Defibrillation consists of delivering a therapeutic dose of electrical energy to the affected heart with a device called a defibrillator. An implantable cardioverter- defibrillator (ICD) is a small device that is implanted into the chest to reduce the risk of heart failure if the chambers of the heart go into a dangerous rhythm and stop beating. It is generally implanted in patients who have:
- Ventricular fibrillation: A life threatening condition in which the ventricles contract in a rapid, chaotic rhythm and cannot pump blood to the body
- Ventricular tachycardia: A severe condition in which the ventricles cause a fast heartbeat
- Heart failure: A chronic condition when the heart is unable to pump blood effectively to meet the body’s metabolic needs
- Family history of sudden cardiac arrest
Implantable cardioverter-defibrillators work by identifying and stopping abnormal heartbeats (arrhythmias). An implantable cardioverter-defibrillator continuously monitors the heartbeat and delivers extra beats or electrical shocks to restore a normal heart rhythm when necessary.
Before defibrillator surgery, it is important that a patient take the following steps:
- Informing the doctor of any medications currently being used
- Informing the doctor of any cold, flu, fever, herpes breakout or other illness
- Washing the whole body below the neck with a special soap
- Avoiding drinking or eating anything after midnight the night before the surgery
- Taking drugs only prescribed by the doctor
- Arranging for transportation to and from the hospital
- Arranging for home care during recovery after surgery
During defibrillator surgery, a surgeon usually inserts the ICD while the patient is awake; however, the area of the chest wall below the collarbone is numbed with anesthesia, so no pain is felt. The surgeon then makes an incision through the skin and forms a space under the skin and muscle for the ICD generator (usually near the left shoulder). Using special x-ray to see inside the chest, the surgeon inserts the electrode into a vein and then into the heart. The electrodes are then linked to the pulse generator and pacemaker. The overall surgical procedure takes 2 to 3 hours.
Like with any surgical procedure, possible risks that can arise from implantation of an ICD include:
- Infection at the implant site
- Swelling or bruising at the implant site
- Bleeding at the implant site or around the heart, which can be life-threatening
- Damage to the vein where the ICD leads are placed
- Allergic reaction to medications used during surgery
- Injury to the heart or lungs
- Dangerous heart arrhythmias
After surgery, most patients are allowed to go home the next day. It is recommended that a patient refrain from vigorous activities such as playing contact sports, following an intense exercise program, or lifting heavy objects for the first 4 weeks after surgery. Full recovery generally takes 4 to 6 weeks. Making follow up visits with a doctor is necessary to monitor the patient’s heart and ensure that the ICD is working properly (sensing the heartbeat, counting the overall shocks delivered and checking for battery power).
