An implantable cardioverter defibrillator (ICD) is a small, battery-operated device that monitors the heart’s rhythm and provides appropriate treatment. Most ICDs have both pacemaker and defibrillator functions. If the heart beats too slowly, the ICD can help the heart beat at a normal pace. If the heart begins to beat in a disorganized way, the device provides a shock to restore a normal rhythm. ICD implantation is the surgical insertion of an ICD.
Certain heart rhythms are extremely dangerous and can lead to sudden cardiac death or cardiac arrest. Some irregular rhythms that may require an ICD implant include:
ICDs are implanted in patients who:
If you are planning to have a defibrillator implanted, your doctor will review a list of possible complications, which may include:
Some factors that may increase the risk of complications include:
The following test may be conducted prior to your procedure:
Leading up to your procedure:
For the implantation of the ICD, light sedation and a local anesthesia will usually be used.
After the ICD is in place, it will need to be tested. General anesthesia will be used for this step.
The area where the ICD is to be implanted will be washed with antiseptic. A small incision will be made below the collarbone on the left or right side.
A wire, called a lead, will be threaded through a vein in the upper chest to the heart. An x-ray monitor will be used to watch the lead move through the vein to the heart. The signals between the heart and the ICD will be carried on this lead.
A pocket will be created under the skin at the incision site. The ICD will be implanted into the pocket.
When the ICD is in place, the sedation will be increased. The ICD will be tested to make sure that it shocks the heart appropriately. Every precaution will be taken to ensure that this is a safe process. When it is determined the ICD is working properly and in the right place, the incision will be closed with stitches.
You will be taken to a recovery room after the procedure. Your pulse, blood pressure, and incision site will be checked regularly. Chest x-rays will ensure the ICD and leads are in the proper place.
You may feel some pushing and tugging on the skin during the procedure. The anesthesia should minimize any pain. After the procedure, you may experience some pain or stiffness at the incision site. Pain medication may be prescribed.
The day after your implant, you will have an ECG and blood tests. The ICD function may be checked again. This will require sedation.
Do the following to help ensure a smooth recovery:
You will get an ID card that contains important information about your ICD. It is important that you show this card to any doctor, nurse, dentist, or other healthcare professional at the beginning of an office visit or hospital admission.
If your heart requires a shock from your ICD, you may be able to feel it. You may feel lightheaded before the shock. This is from the heart rhythm. The shock administered by the ICD may feel like a light thump or a strong kick in the chest. If you feel a shock, try to stay calm and sit or lie down. If someone is with you, ask him or her to stay. If you feel okay after the shock, contact your doctor’s office to let them know. This is not an emergency. Your doctor may want you to come in for a check-up, particularly if this is the first shock you have received. If you receive multiple shocks in a row or multiple shocks in a day, you should go to the emergency room.
Contact your doctor if your recovery is not progressing as expected or you develop complications such as:
These symptoms are medical emergencies. Call for medical help right away if you:
In case of an emergency, call for emergency medical services right away.
American Heart Association
Heart Rhythm Society
Heart and Stroke Foundation of Canada
American College of Cardiology Foundation and the American Heart Association. ACC/AHA guideline update for implantation of cardiac pacemakers and antiarrhythmic devices. American Heart Association website. Available at: http://circ.ahajournals.org/content/106/16/2145.full.pdf+html. Accessed June 9, 2016.
DiMarco JP. Implantable Cardioverter-Defibrillator. New England Journal of Medicine. 2003;349:1836-1847.
Implantable cardioverter defibrillator. Heart Rhythm Society website. Available at: http://www.hrsonline.org/Patient-Resources/Treatment/Implantable-Cardioverter-Defibrillator. Accessed June 9, 2016.
Implantable cardioverter defibrillator (ICD). Stanford University School of Medicine Medical Center website. Available at: http://stanfordhospital.org/cardiovascularhealth/arrhythmia/treatments/icd. Accessed June 9, 2016.
Pacemakers and defibrillators: Frequently asked questions. University of Iowa Virtual Hospital website. Available at: http://www.uihealthcare.org/2column.aspx?id=16240. Accessed June 9, 2016.
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Winters SL, et al. Consensus statement on indications, guidelines for use, and recommendations for follow-up of implantable cardioverter defibrillators. Journal of Pacing and Clinical Electrophysiology. 2001;24:262-269.
11/19/2008 DynaMed Plus Systematic Literature Surveillance http://www.dynamed.com: Lee S, Ransford B, Fu K, Tadyoshi K, Maisel W. Abstract 662: electromagnetic interference (EMI) of implanted cardiac devices by MP3 player headphones. Circulation. 2008;118:S596.
Last reviewed June 2016 by Michael J. Fucci, DO, FACC
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.