Implantable Cardioverter Defibrillator (ICD) Surgery
Listed below is the step by step procedure of ICD surgery:
- What is ICD (Implantable Cardioverter Defibrillator) surgery?
- Why is an ICD Surgery Required?
- Pre-operative Preparation
- Day Before Surgery
- Procedure Day
- Methods/Techniques of ICD Surgery
- Post Procedure
- Risks and Complications
What is ICD (Implantable Cardioverter Defibrillator) surgery?
An ICD (Implantable Cardioverter Defibrillator) is a device placed surgically under the skin of the heart patient to track the heart rate. It is powered by batteries and connected to the heart of the patient by thin wires. On detection of abnormal heart rhythm, an electric shock is delivered by an ICD for restoring the normal heartbeats in case the heartbeats are fast and chaotic. It is a lifelong commitment to get an ICD which requires regular maintenance. A healthy lifestyle and diet needs to be followed for keeping this device effective.
Why is an ICD Surgery Required?
In cases where a child or person is at high risk of getting ventricular arrhythmia – a life threatening disorder, an ICD insertion is required. Ventricular arrhythmia can occur as a result of following things.
- History of ventricular arrhythmia
- Heart attack
- Recovery from a sudden cardiac arrest
- Brugada syndrome
- Congenital heart disease
The surgeon informs the patient about the basic details of ICD surgery in advance. A consent form is given to the patients prior to the surgery. Patients need to sign the consent form for giving permission to the surgery.Female patients who are pregnant or suspecting to be pregnant need to inform the doctor. Patients suffering from heart valve disease need to inform the surgeon prior to ICD surgery as they need to get an antibiotic treatment. History of bleeding disorders, anticoagulant treatment needs to be informed by the patients. Surgeon will inform the patient to stop taking some medications prior to the surgery. Blood tests can be carried out prior to the surgery to check the clotting factor.
Day Before Surgery
Surgeons inform the patients about overnight fasting prior to the day of surgery. Patients need to inform the surgeon about any known allergies as well as allergies to iodine, latex, anesthetics or tapes prior to the surgery. A sedative can be given to the patients prior to the surgery for relaxing.
On the day of surgery, insertion of ICD is carried out by an electrophysiologist in an electophysiology laboratory. An ICD surgery is less invasive. Most of the times, patients are awake during the surgery. A sedative and local anesthetic is given for making the chest area numb. In some patients, general anesthesia is given which puts them in sleep during the surgery. The procedure of an ICD takes place for few hours.
Methods/Techniques of ICD Surgery
ICD surgery is carried out for insertion of an ICD which is a tiny electronic device used for monitoring of electrical activity of the heart of the patient. The size of an ICD device is of a stop watch and is inserted below the skin in the upper chest area. It consists of leads made up of pulse generator and wires. A tiny computer and battery are parts of a pulse generator. The pulse generator gets connected to the various areas of the heart through one or multiple leads. Even though small in size, this device helps in saving the life of the patient. Listed below are the main functions of an ICD:
- Anti-tachycardia pacing (ATP)
- Cardioversion (light shock)
- Defibrillation (stronger shock)
- Backup pacing
Anti-tachycardia pacing (ATP) involves regular pacing of impulses at rapid rate. It helps is delivering and restoring normal rhythm. For this, it needs to overtake an irregular rhythm at faster rate. Defibrillation is termed as "kick in the chest” by many patients based on their experience. Whenever required, an ICD can be used as a back-up pacemaker. Post shock, heart beats can be slow. The advantage of an ICD is, it can act as a pacemaker anytime when heart rate drops down and not only after experiencing shock.
The process of insertion of an implanted cardioverter defibrillator is performed on an outpatient basis or at the hospital. In general, following process is followed during an ICD surgery.
- All objects, such as valuables, jewelery, money and other belongings need to be kept away during surgical process.
- A gown provided by the hospital needs to be worn by the patients.
- Emptying of bladder prior to the surgery is expected.
- Patients need to lay on on their back on the operation table.
- An IV injection is used for provision of medications and other fluids.
- At the beginning, vital signs, such as heart rate, blood pressure, level of oxygenation and breathing rate are checked.
- An ECG monitor is connected during the surgical process for monitoring electrical activity of the patient.
- Electrode pads of large size need to be placed on the front as well back side of the chest.
- The areas which need placement of electrode patches need to be shaved and cleaned. Excessive hair at the site of surgery need to be clipped off.
