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Background
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Routine ICD follow up in the outpatient clinic.
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The implantable cardioverter defibrillator (ICD) is a device whose main purpose is to prevent sudden cardiac death from very fast heart arrhythmias which might lead to sudden collapse of the circulation, unless promptly treated. The ICD system generally consists of a generator, and one or two leads (wires) that sense your heart rate/rhythm and deliver either pacing or shocking therapies in order to terminate cardiac arrhythmias. An ICD is larger than a conventional pacemaker and is placed under the skin near the left shoulder, just under the left collarbone. All ICDs have backup pacemaker capability.
Preparation
Please do not eat or drink after midnight before the procedure. Also, if you take coumadin (warfarin) we will ask you not to take it for several days prior to the procedure.
During the procedure
The procedure for implantation of an ICD is in general similar to that involving a pacemaker, but these are few distinct differences. You will lie on an x-ray table, with a sterile drape over your entire body. The physician will numb the site of implant (typically near the left shoulder) with a local anesthetic agent, and you will receive intravenous sedative and pain medication to maximize your comfort. An incision about 2 inches long is made, and a vein is identified through which one or two leads are threaded to the heart using X-ray guidance. You may experience some discomfort during the placement of the leads, but it is generally momentary. After the leads are positioned, they are attached to the ICD generator, which rests under the skin. The incision is sewn up using absorbable sutures. The procedure generally takes 2 to 3 hours to complete.
One difference from the pacemaker implantation procedure is that during your procedure, testing of the ICD most likely will be performed. A general short acting anesthetic agent is administered under the supervision of an anesthesiologist, in order to have you fall asleep for several minutes. While you are asleep, your physician will cause your heart rhythm to change to ventricular fibrillation, and will verify that the ICD shocks your heart back to a normal rhythm. Testing is performed in the controlled conditions of the Cardiac Electrophysiology Laboratory, in the presence of back-up defibrillators and therefore the risk is generally extremely low.
After the implant you will usually be admitted to the hospital for overnight observation. You will be asked to restrict the use of your arm on the side of the pacemaker for the first 6 weeks after implant (no heavy lifting or stretching). Defibrillators are usually checked in the office (please see pacemaker/defibrillator clinic) every several months.
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