What is it?
An implantable cardioverter-defibrillator (often called an ICD) is a device that briefly passes an electric current through the heart. It is "implanted", or put in your body surgically. It includes a pulse generator and one or more leads. The pulse generator constantly watches your heartbeat. It is like a small computer that runs on a battery. The lead (say: "leed") is a wire from the pulse generator to the inside of your heart. The lead takes signals from your heart to the ICD and then takes an electric current from the pulse generator to your heart.
Why is it important?
Normally, your heart has a natural pacemaker that helps your heart beat steadily. An electrical current starts in one of the upper chambers (called the atria) of the heart and goes through the heart to the bottom chambers (called the ventricles). You may need an ICD if you have had, or are at high risk of having, certain heart rhythm problems (ventricular tachycardia or ventricular fibrillation.
Before the procedure
You will not be able to eat or drink for a short time before the operation, primarily because anesthesia will be given prior to surgery. This is standard for most surgeries. Most ICD recipients receive conscious sedation, though some may receive general anesthesia.
Usually, ICDs are implanted just under the skin in the upper chest. This part of your body is shaved (if needed), scrubbed, and painted with a disinfectant to make it as clean as possible.
During the Procedure
Leads for the defibrillator are usually implanted by threading them through a large vein that goes to the heart. This is called transvenous placement. A small incision is made over a vein in the upper chest. One or two leads are inserted through the vein to the heart. A small patch may also be placed under the skin on the left side of the chest. The ends of the leads and patch are tunneled under the skin and attached to the generator, which is usually placed in the left pectoral region (near your left shoulder, above your left breast). The term "pectoral implant" refers to the fact that the generator is now located near the pectoral muscle in the upper chest. On rare occasions, the defibrillator leads can be implanted directly over the heart during surgery. Your doctor will advise you if this is the way your leads need to be implanted.
After the Procedure
After the procedure you may feel drowsy and experience some tenderness and soreness at the implant site. You may stay in the hospital's intensive-care unit (ICU) or telemetry unit for a day or two so that your heart rhythm can be carefully monitored. You may also spend time in the hospital's regular in-patient ward, depending upon the method of surgery the physician has chosen. By the next day, you will probably be walking around; however, it is important to remember that everyone recovers at a different pace. Address specific questions regarding your progress with your physician.
Before you leave the hospital, the physician may again test the implantable cardioverter defibrillator (ICD) system. This is done by starting the arrhythmia and allowing the device to correct it. This will show you what the therapy feels like.
The device may also be programmed to meet your specific needs. This is done with a tabletop computer called a programmer and a programming wand. By holding a programming wand over the implanted ICD, the ICD can be adjusted after it's in your body. The programmer is also used during patient follow-up visits.
- Follow the exercise program prescribed for you.
- You may resume most of your activities that do not involve heavy lifting or straining. Your exercise program will include instructions about how much lifting you can do.
- Resume driving only when your EP doctor says you may. This is for your safety and the safety of others.
Things to avoid:
- Strong magnets or magnetic fields – these can interfere with the action of the device and may even turn the device off. If you work with strong radiofrequency or high-voltage equipment, be sure to discuss this with us.
- Airport security – Show the security personnel your ICD identification card and ask that they check you manually.
- Contact sports or activities that may inflict blows to the shoulder area.
- You may use cell phones, however we recommend that you hold the phone on the opposite side of your ICD, at least 6 inches from the ICD. If your phone transmits more than three watts, increase this distance to 12 inches.Do not carry the phone in a breast pocket.
- Ask your doctor about further recommendations regarding magnetic fields.
- Resume sexual activity when you feel ready.
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