Patient education: Implantable cardioverter-defibrillator insertion (The Basics)

What is implantable cardioverter-defibrillator insertion? — This is surgery to put an implantable cardioverter-defibrillator, or "ICD," in the body.

An ICD is a device that goes under the skin near the heart (figure 1). It can sense and treat certain abnormal heartbeats.

Most ICDs also have a built-in pacemaker. A pacemaker sends electrical signals to the heart. These signals cause the heart to beat at a normal rate. Pacemakers are used to treat a heart rate that is too slow.

An ICD has 2 parts:

●Battery (picture 1) – This sits under the skin. Depending on the type of ICD, it goes either in the upper chest or on the side, near the armpit. When the ICD senses an abnormal heartbeat, the battery creates an electrical shock or shocks that travel through wires to the heart.

●Wires, also called "leads" or "electrodes" – The ICD can have 1, 2, or 3 leads.

There are different types of ICDs. In most ICDs, the wires go from the battery through a vein (blood vessel) and into the heart. There is also a "subcutaneous ICD," or "S-ICD," that has wires that go under the skin. These wires sit near the heart but not actually inside the heart.

To insert an ICD, the doctor makes a cut, or "incision," in the skin of the upper chest to place the battery. They put the leads in the correct place and connect them to the battery.

How do I prepare for ICD insertion? — The doctor or nurse will tell you if you need to do anything special to prepare. Before your procedure, your doctor will do an exam. They might send you to get tests, such as:

●Electrocardiogram, or "ECG" – This test measures the electrical activity of the heart.

●Echocardiogram (also called an "echo") – This test uses sound waves to create a picture of the heart as it beats.

●Lab tests

Your doctor will also ask you about your "health history." This involves asking you questions about any health problems you have or had in the past, past surgeries, and any medicines you take. Tell them about:

●Any medicines you are taking – This includes any prescription or "over-the-counter" medicines you use, plus any herbal supplements you take. It helps to write down and bring a list of any medicines you take, or bring a bag with all of your medicines with you.

●Any allergies you have

●Any bleeding problems you have – Certain medicines, including some herbs and supplements, can increase the risk of bleeding. Some health conditions also increase this risk.

You will also get information about:

●Eating and drinking before your procedure – In some cases, you might need to "fast" before surgery. This means not eating or drinking anything for a period of time. In other cases, you might be allowed to have liquids until a short time before the procedure. Whether you need to fast, and for how long, depends on the procedure you are having.

●Lowering the risk of infection – In some cases, you might need to trim (not shave) your body hair before your procedure. You might also need to wash the area with a special soap.

●What help you will need when you go home – For example, you might need to have someone else bring you home or stay with you for some time while you recover.

Ask the doctor or nurse if you have questions or if there is anything you do not understand.

What happens during ICD insertion? — When it is time for the procedure:

●You will get an "IV," which is a thin tube that goes into a vein. This can be used to give you fluids and medicines.

●You will get anesthesia medicines. This is to make sure that you do not feel pain during the procedure. Types of anesthesia include:

•Local – This type of anesthesia uses medicine to numb a small part of your body so you don't feel pain. You might also get medicines to make you relax and feel sleepy, called "sedatives."

•General – This type of anesthesia makes you unconscious so you can't feel, see, or hear anything during the procedure. If you have general anesthesia, you might get a breathing tube to help you breathe.

●The doctors and nurses will monitor your breathing, blood pressure, and heart rate during the procedure.

●The doctor will make an incision in your skin and create a pocket for the ICD battery. For most ICDs, the doctor will place the leads into a blood vessel and move them to the correct locations in your heart. For an S-ICD, the doctor places the lead along your breastbone.

●The doctor will close your incisions and cover them with clean bandages.

●This procedure usually takes 30 to 90 minutes.

What happens after ICD insertion? — After your procedure, you will be taken to a recovery room. The staff will watch you closely as your anesthesia wears off. You might need to stay in the hospital overnight after your procedure.

As you recover:

●You might feel groggy or confused for a short time. You might also feel nauseous or vomit. The doctor or nurse can give you medicine to help with this.

●If you had a breathing tube, you might have a sore throat. This usually gets better quickly.

●You will get medicine if needed to help with pain. You might need other medicines, too.

What are the risks of ICD insertion? — Your doctor will talk to you about all of the possible risks, and answer your questions. Possible risks include:

●Collapsed lung

●Hole in the heart

●Bleeding

●Infection

●Problem with the ICD or lead wires

What else should I know? — Before you go home from the hospital, make sure that you know what problems to look out for and when you should call the doctor. Make sure that you understand your doctor or nurse's instructions. Ask questions about anything you do not understand.

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