T-icd placement

An implantable cardioverter-defibrillator (ICD) is a small, battery-powered device. It fixes life-threatening changes in your heartbeat. If the ICD detects a life-threatening heart rhythm, it may try to get it back to normal using electrical pulses. If the dangerous rhythm does not stop, the ICD sends an electric shock to the heart to restore a normal rhythm. The device then goes back to its watchful mode.

The doctor puts an ICD in your chest and attaches it to one or two thin wires, called leads. The leads carry the shocks from the ICD to the heart.

Before the procedure, you will get medicine to help you relax. The doctor will make an incision (cut) in the skin just below your collarbone or at the side of your chest. The doctor will put the ICD leads through the cut. For one type of ICD, your doctor puts one or two leads (wires) in a large blood vessel and threads them into the heart. For another type, the lead may be placed under the skin through a small cut in the middle of your chest. Then your doctor connects the leads to the ICD. Your doctor puts the ICD under the skin of your chest and closes the cut. Your doctor also programs the ICD.

The procedure may take about 1 or 2 hours. You may stay in the hospital for at least one night.

You can likely return to many of your normal activities after you get an ICD. But to stay safe, you may need to make some changes to your normal routine. You will need to be careful with certain types of electronic equipment. And you'll need to take extra care with medical and dental tests and procedures. You will be given specific instructions after getting your ICD.

You may feel anxious or worried about having an ICD. This is common. You might feel better if you use techniques to help you relax. Make a plan for what to do if the ICD shocks you. And think about how the ICD will help you. Talk to your doctor about ways to help ease anxiety.

Your doctor will put the ICD under the skin in your chest during minor surgery. You will likely have medicine to make you feel relaxed and sleepy during the surgery.

Your doctor makes a small cut (incision) in your upper chest. The doctor puts one or two leads (wires) through the cut. The leads go into a large blood vessel in the upper chest. Then your doctor guides the leads through the blood vessel into your heart. Your doctor connects the leads to the ICD and places it in your chest. Then the incision is closed. Your doctor also programs the ICD.

Most people spend the night in the hospital, just to make sure that the device is working and that there are no problems from the surgery.

Procedures can be stressful. This information will help you understand what you can expect. And it will help you safely prepare for your procedure.

Preparing for the procedure

• Be sure you have someone to take you home. Anesthesia and pain medicine will make it unsafe for you to drive or get home on your own.
• Understand exactly what procedure is planned, along with the risks, benefits, and other options.
• If you take a medicine that prevents blood clots, your doctor may tell you to stop taking it before your procedure. Or your doctor may tell you to keep taking it. (These medicines include aspirin and other blood thinners.) Make sure that you understand exactly what your doctor wants you to do.
• Tell your doctor ALL the medicines, vitamins, supplements, and herbal remedies you take. Some may increase the risk of problems during your procedure. Your doctor will tell you if you should stop taking any of them before the procedure and how soon to do it.
• Make sure your doctor and the hospital have a copy of your advance directive. If you don’t have one, you may want to prepare one. It lets others know your health care wishes. It’s a good thing to have before any type of surgery or procedure.

Activity

• Rest when you feel tired. Getting enough sleep will help you recover.
• Try to walk each day. Start by walking a little more than you did the day before. Bit by bit, increase the amount you walk. Walking boosts blood flow and helps prevent pneumonia and constipation.
• Do not raise your arm (on the side of your body where the ICD is located) above shoulder level until your doctor says it's okay. This helps keep the ICD and leads in place while you heal. Your doctor may recommend gentle range-of-motion exercises for your shoulder.
• For at least 3 or 4 weeks, or for as long as your doctor says:
  • Avoid activities that strain your chest or upper arm muscles. This includes pushing a lawn mower or vacuum, mopping floors, swimming, or swinging a golf club or tennis racquet.
  • Avoid strenuous activities, such as bicycle riding, jogging, weight lifting, or heavy aerobic exercise.
  • Avoid lifting anything that would make you strain. This may include heavy grocery bags and milk containers, a heavy briefcase or backpack, cat litter or dog food bags, or a child.
• Ask your doctor when you can drive again.
• You may need to take about 1 to 2 weeks off from work. It depends on the type of work you do and how you feel.
• Ask your doctor when it is okay for you to have sex.

Diet

• You can eat your normal diet. If your stomach is upset, try bland, low-fat foods like plain rice, broiled chicken, toast, and yogurt.
• Drink plenty of fluids (unless your doctor tells you not to).

Medicines

• Your doctor will tell you if and when you can restart your medicines. You will also get instructions about taking any new medicines.
• If you stopped taking aspirin or some other blood thinner, your doctor will tell you when to start taking it again.
• Take pain medicines exactly as directed.
  • If the doctor gave you a prescription medicine for pain, take it as prescribed.
  • If you are not taking a prescription pain medicine, ask your doctor if you can take an over-the-counter medicine.
  • Do not take aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve), or other nonsteroidal anti-inflammatory drugs (NSAIDs) unless your doctor says it is okay.
• If you think your pain medicine is making you sick to your stomach:
  • Take your medicine after meals (unless your doctor has told you not to).
  • Ask your doctor for a different pain medicine.

Incision care

• Keep the area clean and dry.
• Ask your doctor when you can shower or take a bath.
• If you have strips of tape on the incision, leave the tape on for a week or until it falls off.
• Wash the area daily with warm, soapy water, and pat it dry. Don't use hydrogen peroxide or alcohol, which can slow healing. You may cover the area with a gauze bandage if it weeps or rubs against clothing.

Exercise

• Ask your doctor what sort of activity and intensity is safe for you.

Other instructions

• Ask your doctor for a list of electric devices that you might need to keep a short distance from your ICD.
• Be sure you have an action plan from your doctor about what to do if you get shocked.
• Carry your ICD identification card with you at all times. The card should include the ICD manufacturer and model information.
• Wear medical alert jewelry that states you have an ICD. You can buy this at most drugstores.
• Tell all of your doctors, dentists, and other health professionals that you have an ICD before you have any test, procedure, or surgery.
• Be sure you know what to do if you hear an alarm or feel a vibration from your ICD. Your doctor can give you instructions.
• Have your ICD checked as often as your doctor recommends. In some cases, this may be done from your home. Your doctor will give you instructions about how to do this.
• Talk with your doctor about the possibility of turning off the ICD at the end of life. You can put your wishes about the ICD in an advance directive.