Your doctor may have told you that you need an implantable cardioverter defibrillator (ICD). This is a device that is placed in your body to help control your heart rhythm (the speed and pattern of your heartbeat). You may be given an ICD if you have had a cardiac arrest or if you have a fast heart rhythm problem that could lead to cardiac arrest. The ICD is not a cure for your heart rhythm problem, but it can save your life by quickly bringing a dangerously fast heart rhythm under control. You will need an ICD for the rest of your life, so having one implanted means a lifelong commitment.

 

An ICD is a small, lightweight electronic device that is placed inside your body. It keeps track of your heart rhythm. When you have an arrhythmia, the ICD helps your heart return to its normal rhythm.

 

An ICD can do one or more of the following:

• Antitachycardia pacing: The ICD can send out a series of pulses to override a fast rhythm. This may feel like fluttering in your chest, or may not be felt at all.
• Cardioversion: If antitachycardia pacing doesn't slow a fast rhythm, the ICD can give the heart one or more small shocks. These break up the fast rhythm. They may feel like thumps in your chest.
• Defibrillation: If the ICD senses a very fast, irregular rhythm, it quickly sends a strong shock to the heart to override the fast rhythm. This may feel as strong as a kick to your chest.
• Bradycardia pacing: An ICD's main job is to slow a fast heart rhythm. But at rare times, your heart might beat too slowly. This may happen if you have a second heart rhythm problem that causes a slow heartbeat. Your heart may also beat too slowly after an ICD shock. Most ICDs can send out pulses to get a slow heartbeat back to the right speed.

 

Putting the ICD in your body is called implantation. This does not require open heart surgery. Rather, it's a minor surgical procedure. The ICD can be placed on the right or left side of your body. If you prefer a certain side, discuss this with your doctor. You will be told what to do before the procedure.

 

Understanding Risks and Complications:

Implanting an ICD is a simple procedure with little risk. But, as with any surgery, complications can occur. You will be asked to sign a consent form. This states that you understand the risks of implantation and gives your permission to have it done. The possible risks of implanting an ICD include the following:

·        Bleeding, swelling, or severe bruising

·        Tearing of the vein or artery wall

·        Clotting or air bubbles in the vein

·        Puncture of the heart muscle or lung

·        Infection at the incision site

·        Nerve damage at the incision site

·        Death (very rare)

 

Before Implantation:

·        Don't eat or drink anything after midnight the night before the procedure, unless told otherwise.

·        The skin where the ICD is implanted will be washed and, if needed, shaved.

·        Before the procedure begins, you will be given medication so you won't feel pain. This medication will make you sleep through part or all of the procedure.

 

During the Procedure:

The ICD generator is implanted under the skin or muscle in either your chest or abdomen. The implantation may take 2 to 3 hours longer.

·              An incision if made in your chest just below our collarbone. For an abdominal implant, a second incision is also made below your rib cage.

·              A pocket (space) is made under your skin or muscle for the generator to sit in. For a chest implant, the pocket is made near the chest incision. For an abdominal implant, the pocket is made near the incision below the rib cage.

·              The lead is threaded through the chest incision and into your vein. X-ray monitors help guide the lead through the vein into your heart. For an abdominal implant, the other end of the lead is threaded under the skin from the chest to the abdomen.

·              The generator is set to treat your heart rhythm problem. Then, the generator is attached to the lead.

·              The generator is placed in the pocket under your skin or muscle. The incision is closed and covered with a sterile dressing.

A patch electrode is sometimes also used to help the ICD do its job. If one is needed, your doctor will make another incision to place the patch under the skin or muscle near your heart. A lead connects the patch to the generator.

 

Open Chest Implantation

In rare cases, the ICD may be implanted through open chest surgery. This may be done along with open chest surgery for another heart problem, or if problems keep the leads from being placed in the veins. The chest is opened and the leads are attached to the outside of the heart. The generator is placed in a pocket of the abdomen.

 

After the Procedure

After your ICD is implanted, you will probably stay in the hospital for a day or two. Before you go home, you will be told how to take care of your incision site or sites as they heal. You may have some tests. You'll also have some follow-up visits scheduled.

 

In the Hospital

During your stay in the hospital, your heart's signals are monitored to be sure the ICD is working right. A nurse may take your pulse and blood pressure and check your incision for bleeding or swelling. Before you go home, an x-ray of your chest may be taken. The ICD settings may also be rechecked. This is done from outside your body. For a week or so, it's normal to have some pain and stiffness around your incision. Pain medication can help make you more comfortable. Don't raise the arm on the side of the incision above your shoulder. This will give the lead a chance to secure inside the vein and your heart.

 

Healing at Home

At home, you can go back to most of your daily activities. But take it easy for a month or so to avoid pulling the lead or leads out of place. For a few weeks, you may feel numbness or fullness in the area around the ICD. This is normal.

·              Visit the doctor, usually in a week or so. During this visit, the doctor may remove your suture or staples, if you have them.

·              Avoid raising the arm on the side of the ICD over your head. Your doctor will tell you for how long – usually 2 to 6 weeks.

·              Ask your doctor when you can return to activities like heavy lifting, running, or contact sports.

 

After You Heal

Your incision should heal completely within about a month after the implantation. You may feel and see a small bump under your skin where the ICD is. This won't be noticeable under your clothes. Even after you heal, avoid playing with the ICD under your skin. If you take medications for your heart problem, keep taking them as directed. Talk to your doctor about driving. In some cases, driving may be restricted. This would be due to your heart rhythm problem, not the ICD.

 

When to Call Your Doctor

Call your doctor if you notice any of the following:

• Signs of an infection (a fever over 100 degrees; redness, swelling or warmth at the incision site; drainage from the incision)
• Twitching chest muscles
• Increasing pain around your ICD
• Bleeding from your incision
• Swollen arm on the side of the incision site