If you experience dangerously fast heartbeats (ventricular tachycardia) or a chaotic heartbeat that restricts blood supply throughout your body (ventricular fibrillation), you could be at risk of sudden cardiac arrest. In these cases, your physician may recommend a device known as an implantable cardioverter-defibrillator (ICD) that keeps track of your heart rate and delivers an electric shock to restore normal rhythm if it detects one of these problems. 

Baptist Health is nationally recognized for excellence in treating arrhythmias. We offer a full spectrum of heart care and the latest approaches to correcting dangerous heart rhythms with implantable cardioverter-defibrillators. Best of all, you’ll appreciate convenient appointment times, locations near you and a personalized focus to meet your needs before, during and after your procedure. 

What Is an Implantable Cardioverter-Defibrillator? 

A traditional ICD is a battery-powered device surgically placed under the skin near your collarbone to track your heart rate and, if necessary, deliver an electric shock through thin wires connected to the heart. This restores a normal heartbeat. Candidates for ICD surgery have known or suspected life-threatening arrhythmias with non-correctable causes.

A newer type of ICD, known as a subcutaneous ICD, is implanted under the skin at the side of the chest below the armpit and attached to an electrode that runs along the breastbone. You may be offered this type of ICD if you have structural defects in your heart that prevent attaching wires to the heart through your blood vessels, or if there are other reasons for not using a traditional ICD.

What Can an Implantable Cardioverter-Defibrillator Accomplish?

An ICD constantly monitors for abnormal heart rhythms and – if detected – tries to correct them instantly. When you have a rapid or irregular heartbeat, wires from your heart to the device transmit signals to the ICD, which sends electric shocks to regulate your heartbeat. You may experience a second or two of pain if your heart receives a shock, but you shouldn’t experience lasting discomfort. 

Depending on your heart rhythm problem, your ICD could be programmed for the following therapies:

Low-energy pacing therapy: When patients have only mild disruptions in the heartbeat, they may have ICDs programmed for this therapy. If you have this type of ICD, you may feel nothing or just a painless fluttering when the ICD responds to rhythm disruptions.

Cardioversion therapy: Often used for people with more serious heart rhythm problems, these ICDs deliver a higher-energy shock. If you have this type and the ICD detects an abnormal heartbeat, you may feel a thump in your chest.

Defibrillation therapy: This strongest form of electrical therapy is used to restore a normal heartbeat in patients with very dangerous, life-threatening heart rhythm problems. During this therapy, it may feel as if you’re being kicked in the chest, and you could even be knocked off your feet. 

An ICD can:

• Restore a normal heartbeat when it detects the heart is beating too fast or chaotically
• Help treat cardiac arrest, even when you are far from the nearest hospital
• Give you peace of mind if you’ve experienced prior ventricular arrhythmias or cardiac arrest or if you have a known congenital heart condition like Long QT syndrome or Brugada syndrome
• Help you resume normal activities

What Can I Expect During the Procedure?

If your physician determines you need a traditional ICD, you’ll be sedated and given local anesthesia. The surgery usually takes a few hours. Your surgeon will insert one or more flexible, insulated wires (leads) into veins near your collarbone and guide them, with the help of X-ray images, to your heart. The surgeon will secure one end of each lead to your heart and attach the other end to the ICD generator, implanted under the skin near your collarbone. Your surgeon will test the ICD and program it for your particular heart rhythm problem. 

Placement of a subcutaneous ICD requires you to have general anesthesia but not X-ray fluoroscopy. The ICD’s pulse generator is placed right below the left armpit using a 4- to 5-inch incision, and an electrode attached to the device is tunneled across the ribcage above the heart and anchored into place under the skin. The surgeon then tests and programs the device while you’re still under general anesthesia. 

Recovery

After either procedure, you’ll spend one or two days in the hospital, and your ICD will be tested. You may experience some pain in your incision site. Your physician may prescribe pain medication, or you may be advised to use over-the-counter pain relievers (but not aspirin). 

Estimated Recovery Timeline

After your one-to-two-day hospital stay, you’ll need to avoid driving for at least two weeks and vigorous activity or heavy lifting for at least one month. Full recovery typically takes a few weeks to a few months. The American Heart Association discourages driving for at least six months after an ICD implant procedure so you can assess whether a shock to your heart will cause you to faint. 

Implantable Cardioverter-Defibrillator Possible Risks

Risks associated with ICD implantation are rare but may include:

• Bleeding around the heart (very rare and very serious)
• Collapsed lung
• Damage to, or leaking from, veins where ICD leads are placed
• Infection at the implant site
• Swelling, bleeding or bruising