Implantable Cardioverter-Defibrillator (ICD) Implantation

An Implantable Cardioverter-Defibrillator (ICD) is a small electronic device that is implanted under the skin to help regulate the heartbeat and prevent sudden death from abnormal heart rhythms. The procedure of implanting an ICD is called ICD implantation.

Indications for ICD Implantation

• Prevention of sudden cardiac death in patients with life-threatening ventricular arrhythmias, such as ventricular tachycardia or ventricular fibrillation
• Treatment of patients with a history of cardiac arrest or near-cardiac arrest
• Patients with certain types of cardiomyopathy, such as hypertrophic cardiomyopathy or arrhythmogenic right ventricular cardiomyopathy
• Patients with long QT syndrome or other inherited disorders that increase the risk of sudden cardiac death

Procedure Overview

The ICD implantation procedure typically takes about 1-2 hours to complete and is usually performed under local anesthesia and sedation. The steps involved in the procedure are:

1. The patient is prepared for the procedure by cleaning and draping the skin where the device will be implanted
2. A small incision is made in the skin, usually in the upper chest area, to create a pocket for the ICD generator
3. One or more leads (thin, insulated wires) are inserted through a vein and guided to the heart using fluoroscopy (a type of X-ray)
4. The leads are connected to the ICD generator, which is then placed in the pocket under the skin
5. The incision is closed with sutures or staples, and the patient is taken to a recovery area for monitoring

Types of ICDs

There are several types of ICDs available, including:

• Single-chamber ICD: This type of ICD has one lead that connects to the right ventricle
• Dual-chamber ICD: This type of ICD has two leads that connect to both the right atrium and right ventricle
• Biventricular ICD (also known as cardiac resynchronization therapy-defibrillator or CRT-D): This type of ICD has three leads that connect to both ventricles and help coordinate the heartbeat in patients with heart failure

Risks and Complications

As with any surgical procedure, there are risks and complications associated with ICD implantation, including:

• Bleeding or hematoma at the site of the incision
• Infection of the device or leads
• Pneumothorax (collapsed lung)
• Damage to surrounding nerves or blood vessels
• Device malfunction or failure

Post-Procedure Care and Follow-Up

After the procedure, patients are typically monitored in a hospital setting for several hours to ensure that the device is functioning properly. Patients will also need to follow up with their doctor regularly to check the device and make any necessary adjustments.

Patients with an ICD should:

• Avoid strong magnetic fields, such as those found in MRI machines
• Avoid close proximity to certain electrical devices, such as microwaves or cell phones
• Carry an ICD identification card at all times
• Inform their doctor or other healthcare providers about the presence of the ICD before undergoing any medical procedures