ICD Implantation

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ICDs are implanted in a very similar fashion to a pacemaker. The pulse generator is implanted under the skin near the collarbone and one or more leads are affixed to the heart directly via a vein to the heart.

S-ICDs, or subcutaneous ICDs, are used when there is a structural defect of the heart that precludes using a traditional ICD. The pulse generator is usually implanted on the side of the chest and the lead runs around the breastbone and into the heart. While the S-ICD is generally less invasive than the traditional ICD, it is also significantly larger.

ICD implantation is usually performed in a surgery center or hospital setting, and most patients go home on the same day. Recovery is relatively swift, but most patients are discouraged from performing strenuous activities for about 4-to-6 weeks after the procedure.

Over time, the ICD may deliver one or both of two forms of electric shock. A mild electric shock that is used for pacing the heart may simply feel like a slight flutter. This low-energy pacing responds to less-severe disruptions in the heart rhythm. High-energy shocks are delivered when the rhythm issue is more severe. The shock can be painful, but patients return to normal within seconds.

A single high-energy shock is usually enough to get the heart back to normal pacing, but if more than two shocks occur during any given 24-hour period, this may be a sign of either a device failure or of a serious issue with the heart. Patients should visit the emergency room immediately in this case.

ICDs offer an exceptional benefit for anyone who requires them. They are truly lifesaving in many cases, and secondarily provide peace of mind to those who would otherwise be concerned about cardiac arrest. However, as with any device, there are risks:

  • Generally associated with any medical device is the risk of pain, blood loss and infection at the implantation site. While the procedure is minor, it still comes with some risk, which is often easily managed by an experienced Electrophysiologist.
  • ICDs also have the possibility of firing inappropriately and when no heart failure is present. This, of course, gives the patient a severe shock which can be off-putting and anxiety inducing. Fortunately, technology has improved to where these false positives have been minimized.
  • As with any battery-operated medical device, the pulse generator has a limited lifespan, and patients may require replacement after some time.