Sarah Lewis, PharmD
What is a defibrillator implant?
A defibrillator implant is the surgical placement of an electrical device called an implantable cardioverter defibrillator (ICD) in your chest or belly. An ICD treats life-threatening abnormal heartbeats (arrhythmias). Arrhythmias can prevent your heart from pumping a sufficient amount of blood to your brain and body. A defibrillator implant uses electrical shocks to restore a normal heartbeat.
Your heart is a muscle that works like a pump. It has four chambers, two upper chambers (atria) and two lower chambers (ventricles). Like all pumps, your heart requires a source of energy to function. Your heart's pumping energy comes from a built-in electrical conduction system.
Your heart's four chambers must pump in harmony with one another to make a normal heartbeat. Electrical signals travel through the chambers to produce the heartbeat. Any malfunction in these signals can make your heart beat too quickly, too slowly, or at an uneven rate. This causes an arrhythmia.
A defibrillator implant is only one method used to treat abnormal heartbeats. Discuss all of your treatment options with your doctor or healthcare provider to understand which options are right for you.
Types of defibrillator implants
An ICD has two main parts. The first part is the wires with electrodes that connect your heart to the ICD. These wires continually monitor your heart rhythm. They send the information to the second part of an ICD, the pulse generator.
The pulse generator is a small battery-operated computer. It is designed to recognize abnormal heart rhythms and respond by sending electrical impulses back to your heart. The pulse generator can send either low-energy pulses or high-energy shocks to correct your heart rhythm.
The types of defibrillator implants include:
Dual chamber ICD. A dual chamber ICD has wires that connect to both an upper chamber and a lower chamber of your heart. It corrects abnormal electrical signals between the two chambers.
Single chamber ICD. A single chamber ICD has wires that connect to one or both of your ventricles (the lower chambers). It corrects abnormal electrical signals within the ventricles.
Other procedures that may be performed
In some cases, an ICD is placed during open-heart surgery for other heart problems. These surgeries include:
Congenital defect repair corrects a variety of heart problems that are present at birth.
Coronary artery bypass grafting (CABG), commonly called heart bypass surgery. A CABG bypasses or provides a new route around diseased coronary arteries with healthy vessels taken from other places in the body. This is the most common heart surgery in adults.
Heart valve repair or replacement. Diseased or damaged heart valves do not allow blood to flow properly through the heart and out to the body.
Left ventricular assist device (LVAD) implant. The LVAD is implanted in the abdomen and attached to the heart to help a weak heart pump more effectively. An LVAD treats severe heart failure.
Why is a defibrillator implant performed?
Your doctor may recommend an implantable cardioverter defibrillator (ICD) to treat a life-threatening heart arrhythmia. Arrhythmias of your heart’s ventricles are particularly serious. This includes ventricular tachycardia and ventricular fibrillation.
Ventricular tachycardia occurs when your ventricles beat too fast. This decreases the amount of blood that your heart pumps to your brain and body. Dizziness and fainting can occur with ventricular tachycardia. It can be life threatening without rapid treatment.
Ventricular fibrillation occurs when your ventricles beat so fast and unevenly that they quiver, or shake. Little or no blood is pumped to your brain and body. Death results within five to 10 minutes without treatment.
Your doctor may only consider a defibrillator implant for you if other treatment options with less risk have failed to prevent life-threatening heart arrhythmias. Ask your doctor about all of your treatment options and consider getting a second opinion before deciding on a defibrillator implant.
Your doctor may recommend a defibrillator implant if you have a high risk of a life-threatening heart arrhythmia. This includes people who have had:
A heart attack and are at high risk for sudden cardiac death
Episodes of any serious heart arrhythmia, such as a rapid atrial fibrillation. This is a rapid quivering of the upper chambers of the heart.
Hypertrophic cardiomyopathy, a complex heart disease characterized by thickened heart muscle and ventricular stiffness
Sudden cardiac arrest and survived
Ventricular tachycardia. A single episode of ventricular tachycardia can warrant an implantable defibrillator.
Your doctor may also recommend a defibrillator implant for warning signs seen on heart tests. These heart tests include electrocardiography (ECG), ultrasounds, stress tests, and a catheter electrophysiology study.
Who performs a defibrillator implant?
