Defibrillator Implantation (ICD)

The information on this page is for patients who are having a heart regulator and monitor implanted under the skin known as an implantable cardioverter defibrillator (ICD). It explains why you may be having it, how it is implanted and any risks or side effects that there may be.

What is an ICD?
It is a device like a pacemaker which consists of a generator and one or more fine wires. It monitors every heart beat and if your heart is beating too fast it will slow it down automatically. If the ICD does not cause it to slow down it may deliver a small shock to the heart to restore a normal heart rhythm. An ICD also works like a normal artificial pacemaker and if the heart beats too slowly it will speed it up.


Why might you need one?
Because you have had, or are considered to be at high risk of having a serious and fast heart rhythm abnormality which may be a threat to life. You may have even survived a cardiac arerrest. Having an ICD may be the best way of treating any recurrence and prolonging your life.

What perparation do you need?
You may have some or all of the following checks: blood test, blood pressure check, heart tracing (an ECG) and possibly a chest xray.
You should inform the nurse if you are allergic to anything (drugs, elastoplast, latex) and any medication you are taking.
you will have the opportunity to discuss the operation with nurses and doctors.

When can I eat and drink?
You must not have anything to eat after 3am on the day of your procedure and you may only drink clear fluids (no milk) until 7am.  After this time you may not have anything until after the procedure.

What tablets can I take before the procedure?
Warfarin needs to be stopped for 5 days prior to your admission date.  Aspirin and clopidogrel should not be taken on the morning of admission.  Insulin dose should be halved on the morning of your procedure.

What should I bring into hospital with me?
You will need to bring all your current medications with you and details of your GP and next of kin.  Please bring a dressing gown and slippers with you, you may also wish to bring a book/magazine.  Please do not bring any large amounts of money or jewellery with you, the hospital is unable to accept any liability for lost or stolen items.

The Implantation
You will usually come into hospital the day before your implantation. A doctor will see you and explain the procedure and ask you to sign a consent form to confirm that you understand the procedure and agree to go ahead with it. You will be given a hospital gown and a nurse will accompany you to the theatre.
An incision is made under the collar bone. The wire(s) are inserted into a large vein that lies just under the collar bone and positioned in the heart using x-ray screening for guidance. Once in position the wire(s) are connected to the generator which is placed in a pocket under the skin in front of the shoulder. The procedure takes about 1 to 2 hours.

After the implantation
You will recover in the recovery ward and stay in hospital over night. Please ask for any painkillers if you need them. The following day a cardiac technician will check the ICD. A sensor is held over the ICD to programme it. This is painless but you might be aware that your heart is beating slightly faster than normal. The the ICD is checked to make sure it is effective at stopping your fast heart rhythm.
You may also have a chest x-ray to check that the wires are in the correct position. You will usually start in a short course of antibiotics. If beaded stitches have been used to close the skin, you will need to make an appointment with the practice nurse to have them removed 7 days after the procedure.

Going home
Please make sure that a friend or relative collects you and takes you home. Your shoulder may feel uncomfortable for a week or so. You may have swelling and bruising but this will return to normal in 2-3 weeks. You will able to feel the ICD beneath your skin, but do not worry it will not pop out. It does feel rather strange at first. You should be able to return to your normal activities within a week or so. Avoid activities involving vigorous arm movement for a few weeks but you should move your arm normally.
You should attend regular check-ups at an ICD clinic. The ICD will last for years but the batteries will eventually run down (approximately 5 years) and then it will have to be replaced.
If you work, the time you need off work to recover varies for different people.  Most people need to take at least 10 days off work to fully recover and if you have a manual job or any concerns about work, you will need to discuss this with your doctor before leaving hospital.

Driving - you must not drive for 6 months after your implant. You must tell the DVLA that you have an ICD. Click the link below for the DVAL website.

Driving Vehicles licensing Authority, DVLA

ICD registration card - this will be given to you (plus information from the manufacturer) following your implant; please carry it with you and show it to any dentist or doctor who may treat you.
Important - if you notice redness, swelling or a discharge at the site of your implant (signs of infection) please tell your GP immediately as infection can spread.

What are the risks?
This implantation can be very successful but as with all procedures there are some small risks. There is a small risk of puncture of the lung( between 1% - 2%) as the vein used for the wire runs close to it. Sometimes no treatment is needed, and sometimes the escaped air has to be removed using a needle or small drain.
There is also a small risk of the wire slipping out of place (between 1% - 4%) if this happens it must be repositioned under x-ray guidance.
The risk of infection (1%) is potentially serious; it can be treated with antibiotics but if this fails then the whole pacemaker system may need to be removed and replaced.

Further advice following implantation
If you get a shock from your ICD phone you local ICD clinic within 24 hours. It is not urgent but it needs to be recorded. If you get several shocks from your ICD you should contact your ICD clinic urgently, your ICD may need checking.
Mobile phones can be used safely but keep it as for as possible from your ICD using the opposite ear or headset.
Electronic surveillance such as airports and anti-theft devices in shops can inerfere with ICDs. They are safe provided you go through quickly, do not linger. Inform security staff.
MRI scans - you must not have an MRI scan (body imaging scan) as it uses strong magnets, other types of scans are safe. Lithotripsy treatment for kidney stones must be avoided.

Any further questions please contact the Arrhythmia Nurse Specialist on 01273 696955 Ext 4071

or the cardiac department on 01273 696955