This is a device implanted under the skin on the chest wall with leads which monitor the heart rhythm to detect any dangerous rapid heartbeat and treat it with pacing or a shock.
An ICD is an device implanted in the chest to detect any dangerous rapid heartbeat. This device is composed of a generator (containing a battery with a lifespan of about 7 to 10 years) and leads which measure electrical signals in the heart and can deliver a shock when required.
This device monitors your heartbeat continuously and should your heart start beating rapidly will try and pace your heart to stop the rapid heartbeat. However, if this does not work then it will deliver a shock to the heart to restart it with the aim of stopping the previous abnormal rhythm. The ICD usually also has a function to keep the heart going if the heart rate becomes too slow.
Patients may need an ICD either because they have had a cardiac arrest or dangerous heart rhythm previously, or because they are considered to be at high risk of this happening.
In a case like this, using only a pacemaker may not be enough since it will not release the defibrillation shocks needed when the heart beats rapidly or dangerously.
The procedure is similar to a pacemaker implantation and some devices implantated have both pacemaker and defibrillator functions.
You will be asked to lie on a table in the special operating theatre which has an X-ray machine. Your heart rhythm will be checked by adhesive stickers on your chest which is linked up to the monitoring equipment. You will have a blood pressure cuff on your arm and a saturation probe on your finger.
Preventing infection is important and some drapes (disposable sheets) will be placed over the upper half of your body after cold cleaning solution has been applied. Local anaesthetic will be injected under the collarbone and you may also be given some medication to make you sleepy (sedative).
A small cut will be made under the collarbone and the leads of the ICD will be fed round to the heart under X-ray guidance via a large vein which sits under the clavicle. You shouldn’t feel any chest pain but may get some bumping feeling in your chest whilst the leads are being positioned. The pacemaker will then be inserted into a small pocket under the incision and it will be closed with stitches to make a neat scar.
The physiologists will check the ICD function and set up the parameters so that it is working optimally. This is done via a programmer that communicates with the ICD through the skin. You may be able to go home the same day or the next morning.
You will need your ICD checking a few weeks afterwards and then at least annually after that, though this can often now be done remotely.
The benefits are a reduction in the chance of dying from a dangerous heart rhythm.
The risks are low and most people do not have any problems with the procedure. There is a small chance (1%) of damage to the lung or blood vessels around the heart which may require drainage. There is also a small chance of one of the leads becoming dislodged which may require a second procedure to relocate it. There is also a small chance of bleeding or infection and this may require and additional procedure.
Even after the procedure, there is a possibility that the ICD will mistake a safe rhythm for an unsafe rhythm and give you a shock – we set the ICD up to minimize this but around 5% of patients receive a shock inappropriately. There are driving restrictions after receiving a shock, and if you drive for a living (Group 2 licence) then an ICD will mean you cannot work any more.
An ICD can be a life-saving procedure but requires careful evaluation and decision-making with an expert. Our cardiologists are available for consultation on any day of the week and weekends as well.
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