A cardiac surgeon performs a defibrillator implant. Cardiac surgeons specialize in the surgical treatment of conditions of the heart and its blood vessels. Cardiac surgeons may also be known as cardiothoracic surgeons.
How is a defibrillator implant performed?
Your defibrillator implant will be performed in a hospital. The procedure takes a few hours and generally includes these steps:
You will dress in a patient gown and lie on a procedure table.
Your team will insert an intravenous (IV) line to provide fluids and medications.
You will have medication (a sedative) to relax you. You may fall asleep.
A team member will prepare an area of your chest or abdomen (belly). This includes shaving if needed, cleaning, and covering with a surgical drape. This is the area where your surgeon will place your defibrillator.
Your surgeon will numb the area with an injection of local anesthetic. You will not feel anything in the area where your surgeon places the defibrillator.
Your surgeon will thread the wires of your defibrillator through a vein to your heart using real-time X-ray guidance.
Once the wires are in place, your surgeon will make a cut in either your chest or your abdomen and place the pulse generator.
Your surgeon will test the pulse generator once everything is connected. Your team will give you more medication to put you in a deeper sleep when the pulse generator is tested. You will not feel the any electrical pulses during the test.
After the surgeon has tested the defibrillator, the skin will be closed with stitches, tape or glue.
Will I feel pain?
Your comfort and relaxation is important to you and your care team. You may feel a pinch or prick when the IV is inserted and stinging when the local anesthetic is injected. Your doctor will give you sufficient sedative medications so that you are comfortable. Tell your doctor if you are uncomfortable in any way.
What are the risks and potential complications of a defibrillator implant?
As with all surgeries, a defibrillator implant involves risks and possible complications. Complications may become serious and life threatening in some cases. Complications can develop during surgery or recovery.
General risks of surgery
The general risks of surgery include:
Adverse reaction or problems related to sedation or medications, such as an allergic reaction and problems with breathing
Bleeding, which can lead to shock
Blood clot, in particular a deep vein thrombosis that develops in the leg or pelvis
Potential complications of a defibrillator implant
Complications of a defibrillator implant include:
Blood clots or air bubbles in the vein
Defibrillator malfunction requiring your doctor to reprogram it or replace it
Heart or nerve damage
Punctured heart or lung
Tearing an artery or vein
Unnecessary electrical pulses (impulses). This occurs when the defibrillator sends pulses that are not needed. This can damage your heart, cause irregular heart rhythms and pain, and be emotionally upsetting. It is the most common complication of a defibrillator implant.
Reducing your risk of complications
You can reduce the risk of certain complications by following your treatment plan and:
Avoiding close or prolonged exposure to electrical devices or devices that have a strong magnetic field. Your doctor will give you specific instructions about these devices.
Following activity, dietary and lifestyle restrictions and recommendations before surgery and during and after recovery
Notifying your doctor immediately of any concerns, such as bleeding, fever, increase in pain, or wound redness, swelling or drainage
Taking your medications exactly as directed. Some medications reduce the risk of unnecessary pulses (impulses).
Telling all members of your care team if you have any allergies
How do I prepare for my defibrillator implant?
You are an important member of your own healthcare team. The steps you take before surgery can improve your comfort and outcome.
You can prepare for a defibrillator implant by:
Answering all questions about your medical history and medications. This includes prescriptions, over-the-counter drugs, herbal treatments, and vitamins. It is a good idea to carry a current list of your medical conditions, medications, and allergies at all times.
Arranging a ride home from the hospital. You will not be able to drive for some time after a defibrillator implant. The time will vary depending on several factors. Your doctor will tell you when you are able to drive again.
Following all instructions about eating and drinking before a defibrillator implant
Getting preoperative testing as directed. Testing varies depending on your age, health, and specific procedure. Preoperative testing may include a chest X-ray, EKG (electrocardiogram), blood tests, and other tests as needed.
Losing excess weight before the surgery through a healthy diet and exercise plan
Stopping smoking as soon as possible. Even quitting for just a few days can be beneficial and help the healing process.
Taking or stopping medications exactly as directed. This may include not taking aspirin, ibuprofen (Advil, Motrin), and blood thinners.
Questions to ask your doctor
Facing surgery can be stressful. It is common for patients to forget some of their questions during a brief doctor’s office visit. You may also think of other questions after your appointment. Contact your doctor with concerns and questions before a defibrillator implant and between appointments.
