
An implantable cardioverter defibrillator, also called an ICD, is an electronic device that is implanted in the body and connected to your heart. It helps monitor and maintain a steady heartbeat in people who have dangerously fast or irregular heartbeat patterns, called arrhythmias. When an irregular heartrate is detected or when all heart activity stops (cardiac arrest), the ICD device delivers an electric shock designed to restore your heart to a regular rhythm. The device also records your heart’s function on an ongoing basis and can provide that information to your doctor to assist with the development of ongoing treatment.
Why you might need it:
You may need an ICD if you have survived a cardiac arrest due to sustained ventricular tachycardia or ventricular fibrillation or if you have genetic heart conditions. If you are at high risk of a cardiac arrest due to heart failure, an ICD may be recommended as it lowers the risk more than medication alone.
Risks:
The risks associated with an implantable cardioverter defibrillator can range from minor to potentially life threatening. Bleeding or bruising at the insertion site, damage to blood vessels or infection can occur. With an ICD, you are at risk of heart muscles tearing (called cardiac perforation – a rare complication), a collapsed lung or bleeding around or in the heart where the ICD is placed are more uncommon risks.
How to prepare:
Prior to having an implantable cardioverter defibrillator placed, you will likely have a series of tests which may include echocardiogram or electrocardiogram or an electrophysiology study. You may also be asked to wear a Holter or event monitor for a period of time.
Your healthcare provider will ask you to fast for a period of time prior to the procedure. They may also instruct you on which medications to take or discontinue – you should always follow the guidance of your healthcare team before taking or discontinuing any OTC or prescription medications prior to any procedure. Be sure to tell your doctor if you’re pregnant, actively trying to get pregnant or breastfeeding.
Plan to wear comfortable clothing and leave any valuables such as jewelry at home. Be sure to have someone you trust accompany you to and from your appointment. Due to the sedation involved, you will not be able to drive and will need someone to escort you home after the procedure.
What to expect/results:
Upon your arrival you will be asked to change into a hospital gown and given an IV. Your healthcare team may administer a sedative through the IV to help you relax for the procedure. Your healthcare team will place several electrodes or sensors to areas of your body to monitor you during the procedure. You may receive anesthesia for the placement, although this procedure is often done while you are awake and sedated. You will be given a local anesthetic to help numb the area, then the doctor will make a small incision on your chest where the ICD will be placed. They will lead a small plastic tube into a blood vessel, then wires (the number of wires can vary based on your specific condition) will be led through the tube to the heart. One end of each wire will be attached to the heart, and the ICD device will be placed under the skin hear your collarbone.
Once the device is in place, the doctor will test it out to ensure it is working properly. They will use a special camera called a fluoroscopy to ensure the device is positioned properly when placing it. The doctor will then remove the tubing and close the incision. From start to finish, placing an ICD can take a few hours. You will be taken to recovery where you will be closely monitored. Chest x-rays may be taken to ensure your lungs are stable and functioning properly. Once you are fully awake, you will be discharged with specific instructions although sometimes you may need to remain in the hospital for observation for a day or so, depending on your condition.
You may need to wear a sling for a period of time afterwards to ensure the ICD device does not move around. Always follow the post-procedure instructions of your healthcare provider, including any mediations to take and not to take, as well as physical activity or exercise and when it’s safe to resume driving. Contact sports are generally not recommended after an ICD placement, as a hit to the device could result in movement of the device.
Your healthcare team will instruct you on what to do when your ICD delivers a shock. It can be unsettling the first time this happens, so always follow their guidance and remember to breath deeply to help calm any anxiety that may occur. Always report any concerning symptoms to your doctor and if you feel there is a life-threatening emergency, you should not hesitate to call 9-1-1.
It's important to note that the electrical signals can interfere with your ICD device, such as cell phones, metal detectors, medical equipment, security systems, generators, chargers and/or magnets. You should always carry an ID card that states you have the device for use in situations such as building or airport security. Your doctor or healthcare team should instruct you on things to be aware of when you have an ICD device.
Ongoing monitoring – Usually about every 3 months we will be required to check the health of your heart and ensure the device is working properly.