Implantable Cardioverter Defibrillator (ICD)

An implantable cardioverter defibrillator (ICD) is a device that is placed permanently inside your body. It monitors the speed and pattern of your heartbeat (heart rhythm). If this rhythm becomes too fast and potentially dangerous, the ICD sends out electrical signals, either rapid pacing to override the fast rhythm, or an electric shock to reset the heart's rhythm. Both of these methods help bring the rhythm back to normal. The ICD is put inside your body during a minor surgical procedure called implantation. In most cases, implantation takes about an hour.

How do I get ready for this procedure?

  • Follow any directions you are given for not eating or drinking before surgery.

  • Follow your healthcare provider's instructions on what medicines to take beforehand.

  • You may be asked to shower with antibacterial soap the night before your procedure and the morning of the procedure. Ask your provider if he or she wants you to use a certain kind of soap.

  • Your provider may ask you to use clean bed sheets and pajamas the night before the procedure.

What happens during the procedure?

The ICD is usually put on the left side of your chest. Putting the ICD in your body (implantation) doesn't require open heart surgery. This means your chest will not be opened. During the procedure:

  • You will be given medicine to help you relax.

  • The doctor makes a cut (incision) in the skin below your collarbone. This creates a “pocket” to hold the ICD.

  • The doctor threads a wire (lead) through the incision into a vein in the upper chest. With the help of X-ray monitors, the doctor guides the lead into one of the heart’s chambers. Depending on how many leads your ICD has, this process may be repeated to guide leads into other chambers.

  • The doctor attaches the leads to the heart muscle so they will stay in place. The leads will be tested to make sure they are placed correctly.

  • The battery (generator) is attached to the leads. Then the doctor places the generator in its pocket under the skin.

  • The doctor may start (induce) a fast heart rhythm to test the ICD.

  • Antibiotic solution is used to clean the pocket.

  • When everything else is done, the incision is closed with stitches that dissolve, medical glue, or staples.

Other implantation sites

In some cases, the ICD can be put elsewhere in the body. This could be on the right side of the chest, or on the left side under the muscle.  If one of these is an option for you, your doctor will explain more.

What happens after the procedure?

You will stay in the hospital overnight. While you are in the hospital, your heart’s signals are monitored to see how the ICD is working. You can go home when your condition is stable. Once you get home:

  • Follow your discharge instructions to care for your incision. Watch for signs of infection (see box).

  • Follow any special instructions to care for the side of your body where your ICD was implanted. Your doctor may tell you not to raise that arm above the shoulder for a certain amount of time. You may also be discharged with a sling or other device to help keep your arm from moving after the procedure.

  • You’ll likely have bruising at the incision site. This is normal and will go away as the incision heals.

  • You can probably return to your normal routine soon after implantation. Ask your doctor when you can return to work and what limits you may have.

  • You may be told not to drive for a certain amount of time. Generally, you should not drive for about 6 months after having an ICD implanted, or after the device delivers a shock. Commercial driving with an ICD is not allowed by most state laws because of the risk of losing consciousness from life-threatening heart rhythms that this device is designed to treat. Discuss your situation with your healthcare provider.

  • See your doctor for follow-up visits as recommended.

When to call your healthcare provider

Call 911 if you have:

  • Chest pain

  • Severe shortness of breath

Call your healthcare team if you have any of the following:

  • Signs of an infection, such as: fever over 100.4ºF (38ºC), drainage from the incision, or redness, swelling, or warmth at the incision site

  • Twitching chest muscles

  • Pain around your ICD that gets worse, not better

  • Bleeding from your incision

  • Swelling in the arm on the side of the incision site

  • Severe swelling of the incision site (bulging up like a golf ball)

  • You receive a shock from your ICD

  • Your device generator feels loose under the skin or wiggles in the pocket

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