How should I prepare for an ICD implantation?
Before the procedure, be sure to talk to you doctor about which of your medications you should and should not take. If you are taking any medications for diabetes, ask your doctor if you need to adjust these medications since you will not be allowed to eat anything before the procedure. If you are taking any blood thinners like warfarin (Coumadin), clopidogrel (Plavix) or aspirin, your doctor may instruct you to change the dose you are taking or stop taking the medication in the days before the procedure.
The night before the procedure, you should not eat anything after midnight; this includes drinking water. If you need to take any pills the morning of the procedure, drink only a sip of water to take them.
Be sure to let your doctor or the anesthesiologist know if you have recently been sick or had an infection, or if you or a family member has ever had a bad reaction to anesthesia.
What happens during the procedure?
When you arrive at the procedure room, you will be asked to lie down on an x-ray table. A nurse will place a blood pressure cuff on your arm and small sticky pads will be placed on your chest to allow the doctor to monitor your heart rate and rhythm on an ECG during the procedure. An IV will be inserted into your arm to deliver your medications. You will be awake during the procedure, but you will receive some medication (sedatives and pain medication) to help calm you, make you sleepy and make you feel as comfortable as possible. You will also receive a local anesthetic to numb the area where the ICD will be placed. You should not feel any pain during the procedure, although you may feel some discomfort.
The doctor will clean the area where the ICD is to be implanted and a small incision (about 2 inches) will be made under your collarbone. Wires will be placed through a large vein in that area and moved towards your heart. The doctor will use x-rays to make sure the wires are going to the right place. Once in the heart, the wires are tested to make sure they are in the correct location. The wires will then be connected to an ICD generator, and the generator will be inserted into the same incision. The incision will be closed with stitches.
After the ICD is implanted, the doctor will need to make sure it is working properly. You will be given some medication to make you fall asleep for a short time. While you are asleep the doctor will change your normal heart rhythm and cause your heart to fibrillate to ensure that the ICD responds properly. This is done in a controlled setting with backup defibrillators so the risk is very low. An x-ray will also be done to make sure that the wires and the generator are in the right places.
The entire procedure takes 3 to 5 hours.
What happens after the procedure?
You will rest in bed until the sedative wears off. After that, you will be allowed to eat and drink again. You may feel some discomfort in the area where the ICD was placed. Ask your doctor for pain medication if needed. Depending on your age and overall health, you may stay in the hospital anywhere from overnight to a few days. Your doctor may examine your ICD to make sure it is working properly and change its settings. To do so, she or he will place a special magnet on it; you should not feel any discomfort.
Your doctor will talk with you about what level of activity is appropriate after the procedure and for how long you need to limit your activity. Generally, you should avoid contact sports, heavy lifting, and pushing/pulling/stretching of the arm on the side of the implantation for the first 6 weeks. How soon you can resume working depends on the nature of your work and your general health. Ask your doctor before you resume these activities.
Keep the incision site dry including the bandages. Your may be instructed not to shower for the first few days after the procedure. After that you will usually be able to shower with soap and water normally, but you should avoid placing unusual pressure on the ICD. Check your wound daily to make sure that it is healing. Let your doctor know if the wound becomes red or swollen, if you notice any pus coming out of the wound, or if you develop fevers or chills, as these are signs that the incision may be infected. Complete recovery from the procedure usually takes 3 to 6 weeks.
Your will be given a temporary card listing the type of ICD and wires you have, when it was implanted, and the name of the doctor who performed the procedure. You should receive a permanent card from the ICD company by mail within a few months. Be sure to carry one of these cards with you at all times: they inform doctors in any hospital of your ICD and how to check it if they need to.
What are the risks of the ICD implantation procedure?
Like all surgical procedures, ICD implantation carries some risk. Women are slightly more likely than men to experience complications after ICD implantation. In one study that looked at more than 160,000 patients who received an ICD (27% were women), 4.4% of women experienced complications in the hospital compared with 3.3% of men.16 Complications can include:
- Swelling and bruising where the ICD is placed
- Infection of the ICD incision
- Rarely, more serious damage to the blood vessels, nerves, heart, or lungs
Many minor problems can be avoided by carefully following your doctor's instructions before and after the procedure and keeping the wound clean.