It is also a good idea to bring a list of questions to your preoperative appointments. Questions can include:
Why do I need a defibrillator implant? Are there any other options for treating my condition?
Which type of defibrillator implant will I need?
How long will the surgery take? When can I go home?
What restrictions will I have after the surgery? When can I return to work and other activities?
What kinds of electrical devices should I avoid? What kinds of medical testing should I avoid?
What kind of assistance will I need at home?
How do I take my medications?
How will you treat my pain?
When should I follow up with you?
How should I contact you? Ask for numbers to call during and after regular hours.
What can I expect after my defibrillator implant?
Knowing what to expect can help make your road to recovery after a defibrillator implant as smooth as possible.
How long will it take to recover?
You will stay in the recovery room after surgery until you are alert, breathing effectively, and your vital signs are stable. A hospital stay of one to two days may be required. This allows your care team to monitor your heart rhythm and make sure that your defibrillator is working properly. You will go home with instructions about how to care for your defibrillator.
Recovery after surgery is a gradual process. Recovery time varies depending on the procedure, your general health, age, and other factors. Your doctor may ask you to avoid strenuous activities or lifting anything over 20 pounds for about a month after surgery. Most people return to light to moderate activities within a few days.
How will I feel after the defibrillator implant?
You may have mild pain, swelling and tenderness at the placement site for several days after the surgery. Over-the-counter pain medicines can reduce discomfort. Ask your doctor before taking any pain medication and only take pain medication as directed. Call your doctor if your pain gets worse or changes in any way because it may be a sign of a complication.
When should I call my doctor?
It is important to keep your follow-up appointments after a defibrillator implant. Contact your doctor for questions and concerns between appointments. Call your doctor right away or seek immediate medical care if you have:
Breathing problems, such as shortness of breath, difficulty breathing, labored breathing, or wheezing
Change in alertness, such as passing out, dizziness, unresponsiveness, or confusion
Chest pain, pressure or squeezing or palpitations
Fever. A low-grade fever (lower than 101 degrees Fahrenheit) is common for a couple of days after surgery and not necessarily a sign of a surgical infection. However, you should follow your doctor's specific instructions about when to call for a fever.
Pain that is not controlled by your pain medication
Unexpected drainage, pus, redness or swelling of your incision
How might a defibrillator implant affect my everyday life?
A defibrillator implant can help you lead an active, normal life. It does not cure heart disease, but it can lower your risk of dying from sudden cardiac arrest. It can also cause significant changes to your body that may affect your everyday life.
When your defibrillator senses a mild change in your heart rhythm, it will send a low-energy pulse. This is called pacing. You may feel a fluttering in your chest or nothing at all with pacing. If pacing doesn’t work, your defibrillator will send a mild shock. This shock is called cardioversion. People often describe the feeling of cardioversion as being thumped on the chest.
When your defibrillator senses a serious change in your heart rhythm, it will send a high-energy shock. This is called defibrillation. Defibrillation can be painful and is often described as being kicked in the chest. The sensation should only last a few seconds. Defibrillation can be upsetting, but be assured that your defibrillator is doing its job.
Contact your doctor if you have an episode of cardioversion. Seek immediate medical care (dial 911) if you have defibrillation.
Other lifestyle changes include:
Alerting all of your healthcare providers, including your local fire department, that you have an ICD. Certain medical procedures need to be avoided if you have an ICD. You should carry an ID card that identifies your ICD device.
Avoiding close or prolonged exposure to certain electrical devices or devices that have a strong magnetic field. Your doctor will provide specific instructions on which devices to avoid. You should avoid magnetic resonance imaging (MRI).
Avoiding contact sports and activities that could loosen your defibrillator wires
Driving only after your doctor has approved it. The length of time it takes to regain driving privileges varies depending on your local laws and your recovery. Your doctor may ask you to refrain from driving until you have gone six months without an episode of fainting.
Following up several times a year with your doctor. Your doctor will need to check your ICD on a regular basis. Your doctor will assess if the battery or wires need to be replaced and if other devices have affected the signaling. Your doctor will also check progression of your disease and reprogram your ICD as needed. Some devices will alert your doctor when a shock is delivered.
Needing future surgery to replace the battery, wires, or the entire ICD device. Batteries generally last five to seven years.
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