What implantable cardioverter-defibrillator (ICD) is for?

1. You might need an ICD if you suffer from dangerously fast heartbeats (ventricular tachycardia) or a fast chaotic heartbeats (ventricular fibrillation), where heart fails to supply enough blood to the rest of your body
2. ICDs can continuously monitors your heartbeat beats and automatically detect and stop abnormal heartbeats (arrhythmias).

What to expect before the procedure?

1. Before your procedure, your doctor will review your medical history, including allergies and medications you take. The team may perform a physical exam and check your vital signs including blood pressure and pulse.
2. The doctor will obtain verbal and written consent ( after explaining procedure and potential complications)
3. You will be asked, not to drink or eat anything for at least 4-6 hours before the procedure.
4. An IV line is inserted into a vein in your arm for IV fluids and other medications
5. If you are on blood thinners, your doctor may stop medications few days before procedure ( please discuss with your doctor)

Possible Complications

Implantable cardioverter-defibrillator (ICD implant is generally a very safe procedure but as with any invasive procedures, there are some risks associated with the procedures. These include:

1. Bleeding
2. Infection
3. Air leak into the lung (pneumothorax)

What to expect during the procedure?

1. For the procedure, you will be transferred inside a catheter lab or operating room.
2. You will then lie on x-ray table. The team can adjust the table height and position. The X-ray cameras may move over and around your head and chest to take pictures from many angles.
3. The doctor may give you medications including pain killers and sedatives ( to help you relax). You may feel sleepy but you'll still be able to be easily awakened to follow any instructions.
4. You will be attached to heart monitor, blood pressure cuff and Oxygen monitor.
5. A small amount of hair may be shaved from the upper chest wall on the right or left side. The area is washed and disinfected and then numbed with an injection of local anesthetic.
6. You will be completely covered with sterile drape sheets during the procedure.
7. You may be given an antibiotic through the IV at the beginning or during the procedure.

Procedure

A small incision (2-3 inches) is made at the upper chest wall on the right or left side (most commonly). The lead(s) is inserted through the incision and into a vein, and then guided to the heart with the help of X-rays. The lead tip attaches to the heart muscle, while the other end of the lead (attached to the pulse generator) is placed in a pocket created under the skin in the upper chest.

You should not feel any movement of wire inside your body. Tell your health care team if you have any discomfort.

In some patients, small amount of Dye (contrast material) is injected through the veins. When this happens, you may have a brief sensation of flushing or warmth.

Once the leads and ICD are implanted, then various tests are performed on the device. Testing the ICD might require speeding up your heart and then shocking it back into normal rhythm.

How long does the procedure last?

1. The ICD implantation procedure may last from 2 to 3 hours, depends on the types of devices ( single, dual or three leads)

What to expect after the procedure?

1. After the procedure, the doctor will close the puncture site with sutures and apply bandage
2. You will be admitted to the hospital and stay overnight after the procedure. Usually you will be able to go home the day after your ICD was implanted.
3. A chest X-ray will be done after the ICD implant to check your lungs as well as the position of the ICD and lead(s).
4. Before you are discharged, your device will be checked.
5. If you feel any swelling or bleeding from the entry site, immediately inform the medical team.
6. You will also receive an ICD ID-card that indicates what type of device and leads you have, the date of implant and the doctor who performed the implant.

After discharge from hospital

1. You may see some bruise at the puncture site which will improve itself. If you feel some discomfort, you can use paracetamol or other simple painkillers.
2. You may be given antibiotics for few days.
3. Avoid heavy lifting for 7 days after the procedure.
4. You will be called back to be seen in an ICD Clinic few days after discharge.

Activities after Discharge

** Discuss with your doctor/nurse. The general guidance is as follows: **

1. Driving
1. Do not drive for 7 days after implantation ( if implanted for prevention)
2. Avoid driving for 6 months if ICD was implanted due to a previous cardiac arrest or ventricular arrhythmia.
3. If shocked by ICD, you'll need to stop driving until you've been shock-free for another six months.
4. You can't get a commercial driver's license if you have an ICD.
5. Inform your local Driving licensing authority and seek clarification.
2. For 4 weeks avoid:
1. Vigorous above shoulder activities or exercises, including golf, tennis, swimming, bicycling, bowling or vacuuming
2. Lifting anything weighing more than 5 pounds
3. Playing contact sports
4. Strenuous exercise programs

Devices that can interfere with a ICD include:

1. Cell phones and MP3 players (for example, iPods)
2. Household appliances, such as microwave ovens
3. High-tension wires
4. Metal detectors
5. Industrial welders
6. Electrical generators

Traveling by Aircraft

1. The new airport security scanners (which the TSA prefers to call "full body scanners") should not affect your ICD
2. Carry your ICD Card with you if asked on airport-security
3. Patients with an ICD implanted can fly after a few days, but if the procedure was complicated by air leak (pneumothorax), in which case they should wait until two weeks after it has fully healed

Working

Return to work will depend on your occupation. In general, you may return to work in 3-7 days after an ICD implantation but usually depends on the nature of your job.

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