Implantable Cardioverter Defibrillator (ICD)

What is an implantable cardioverter defibrillator (ICD)?

An implantable cardioverter defibrillator or ICD is a battery-powered device about the size of a pocket watch that gets implanted in the skin, usually just beneath the collarbone. The ICD has thin wires (leads) that get connected to your heart by way of the blood vessels. The device delivers an electric shock to the heart if it beats too quickly or slowly, or erratically. Electrical signals are what tell the heart when to contract and release in order to pump blood to other parts of the body. An ICD may be recommended if you have a life-threatening arrhythmia (abnormal heart beat) or if you have had a heart attack or survived sudden cardiac arrest. You may also need an ICD if you have:

• Long QT syndrome
• Brugada syndrome
• Congenital heart disease

If the heart does not respond adequately to low-level electrical impulses from the ICD, the device will deliver high-energy pulses. The higher energy pulses are very brief (a fraction of a second) but may be painful.

Many ICDs also function as pacemakers, another type of device often used for less life-threatening heart rhythms.

The Lankenau Heart Institute at Paoli Hospital was the first in the Philadelphia region to implant a cardiac resynchronization therapy defibrillator (CRT-Ds) approved by the FDA for use with magnetic resonance imaging (MRI) scans.

What to expect during ICD implant surgery

Implantation of the device is a minor surgery usually performed in the hospital. You will have anesthesia and will likely sleep through the procedure. Through an incision (cut) in the skin the doctor will implant the ICD and run the wires through a vessel to the heart. The ICD device itself is a mini computer and pulse generator so the doctor will test it to make sure it is pulsing properly before closing up the incision.

After surgery you will likely remain in the hospital for one to two days to be monitored by your health care team.

ICD implant risks and recovery

You may have some swelling and pain in the area where the incision was made. Your doctor may advise against any intense activity or heavy lifting for the first 30 days after surgery. Be sure to contact your doctor if you have any reaction to anesthesia or problems related to the implant, such as bleeding from the incision site, or continued swelling, bruising or infection.

You may notice a slight fluttering in your chest, which is normal, or you may feel nothing at all. Also be aware that some electrical devices can interfere with your ICD, such as cell phones, metal detectors and electrical generators.

ICD batteries need to be replaced every five to seven years and the wires may eventually need to be replaced as well.

You will continue to see your doctor who may recommend additional medications and will monitor your heart’s electrical activity via the ICD.