- After cleaning the insertion site with antiseptic soap, local anesthetics are given at the site of surgery.
- Once patient is under the effect of an anesthesia, small cuts are made by the surgeon at the site of ICD insertion.
- In general, a sheath is inserted under the collarbone into a blood vessel. A sheath is a tube made up of plastic. It is used to pass the ICD lead wire into the blood vessel and then into the heart. Location of the leads can be monitored using fluoroscopy.
- Once the lead wire is linked with the generator, an ICD will be placed under the skin of the patient through the incision.
- In case of right-handed patients, an ICD device is placed in upper left chest area while in left-handed patients, it is placed in upper right chest area.
- Once the insertion of ICD device is completed, the incisions are closed with the help of sutures, special kind of glue and adhesive stripes. After that, dressing is applied to the wound.
Mechanism of Work of an ICD
- An ICD determines when the heartbeats are not normal and then tries to make them normal.
- An ICD with a pacemaker feature sends tiny signals to the heart of the patient when the heartbeat is very slow.
- During fast heartbeats, defibrillation shocks are given by an ICD for stopping abnormal rhythm.
Post surgery, regular evaluation of an ICD device is required. This needs to be done for checking the status of battery and working of an ICD device. Based on the condition of patients, recovery varies. Highly intense activities such as weight lifting need to be avoided. Given below are the unusual symptoms which if observed, need to be reported to the surgeon immediately.
- Excess pain
- Chest pain
- Pressure on the chest
- Bleeding or drainage from the site of insertion
After ICD implantation, you may feel anxious or depressed. This is not uncommon for ICD recipients, especially in the first months or year after implantation. Unfortunately, it is uncommon for patients to seek help for their anxiety and depression. If you experience these feelings, or even anticipate them, consult with your doctor or healthcare team and get help. There is no reason to feel embarrassed or alone due to your feelings. By asking questions and expressing your concerns about the ICD and your reactions to it, you might prevent or alleviate potential anxiety or depression.
Post Procedure Care
After ICD surgery, patients need to take some precautions. Given below is the list of precautions.
- An identity card needs to be carried by ICD surgery patients. A medical identification bracelet may be provided to these patients for indication of having done an ICD surgery.
- There are chances of interaction of anti-theft systems with ICD device. Patients undergone ICD surgery need to be careful while dealing with security detection checks.
- MRI (Magnetic Resonance Imaging) may not be for the patients of ICD surgery. They need to avoid magnetic fields post surgery. These fields include industrial sites and power generation sites.
- ICD patients should abstain from diathermy – a process to treat the muscles with heat as a part of physical therapy.
- Heating pads cannot be used on ICD devices directly.
- Patients of ICD need to be away from radar machinery and television transmitters.
- Post ICD surgery, if any other surgical treatment is necessitated, patients need to inform their surgeon. This prevents interference of operative processes with an ICD device.
- Sporting activities that pose risk of trauma to ICD patients need to be avoided.
- It is safe to use cell phone post ICD surgery. Though this is the case, it is recommended to keep cell phone at least 6 inches aways from ICD device.
Risks and Complications
Similar to other surgical methods, an ICD surgery also has some risks. Apart from pain, there are other severe complications. Patients can also get allergic reactions to some medications used during surgical procedure. Given below are the possible risks of ICD surgery
- Infection at the site of surgery
- Heart damage (damage to the valves or arteries)
- Blood clots
- Heart attack
- Heart muscle perforation
- Collapsed lung
- Which patients need insertion of an ICD?
A. The patients with heart muscle weakness, coronary artery disease with risk of getting an ischemic cardiomyopathy need insertion of an ICD. An ICD helps in monitoring normal heartbeat in these patients.
- Is an ICD device too big?
A. An ICD device is thinner and smaller than a deck of cards.
- How patients feel after getting shock?
A. It varies from patient to patient. In case of some patients, a shock by an ICD feels like kicking by a horse while some patients feel as if hit by a baseball bat. This shock lasts for few seconds. In most of the cases, it is experienced in the back side than in the front.
- What should patients do after experiencing a shock?
A. Patients needs to sit down post shock. After experiencing the shock, they need to make sure that they will not fall. Immediate consultation with the doctor is necessary after receiving the shock. Upon receiving multiple shocks, patients need to be treated as an emergency case. Doctors can remotely monitor an ICD device to know exact happenings.
- What is the impact of ICD while at airport security?
A. An ICD card needs to be kept handy at airport by the patients traveling after surgery. This prevents unnecessary stress.
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