ICD Implantation

Basic Facts:

  • ICD stands for “implantable cardioverter defibrillator”. It is a pacemaker-like device that is implanted in a patient in order to intervene and restore normal heart rhythm if a serious, potentially fatal rhythm is coming from the bottom chambers of the heart (ventricles).  

  • Under sedation, a small generator is implanted in a pocket under the skin, then metal wires called “leads” are attached to it and run into heart through a vein. The leads carry electricity to the heart when needed. 

  • ICD’s can also prevent the heart rate from becoming too slow, like a pacemaker does, but ICD’s have the added function to sense and treat fast heart rates originating from the ventricles, such as ventricular fibrillation (V-Fib) or unstable ventricular tachycardia (VTach).  

Implantable Devices

  • There are 4 types of ICD’s:

  • Single-Chamber: only one wire in the heart, typically in a bottom chamber (ventricle), sometimes in a top chamber (atrium)
  • Dual-Chamber: two wires in the heart, one in the top chamber (atrium) and one in the bottom chamber (ventricle) 
  • Biventricular: two wires, one in each of the bottom chambers (ventricles) to help them contract simultaneously. This is also known as Cardiac Resynchronization Therapy (CRT)
  • Subcutaneous: the device is implanted on the left side of the chest, and wires are implanted underneath the skin rather than into the heart muscle. 

This procedure is performed in a hospital by a doctor with specialty training in the electrical system of the heart, called an electrophysiologist (EP), along with a team of specialized cardiovascular nurses and technicians: 

  1. Under gentle sedation, the doctor makes an incision and creates a small pocket under the skin, typically just below the left collarbone. 

  1. A small generator is implanted in the pocket, then metal wires called “leads” are attached to it and run into heart through a vein. The generator has a battery and provides the electricity that is carried to the heart through the lead(s). 

  1. The incision is closed and either glued or sewn shut.  

  1. Patient will be monitored for several hours afterwards, as the anesthesia wears off. 

  1. Most patients can go home later the same day, once the access site is stable. Others will need monitoring overnight.  

The Virginia Heart Care Team will provide each patient with specific pre- and post-procedure instructions, including which medications to take or not. Other general guidelines include: 

  • Stop eating and drinking the night before the procedure.  

  • The patient will be provided with special bathing instructions for the days leading up to implantation, to reduce risk of infection. 

  • If leaving the same day as the procedure, a patient needs to have someone else drive them home, as they were under sedation. 

  • Limit use of the arm on the side the pacemaker was implanted:  no heavy lifting / pushing / pulling (over 10 lbs), or raising the elbow above the shoulder for about 1 month after implant. Then no further restrictions. 

  • Avoid baths for a few days (showers are usually permitted after 24 hours). 

  • Sexual activity can usually be resumed within three to five days. 

  • Soreness and some puffiness around the generator site is common afterwards, but it should not last more than one week.  

  • Follow-up office visit should be in about one week to check the incision and schedule the first device check visit in the office about 6 to 8 weeks after implant. 

  • A patient who has had an ICD implanted does NOT need antibiotics prior to dental visits.