Implantable cardioverter-defibrillator

  • Definition
    • An implantable cardioverter-defibrillator (ICD) is a device that detects any life-threatening, rapid heartbeat. This abnormal heartbeat is called an arrhythmia. If it occurs, the ICD quickly sends an electrical shock to the heart to change the rhythm back to normal. This is called defibrillation.

  • Alternative Names
    • ICD; Defibrillation

  • Description
    • An ICD is made of these parts:

      • The pulse generator is about the size of a large pocket watch. It contains a battery and electrical circuits that read the electrical activity of your heart.
      • The electrodes are wires, also called leads, that go through your veins to your heart. They connect your heart to the rest of the device. Your ICD may have 1, 2, or 3 electrodes.
      • All ICDs have a built-in pacemaker. Your heart may need pacing if it is beating too slowly or too fast, or if you have had a shock from the ICD.
      Implantable cardioverter-defibrillator

      A cardiologist or surgeon most often will insert your ICD when you are awake. The area of your chest wall below your collarbone will be numbed with anesthesia, so you will not feel pain. The surgeon will make an incision (cut) through your skin and create space under your skin and muscle for the ICD generator. In most cases, this space is made near your left shoulder.

      Using a special x-ray to see inside your chest, the surgeon will place the electrode into a vein, then into your heart. Then the surgeon will connect the electrodes to the pulse generator and pacemaker.

      The procedure most often takes 2 to 3 hours.

  • Why the Procedure Is Performed
    • An implantable cardiac defibrillator is placed in people who are at high risk of sudden cardiac death. Reasons you may be at high risk are:

      • You have had life-threatening periods of abnormal heart rhythms, such as ventricular tachycardia (VT) or ventricular fibrillation (VF).
      • Your heart is weakened, too large, and does not pump blood very well. This may be from earlier heart attacks, heart failure, or cardiomyopathy (diseased heart muscle).
      • You have a type of congenital (present at birth) heart problem or genetic health condition.
  • Risks
    • Risks for any surgery are:

      Possible risks for this surgery are:

      • Wound infection
      • Injury to your heart or lungs
      • Dangerous heart arrhythmias

      An ICD sometimes delivers shocks to your heart when you do not need them. Even though a shock lasts a very short time, you can feel it in most cases.

      This and other ICD problems can sometimes be prevented by changing how your ICD is programmed. It can also be set to sound an alert if there is a problem. The doctor who manages your ICD care can program your device.

  • Before the Procedure
    • Always tell your health care provider what drugs you are taking, even drugs or herbs you bought without a prescription.

      The day before your surgery:

      • Let your provider know about any cold, flu, fever, herpes breakout, or other illness you might have.
      • Shower and shampoo well. You may be asked to wash your whole body below your neck with a special soap.
      • You may also be asked to take an antibiotic, to guard against infection.

      On the day of the surgery:

      • You will usually be asked not to drink or eat anything after midnight the night before your surgery. This includes chewing gum and breath mints. Rinse your mouth with water if it feels dry, but be careful not to swallow.
      • Take the drugs you have been told to take with just a small sip of water.

      You will be told when to arrive at the hospital.

  • After the Procedure
    • Most people who have an ICD implanted are able to go home from the hospital in 1 day. Most quickly return to their normal activity level. Full recovery takes about 4 to 6 weeks.

      Ask your provider how much you can use the arm on the side of your body where the ICD was placed. You may be advised not to lift anything heavier than 10 to 15 pounds and to avoid pushing, pulling, or twisting your arm for 2 to 3 weeks. You may also be told not to raise your arm above your shoulder for 6 weeks.

      When you leave the hospital, you will be given a card to keep in your wallet. This card lists the details of your ICD and has contact information for emergencies. You should always carry this wallet card with you.

      You will need regular checkups so your ICD can be monitored. The provider will check to see if the device is properly sensing your heartbeat, how many shocks have been delivered, and how much power is left in the batteries.

  • Outlook (Prognosis)
    • Your ICD will constantly monitor your heartbeats to make sure they are steady. It will deliver a shock to the heart when it senses a life-threatening rhythm. This device can also work as a pacemaker.

  • References
    • Epstein AE, DiMarco JP, Ellenbogen KA, Estes NA 3rd, Freedman RA, Gettes LS, et al. 2012 ACCF/AHA/HRS focused update incorporated into the ACCF/AHA/HRS 2008 guidelines for device-based therapy of cardiac rhythm abnormalities: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society. Circulation. 2013 Jan 22;127(3):e283-352.

      Swerdlow CD, Zipes DP. Pacemakers and implantable cardioverter-defibrillatiors. In: Mann DL, Zipes DP, Libby P, Bonow RO, Braunwald E, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 10th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 36.