ICD Implantation at EHMC's Arrhythmia Center
What is an ICD?EHMC's Arrhythmia Center offers implantable cardioverter defibrillators (ICDs) for patients with life-threatening ventricular tachycardia or fibrillation. These devices, which are generally 99 percent effective in halting arrhythmias, consist of two main parts:
- A pulse generator, about the size of a pager, which contains a small computer and a battery. This unit is usually implanted under the skin in the upper chest. The memory in the generator stores vital information such as the status of the battery, when and how many therapies were delivered to your heart, and whether these therapies corrected the arrhythmia. This information is retrieved and analyzed regularly to determine if your ICD is working or if it needs to be reprogrammed.
- One or more leads, flexible insulated wires extending from the pulse generator into your heart, into the ventricle containing the site of the arrhythmia.
How does an ICD work?
An ICD may function like a pacemaker and treat slow rhythms; however, its main purpose is to treat potentially lethal fast heart rhythms. If your heart goes into a lethal rhythm (ventricular tachycardia or fibrillation), the leads from the ICD sense this and send signals from the heart to the pulse generator. Upon receiving these signals, the generator delivers one of two types of therapies to restore the heartís rhythm to normal.
Your ICD may deliver small pacing impulses to slow a fast heart rate; many patients do not feel these or report that they are painless. When your ICD delivers a cardioversion shock (used when pacing does not stop a rapid heart rate), you may feel a thump in your chest and mild or moderate discomfort. Defibrillating shocks may feel stronger, more like a kick in the chest. These sensations pass quickly. Be sure to call us at 201-894-3533 if your ICD delivers a shock. If your device delivers multiple shocks, call 911 or your local emergency number for assistance.
How is an ICD implanted?
ICDs are implanted in the Cardiac Electrophysiology Laboratory on the 1st Floor of EHMC, using local anesthesia and sedation. This approach obviates the need for surgical procedures in the operating room that require general anesthesia. (Open-chest surgery may be used to implant ICDs in patients who are having another type of heart surgery, such as bypass surgery.) The Arrhythmia Center assumes full responsibility for preparation, implantation, discharge planning, and long-term follow-up of all implanted devices.
Before Your Procedure
ICD implantation, including preparation and recovery time, may take several hours. Be sure to plan accordingly and to bring a care partner with you to the hospital.
- You will undergo Pre-Admission Testing several days to a week before the procedure. This testing will include blood tests, and a medical history assessment. You will also be asked to sign a form giving EHMC consent to perform the procedure.
- Do not eat or drink anything after midnight the night before your procedure. You may be permitted to take your regular medications with a sip of water; check with your doctor.
- On the day of your procedure, report to the Admitting Department on the first floor of EHMC at the scheduled time.
- The Admitting Clerk will direct you to the Cardiac Electrophysiology Laboratory on the 1st Floor of EHMC when the team is ready to perform your procedure.
During the Procedure
- When you arrive at the Cardiac Electrophysiology Laboratory, you will be assisted to a special x-ray table and attached to a heart monitor and blood pressure cuff.
- You will receive a sedative intravenously so you will feel drowsy and relaxed during the procedure. A local anesthetic will be injected into the area where the generator will be implanted.
- Your doctor will make a small incision, most often in the upper chest (but sometimes in the abdomen) and create a pocket under your skin in which to insert the generator of the ICD.
- He will then insert the ICD leads into a vein through this incision. Guided by an x-ray camera, your doctor will pass the leads through the vein and position them into the appropriate area of your heart.
- After testing the leads to ensure that they can sense the heart's signals clearly, your doctor will attach them to the pulse generator.
- The pulse generator is programmed to treat your particular arrhythmia, and is then inserted into the pocket of skin in your chest. After ensuring that the device works correctly, your doctor will close the incision and cover it with a sterile dressing.
- When the procedure is over, you will be brought to a room in EHMC on a stretcher.
After the Procedure
- Once in your Room of the, the staff will monitor you closely, taking your blood pressure, pulse, and temperature frequently and checking your incision for bleeding or swelling. Your care partner should stay with you in the room.
- You will be able to eat once you awaken fully from the sedation.
- Keep the arm on the side of the incision close to your body. Avoid excessive movement, pulling, or straining.
- Do not try to get out of bed alone; a staff member will help you get out of bed for the first time after your procedure.
- If you feel palpitations, chest pain, or any unusual sensations, tell your nurse immediately.
- You will stay at least one night in the hospital so we can monitor you after your ICD implantation.
- Your doctors will meet with you before your discharge and discuss the results of your ICD implantation. We will meet with you after the procedure to provide you with specific discharge instructions.
- To care for your incision, keep the protective Steri-Strips dry and open to air, allowing them to fall off on their own over the next couple of weeks. You may shower, but do not bathe or swim. Lightly pat the strips dry after showering.
- The incision will usually heal over the next two weeks. The sutures will dissolve on their own and do not need to be removed.
- If your incision bleeds or develops signs of infection (swelling, increased pain, redness, drainage, increased temperature, or opening), call us at 201-894-3533, 24 hours a day to speak with a physician.
- You can usually resume your normal activities the following day, or as directed by your doctor. Avoid lifting or straining, heavy housework, sports, or exercise for the next two weeks. Between two and six weeks, avoid any exercise or repetitive movements that place significant strain on the affected side (such as swimming, golf, or tennis).
- Be sure to schedule a follow-up appointment with us for two weeks after the procedure. We can be reached at 201-894-3533.
- If your ICD delivers a shock, call us as soon as possible at 201-894-3533.
- If your device delivers multiple shocks, call 911 or your local emergency number for assistance.
- You will need to see us every 3 months at the Arrhythmia Center's offices so the data stored in your ICD can be retrieved and analyzed, the ICD function can be checked, and your ICD reprogrammed, if necessary. For more information, visit the section on Follow-up Programs on this site.