What do ICDs do and why are they implanted?
An implantable cardioverter-defibrillator (ICD) is a small device that helps people with heart problems. It is placed inside the body during surgery. The ICD does two main things: it monitors the heart all the time, and if it finds a dangerous heart rhythm that may cause cardiac arrest, it first tries to pace the rhythm away and if that is not successful, it gives an electric shock to fix it. The shock is called defibrillation. The ICD can also send small electrical pulses to help control the heart rate.
ICDs are used for people who have a high risk of dangerous heart rhythms. These rhythms can be life-threatening and cause the heart to stop suddenly. By implanting an ICD, doctors can prevent this from happening and save lives.
Having an ICD means that the person needs to visit the doctor regularly to make sure everything is working well. The doctor can adjust the settings of the ICD if needed. It’s important to take care of the ICD and follow the doctor’s instructions to stay healthy and safe.
Why would my doctor recommend a subcutaneous defibrillator over a standard ICD?
A subcutaneous ICD (S-ICD) and a standard ICD are two different types of devices that help people with heart problems.
The main difference is where they are placed in the body. A standard ICD has wires that go inside the heart, while an S-ICD is put just under the skin, on the left side of the chest.
The wires in a standard ICD monitor the heart’s electrical activity and give treatment directly to the heart when needed. But an S-ICD has a single wire that stays outside the heart and detects the heart’s signals from there.
Both types of ICDs can give electrical shocks or send signals to help the heart beat normally. The difference is how they do it. In a standard ICD, the shocks or signals go inside the heart, while in an S-ICD, they go to the outer surface of the heart.
The choice between a standard ICD and an S-ICD depends on things like the person’s heart condition and body shape. The doctor will recommend which one is best for each person.
Both types of ICDs are used to help people with heart problems stay healthy and safe.
What are the risks of defibrillator implant?
- Infection: There is a chance of getting an infection of the cut in the skin used to put-in the defibrillator. Signs of infection include redness, swelling, warmth, or fluid coming out of the cut. If you see any of these signs, tell your doctor right away. If bacteria enter the blood stream, the defibrillator can become chronically infected and require removal.
- Bleeding or Bruising: Sometimes, there might be a little bleeding or bruising around the cut used to put the defibrillator in.
- Damage to blood vessels or nerves: Sometimes, nearby blood vessels or nerves can get hurt during the procedure. This might lead to pain, bleeding, or problems with the arm on that side.
- Lung Collapse or Pneumothorax: In rare cases, defibrillator placement can cause lung collapse. This can make it hard to breathe or cause chest pain. In severe cases, a chest tube is needed for a short period of time, but most of the time the lung re-opens on its own.
- Perforation or puncture of the heart: puncturing the heart during defibrillator implant can cause bleeding around the heart. This is serious, but very unlikely and treatable.
- Device-related issues: There’s a chance of complications with the device itself, like the wires moving out of place or breaking. If that occurs, more procedures or replacing the device may be necessary.
- Allergic reaction: In very rare situations, a person might have an allergic reaction to the materials used in the device.
- Long-term complications: Over time, the tissue around the device can become scarred or thickened. This might require adjustments or repositioning of the device.
Remember, these risks are not very common, and doctors will do their best to minimize them. It’s essential to talk to your doctor about any concerns you have and ask any questions you may need answers to.
Why should I have this procedure with South Denver Cardiology?
Dr. Jehu Mathew, Dr. Ryan Jordan, Dr. Sri Sundaram, Dr. William Choe, Dr. Daniel Alyesh, and Dr. Nicholas Palmeri routinely do this procedure. Our EP providers, who specialize in these devices, perform a significant number of these procedures annually. Our center has consistently maintained a lower rate of complications compared to the averages reported in the literature.
What happens during the procedure?
During a defibrillator procedure, here’s what happens in simple terms:
- Getting ready: Before the procedure starts, you’ll be given medicine to make sure you don’t feel any pain. You might either sleep through the procedure or just have the area where the defibrillator is placed numbed with local anesthetic.
- Making a cut: The doctor will make a small cut in your upper chest or left side of your abdomen, depending on where the defibrillator will be placed. They’ll create a little pocket underneath the skin to hold the device.
