Procedures

Cardiac Device

Implantable Cardiac Defibrillator (ICD)

Under certain circumstances, the beating of the heart can become abnormally fast in a very dangerous way. This usually occurs in people who have major abnormalities of the electrical system of the heart or of the heart muscle. An Implantable Cardioverter Defibrillator (ICD) can detect such fast heartbeats and correct them by applying a series of electrical impulses to the heart or by delivering a shock to the heart.

An ICD is made up of a pulse generator, which lies under the skin just below the collarbone (usually), and 1 to 3 leads that arise from the pulse generator and go into the heart. The leads transmit the electrical impulses or shock from the pulse generator to the heart muscle.

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An image of the back side of a Medtronic heart rhythm monitoring device

Why do I need an ICD?

You may need an ICD if you have had, or are at high-risk of having, ventricular tachycardia (VT) or ventricular fibrillation (VF). These are two life-threatening heart arrhythmias that cause the heart to beat very fast. These conditions can be fatal if you do not get immediate treatment.

An ICD might also be recommended if you have;

  • Survived a cardiac arrest
  • A history of coronary artery disease and a heart attack has weakened the heart.
  • An enlarged heart muscle such as hypertrophic cardiomyopathy
  • A genetic heart condition that increases the risk of dangerously fast heart rhythms, such as some types of long QT syndrome
  • Other rare conditions that may affect the heartbeat

What is involved in ICD implant?

ICD insertion is a common procedure and is performed under general anaesthetic. The procedure takes approximately 1 to 2 hours and is performed in the cardiac catheter laboratory. This is a special room that has a patient table, X-Ray tube, ECG monitors and other equipment. The staff in the lab will all be dressed in hospital theatre clothes during the procedure and will be wearing hats and masks. Many ECG monitoring electrodes will be attached to your chest area. A nurse or doctor will insert an intravenous line usually into the back of your hand – this is needed to give you medications during the procedure without further injections. You will also have a blood pressure cuff attached to your arm that will automatically inflate at various times throughout the procedure. There will also be considerable attention to cleaning the skin under the collarbone where the ICD will be inserted. You will also receive antibiotics prior to the procedure. You should ensure that you inform the doctor if you have any allergies.

The ICD is inserted just under the collarbone. The area is prepared with a special sterile solution that may feel cold. A large sterile sheet that will partly cover your face will cover you. You will be able to look out from under the sheet to the side and a nurse will be present at all times. You will be given oxygen to breathe by a small tube that is positioned under your nostrils. At the end of the procedure a fast heart rhythm will be induced and the effectiveness of the ICD will be tested.

After the procedure

You will usually stay in the hospital for one night after having an ICD implanted. You may experience some bruising and discomfort to the area of the ICD site, and this may persist for one to two weeks. This can be relieved with simple pain relief such as paracetamol and ibuprofen, but this should be discussed with your doctor before doing so.

You should avoid strenuous activities with your arm for a period of 4 weeks. This is very important after your procedure to avoid the leads from moving. If the leads do move you will have to re-admit to the hospital for a lead revision. If the ICD is implanted without previous rhythm disturbance, (primary prevention) you are legally required to refrain from driving for 2 weeks after the procedure. If the ICD is implanted after a previous rhythm disturbance (primary intervention) you are legally required to refrain from driving for 6 months and then after clearance by your doctor. You will be allowed to discharge home the day after your procedure and a follow-up appointment will be arranged to have your device checked in the clinic.