Implantable Cardioverter Defibrillator

An ICD is a small device, similar to a pacemaker, that can treat people with dangerously abnormal heart rhythms. It sends a larger electrical shock to your heart to get it pumping again.

Some devices contain both an ICD and a pacemaker.

A battery-powered electronic circuit called a pulse generator and one or more pacing leads make up an ICD.

There are two basic types of ICD:

• Traditional/transvenous ICD – the device is surgically implanted in your chest and its pacing lead is passed through your vein to your heart. This is the most common type of ICD procedure.
• Subcutaneous ICD (S-ICD) – the device and pacing lead are implanted under your skin. The device is inserted to the side of your chest below your armpit and the pacing lead runs along your breastbone.

An implantable cardioverter-defibrillator is connected to your heart with thin wires. It continuously checks your heart rhythm and heart rate.

If the device detects a dangerous heart rhythm it will deliver treatment in one or more of the following ways:

• Pacing – a series of low-voltage electrical paced impulses are given at a fast rate to try to correct your heart rhythm.
• Cardioversion – one or more small electric shocks try and restore your heart to a normal rhythm.
• Defibrillation – one or more larger electric shocks try and restore your heart to a normal rhythm.

It is likely that you will be also given medication to reduce your number of heart rate irregularities. This medication should reduce the need for your ICD to generate unnecessary impulses and helps to prevent an ICD electrical storm.

Heart conditions that require an implantable cardioverter-defibrillator include:

• Arrhythmias/irregular heartbeats – including:
  
  ventricular tachycardia - when the lower chamber of the heart beats too fast to pump well and the body doesn't receive enough oxygenated blood.
  ventricular fibrillation – also called V-fib, is a life-threatening medical emergency. It causes your heart’s lower chambers to quiver (fibrillate), instead of beating normally which prevents your heart from pumping blood and causes collapse and cardiac arrest.
  heart rhythm problems - that cannot be controlled by medication or the medication causes severe or unacceptable side effects.
  
  
• Prevention of cardiac arrest after previous episodes.
• Brugada syndrome – a rare disease that causes an abnormal heart rhythm in your heart's lower chambers.
• Certain types of congenital heart disease.
• Hypertrophic cardiomyopathy - a disease that causes your heart muscle to enlarge.
• Long QT syndrome - a disorder of your heart’s electrical system.

An ICD is also used to gather data about your heart’s function that is used to make treatment recommendations.

The insertion of an implantable cardioverter defibrillator is performed under local anaesthetic and sedation. The surgery takes a few hours. The exact procedure will depend on your health, the type of device, and other surgery you need at the same time.

Typically, a small cut is made near your collarbone and a pouch is created to place your battery-powered pulse generator device. It is about the size of a pocket watch. The pacing leads are fed through your veins to your heart.

Before an ICD

Your health care provider will arrange several blood, urine, and other tests, which may include electrocardiography (ECG), echocardiography, and Holter monitoring.

You will probably be asked to avoid food and drinks for a number of hours before the procedure.

If you take medications, you should talk to your surgeon about them and find out whether you should continue to take them before your ICD implantation.

During the procedure

You will likely be given a sedative and a local anaesthetic.

During surgery, your cardiologist will use X-ray images to guide the placement of one or more flexible, insulated pacing leads into veins near your collarbone, with one end attached to a shock generator device and the other attached to your heart. The device is implanted in a pocket under your skin beneath your collarbone.

The ICD implantation procedure usually takes a few hours.

Once the ICD is in place, your cardiologist will test it and program it for your specific heart rhythm needs.

After an ICD

You may feel some soreness around the site where your ICD was implanted. You can take pain medication to manage your discomfort.

The time you spend in the hospital will depend on your condition and which procedure you had.

Your healthcare team will give you instructions on when it is safe for you to return to driving and other daily activities. Some people may be advised to wait several months before driving.

For the first four weeks, you may be asked to avoid above-the-shoulder activities such as golf, tennis, swimming, bicycling, or vacuuming; heavy lifting; and strenuous exercise. Your healthcare team will probably advise you not to play contact sports again as they can damage your device or dislodge the wires.

For up to eight weeks, you will usually be advised to avoid abrupt movements that raise your left arm above your shoulder to avoid the leads from moving until the area has healed.

Implantable cardioverter-defibrillator batteries last about seven years. Your healthcare provider should check them regularly, every three to six months. When the battery is nearly out of power, a minor outpatient procedure will be arranged to replace the generator with a new one.

Yes, you will need to take precautions if you have an ICD implantation. These include:

• Mobile phones, headphones, wireless chargers, and magnets – avoid placing them within six inches when turned on as they may interfere with your ICD.
• Security systems – your ICD may set off airport security alarms and hand-held metal detectors often contain a magnet that can interfere with an ICD. Always show your card that says you have an ICD.
• Medical equipment - magnetic resonance imaging (MRI), magnetic resonance angiography (MRA), and radiofrequency or microwave ablation may not be recommended if you have an ICD. Tell your health care providers that you have an ICD. They may be able to offer you an alternative test.
• Power generators - stand at least 0.6 meters away from welding equipment, high-voltage transformers, or motor-generator systems. If you work near this equipment, your health care provider can arrange a workplace test to check if it affects your ICD.

The benefits of an implantable cardioverter defibrillator are that it:

• continuously monitors your heart and restores your heart to its normal heart rate, all day every day
• provides important information about your heart to your cardiologist
• reduces sudden cardiac arrest and death
• stops life-threatening ventricular arrhythmias

The possible risks of ICD insertion include:

• swelling, bleeding, or bruising at the incision or catheter insertion site
• blood vessel damage from ICD leads
• infection at the surgical site and/or sensitivity to the device material
• collapsed lung
• bleeding around your heart, which can be life-threatening
• blood leaking through your heart valve where the ICD lead is placed
• dislodging of the device or leads that requires another procedure to reposition the leads.

The cost of a CT angiography will depend on your Ramsay hospital of choice.

You will receive a formal quotation price for your cardioverter defibrillator implantation following your consultation with one of our expert cardiologists. This formal quote will be valid for 60 days.

Ramsay is recognised by all major medical insurers. A  cardioverter defibrillator implantation is covered by most medical insurance policies. We advise you to obtain written authorisation from your insurance provider.

We have a number of payment options if you are paying for the procedure yourself that suits you and your finances, find out more about accessing healthcare with us here,