- Putting in wires: Thin wires called leads will be carefully inserted through a vein and guided to your heart. The doctor will make sure the wires are in the right spot.
- Testing it out: Once the wires are in place, the doctor will test the defibrillator to make sure it’s working correctly. They might cause an abnormal heart rhythm on purpose to see if the defibrillator can fix it.
- Placing the device: After the tests, the defibrillator, which has a generator or battery, will be put into the pocket created earlier. The generator can be near your collarbone or in your left side of the abdomen. Then, the doctor will close the cut with stitches and surgical glue.
- Recovering: After the procedure, you’ll go to a special area where the medical team will watch over you. They’ll check your vital signs like your heartbeat, blood pressure, and oxygen level and make sure you’re feeling okay. If everything is fine, you might go home the same day or the next day.
The doctors and nurses are there to make sure everything goes smoothly and that you stay safe and comfortable throughout the procedure.
What happens right after the procedure?
After getting a defibrillator, here’s what happens next:
- Rest and Recovery: You’ll be taken to a special area where the medical team will watch over you. They want to make sure you wake up properly from the procedure and that there are no problems. They’ll check your heart rate, blood pressure, and other signs to make sure you’re doing okay.
- Checking on You: The medical team will keep an eye on you for a while. They’ll ask how you’re feeling and make sure you’re comfortable. If you have any pain, they can give you medicine to help.
- Instructions: Before going home, the doctor or nurse will give you some important instructions. They’ll tell you how to take care of yourself after the procedure. There will be lifting and range of motion restrictions post the procedure for approximately one month. They might tell you to avoid certain activities or not lift heavy things for a little while. They’ll also explain how to keep the cut clean and dry. It’s important to follow these instructions carefully.
- Follow-up Appointments: You’ll need to go back to the doctor for check-ups. They’ll want to see how you’re healing and make sure the defibrillator is working properly. During these visits, you can ask any questions or talk about any concerns you have.
- Getting Back to Normal: Once you’re home, you can start doing your regular activities slowly. Take it easy at first and don’t overdo it. Pay attention to how you feel and rest if you need to. If anything doesn’t feel right, tell your parents or caregivers so they can contact the doctor.
Remember, everyone’s recovery is different, and it’s important to be patient with yourself. The medical team is there to help you along the way, so don’t hesitate to ask them any questions or let them know if you need anything.
How will I feel after the procedure? What is my expected recovery course?
After getting a defibrillator, here’s what happens as you recover:
- Rest and Healing: Your body needs time to heal after the surgery. You’ll need to rest and take it easy for a few days. This means not doing too much physical activity and giving your body a chance to recover.
- Managing Pain: You might feel some pain or discomfort around the incision area. Your doctor can give you medicine to help with the pain or suggest over-the-counter pain relievers. It’s important to take the medicine as directed and let your provider know if the pain doesn’t go away or gets worse.
- Taking Care of Yourself: You’ll need to take care of the incision site where the defibrillator was put. Your doctor will tell you how to keep it clean and dry. It’s important to follow their instructions and ask for help if you’re not sure what to do.
- Follow-up Visits: You’ll have appointments with your doctor to check on your progress. They will look at the incision site, make sure the defibrillator is working well, and answer any questions you have. It’s important to go to these appointments so that your doctor can make sure you’re healing properly.
- Lifestyle Changes: Your doctor may talk to you about making some changes in your daily life to keep your heart healthy. This might include eating healthier foods, exercising regularly, not smoking (if applicable), and finding ways to manage stress. It’s important to listen to your doctor and follow their advice.
- Feelings and Support: It’s normal to have different emotions after getting a defibrillator. You might feel worried, frustrated, or even sad. It can be helpful to talk to your family, friends, or a trusted adult about how you’re feeling. They can support you and help you feel better.
- There are permanent restrictions around heavy metal welding for patients with an ICD. You will also set off airport metal detectors but have a card that you can give to TSA to indicate you have a device.
Remember, it takes time to recover, so be patient with yourself. If you have any concerns or feel unwell during your recovery, make sure to contact your doctor. They are there to help you and make sure you’re getting better.
Note on Pre-Op and Post-Op instructions: The most up-to-date pre- and post-operative instructions will be the ones provided to you during your pre-op visit & on your hospital DC instructions given to you when checking-out of the hospital.
