An implantable cardioverter defibrillator (ICD) is a small device that sends a strong electrical shock to your heart. If you have an abnormal, life-threatening rhythm, the shock helps to restore the heart rhythm back to normal. The ICD can pace your heart if needed. An ICD has two parts, a generator (battery) and the lead(s). Leads are wires that connect the generator to your heart tissue.
Traditional ICD
A traditional ICD is placed under the skin just below the collarbone. The lead(s) go inside your heart. The number of leads can vary. You may have:
1 lead (single chamber ICD)
2 leads (dual chamber ICD)
3 leads (cardiac resynchronization therapy defibrillator, also called CRT-D or biventricular ICD)
The Day Before Surgery
A nurse will call you the day before surgery (or the Friday before a Monday surgery). The nurse will review your instructions, including medicine holds, and discuss arrival time. Please let your nurse know if you have a contrast dye allergy. If you don’t hear from us by 4 pm, please call the clinic.
If you feel sick or have a fever over 101.5°F the day before surgery,call the clinic.
The Day of Surgery
In the pre-op area, an IV will be placed in your hand or arm. Blood may be drawn for labs. If needed, a small area around the surgical sites will be shaved. Your skin will be cleaned with a special soap. You may receive antibiotics through your IV to help prevent infection.
Your care team will determine a plan to make sure you are comfortable. We will go over options for sedation (anesthesia). Sterile drapes will cover your whole body. Only the surgical site(s) are exposed.
The Procedure
The vein below your collarbone is used because it travels to your heart. A small “pocket” is made under your skin for the new device generator and lead(s) to sit in. The leads go into the heart through the blood vessel. X-ray is used for guidance.
Once the lead(s) are in place, they are secured. Then, the lead(s) are connected to the generator (battery). The site is closed with dissolvable sutures or surgical glue. Afterwards, it is covered with a surgical dressing. The whole process takes about 1-3 hours.
Going Home
You may go home the same day or stay in the hospital overnight. Your device will be checked before you leave, and you may have an x-ray. We will review discharge instructions with you.
If you go home the same day as your procedure, someone should stay with you overnight. You may be asked to send a remote transmission the following morning to check your device.
You cannot drive yourself home. You need to arrange for someone to drive you home. You may resume driving after 1 week. In some cases, it may be more than one week depending on what your care team recommends.
Do not make any important decisions until the next day.
Restrictions
When the device is first implanted or there are new leads added, you will have restrictions. This allows the device/leads to fully heal in the heart. The restrictions help make sure the device does not dislodge and the leads do not move as healing occurs. Some restrictions vary based on the reason you received the device. The most common guidelines are:
Do not swim, golf, play tennis, or any other contact sports for 3 months.
Avoid dental work for 1 month.
For 6 weeks after surgery:
Do not raise your arm over your head on the side of your device.
Do not reach behind you on the side of your device.
Do not lift more than 10 pounds (i.e. a gallon of milk) with the arm on the side where your device was implanted.
You may want to wear your arm in a sling when you sleep for the first 1-2 weeks. This will help prevent these motions while you sleep.
Medicines
You will receive instructions and directions about medicines after your procedure.
If you take or are prescribed a blood thinner, take this and do not skip any doses.
If you take Coumadin (warfarin), you will need to have a PT/INR level checked. You may need the dosage adjusted. This will be done within 3-5 days of discharge.
Incision Care
It is important that you take care of your incision site to prevent an infection.
Keep the site clean and dry.
Leave the current bandage on for 72 hours.
Do not shower for _____days.
When you can shower, let the soap and water run over the incision and gently pat dry.
Leave the “steri-strips” under the bandage in place until they fall of on their own. The nurse may also remove them at your follow up visit.
If surgical glue was used, this will fall off over time (about 5-7 days)
Do not pick, scratch, or rub the surgical glue.
Do not use any lotions or ointments on the incision.
Do not scratch or rub the site. Itching can occur. It is often part of the normal healing process.
Do not soak in a bathtub, hot tub, or go into a pool, lake, or river until your incision is completely healed.
Infection
Look at the site daily for signs of infection, such as:
Redness
Swelling
Fever (101.5°F or higher)
Drainage
Tenderness
Warm to touch
Pain
You may take a mild pain reliever such as acetaminophen (Tylenol) or ibuprofen (Motrin) for any pain. You may also use an ice pack. Ibuprofen or other NSAID medicines increase your risk of bleeding. You may want to avoid them, especially if you are taking a blood thinner. Please talk with your surgical team if these medicines are safe for you to take.
Device ID Card
You will receive a temporary ID card and will receive your permanent card in about 2 months. Carry your card with you all the time. Tell your health and dental care providers that you have a permanent cardiac device.
Electrical Hazards
You will need to avoid certain types of electrical devices. For more information, call your device company.
Avoid
Working under the hood of a running car
Arc welding
Cautions
Therapeutic radiation machines.
Electrocautery: Discuss with your care team if you will need electrocautery for a procedure in the operating room or at the dentist office.
Cell phones: Keep cell phones at least 6 inches from your device. Place the phone on the ear opposite of your device or use a headset.
Theft detection devices: These are often around the entrances of stores. Walk through them as you normally would. Do not linger near these.
Airport security: Tell security staff you have a device. Show them your Medical Device ID card.
Magnets: Magnetic snap closure (in jackets), magnetic name badges, and any equipment with a magnetic strip. Keep anything with a magnet 6-8 inches from your device.
MRI (magnetic resonance imaging). Discuss with your clinician before having an MRI.
Safe Devices
Microwaves
Hair dryers
Electric blankets and heating pads
Computers
Radios, TVs, and stereos
Follow-up Visit
Location: __________________
Date: ___________Time: ______________
After your first visit, your device will be checked every 3-4 months either in clinic or with home remote checks.
When to Call
If you feel lightheaded, pass out or if your symptoms return that you had before your device.
You have any signs of infection.
If you receive a shock from your device, you are awake and back at your baseline state of health (call as soon as you can).
If you receive more than one shock, lose consciousness, or are not at your baseline, you or someone close to you should call 911 and go to the nearest emergency room.
Who to Call
UW Health Heart and Vascular Clinic
Monday-Friday, 8:00 am – 4:30 pm
(608) 915-0200
After hours, nights, weekends, and holidays this number will give you the paging operator. Ask for the cardiology fellow on call. Give your full name and phone number with the area code. A clinician will call you back.
For questions about your device, call the device company:
Medtronic: 1-800-633-8766
Boston Scientific: 1-800-227-3422
Abbott/St. Jude: 1-800-722-3423
Biotronik: 1-800-547-0394