Defibrillator Placement: Implantable Cardioverter Defibrillator Insertion

If you are either a patient or a family member of a patient that is considering a defibrillator implant, then you may have some questions regarding the procedure involved with it. One of the most common concerns when it comes to defibrillators is their placement. Many individuals are unaware of exactly where the implantable cardioverter-defibrillator(ICD) goes. This article details everything that you need to know concerning the placement of the ICD, as well as the monitoring and maintenance of the device. These are all very important aspects to take into consideration, especially if you yourself are in need of a defibrillator or know someone else who might be.

What is a Defibrillator?

The process of defibrillation is a procedure that is used to treat a number of life-threatening conditions that affect the heart rhythm. Some of the conditions that can be treated by an implantable cardioverter-defibrillator(ICD) are:

• Cardiac arrhythmia
• Ventricular fibrillation
• Pulseless ventricular tachycardia

The procedure involves an electric shock being delivered to the heart which then causes the depolarization of the heart muscles and also re-establishes the normal conduction related to the electrical impulse of the heart. The machine that is used to deliver this electric shock to the heart is known as a defibrillator.

There are numerous types of defibrillators such as external defibrillators, implanted defibrillators, and transvenous defibrillators.

The early form of defibrillation generally delivered a charge that was between 300 to 1000 volts to the heart through the use of paddle-type electrodes. These units were effective; however, they had a major drawback when needed during open-heart surgery. These defibrillators were also pretty large and heavy, making them difficult to transport, and post-mortem examinations found that the technique with which they were used actually caused more damage to the heart muscles. The technique was also unsuccessful in reversing ventricular fibrillation, defeating the purpose of it entirely.

Subsequently, a way of delivering the charge in a way that used resistance to create a weaker sinusoidal wave that would last for five milliseconds using paddle electrodes was developed. The optimal timing regarding when the shocks should be delivered was also developed so that the application of the technique could be used to treat other cases of arrhythmias such as atrial flutters, atrial fibrillation, and a singular form of tachycardia.

Further development relating to the defibrillator took place whereby the implantable cardioverter-defibrillator(ICD) was developed. This device can be used to treat a variety of heart conditions as a result of its implantation. By using this device, patients do not need to go to a medical facility for assistance as the device is implanted within them.

What is Involved in Defibrillator Placement Procedures?

The implantation procedure of a typical defibrillator takes about an hour to complete and does require the patient to stay in the hospital overnight for monitoring purposes. The doctor who is in charge of the procedure should place both the device and wires and then follow this up with x-rays in order to determine that everything is positioned correctly, as well as to check the heart and lungs. These x-rays should be repeated on the following day to evaluate the condition of the lungs and heart, and also to ensure that the device and wires are still in the correct position. The pocket of the device and the incision should also be examined in order to confirm that everything is in order. Once all of these checks have been completed, then you should be allowed to be released.

Why You May Need an Implantable Cardioverter Defibrillator

If you are an individual who has survived sudden cardiac arrest as a result of ventricular fibrillation, have fainted due to ventricular arrhythmia, or even have certain inherited heart conditions, then you may be in need of an ICD.

Generally, anyone who is at a high risk of cardiac arrest as a result of ventricular arrhythmia needs an ICD. People who have heart failure or issues related to the contraction of their heart such as left ventricular ejection fraction are also in need of an ICD. There are some other conditions that may also require the implantation of an ICD, and you should consult your doctor so that they can properly assess your heart rhythms in order to decide whether or not you may be in need of an ICD. 

Risks Associated With an Implantable Cardioverter Defibrillator(ICD)

There are a number of risks that are associated with an ICD, and it is important that any patient considers these risks before going ahead with the procedure. If your heart condition is not life-threatening, then you should probably consider other methods of treatment. This is because of the severe risks that come along with the insertion of an implantable cardioverter-defibrillator. Some of the risks associated with ICD implantation are:

• A collapsed lung
• Tearing of the heart muscles
• Bleeding from the incision or catheter insertion site
• Dislodging of the leads that require another procedure in order to reposition them
• Damage to the blood vessels at the insertion site of the catheter

These are some of the risks that are generally associated with the insertion of an implantable cardioverter-defibrillator. There are a number of other considerations that you should make if you are contemplating getting this procedure done. If you are pregnant or breastfeeding, then you should inform your healthcare provider of this. You should also inform them if you are allergic to any specific medication or latex to ensure your safety throughout the process. There may be other risks associated with the process that depends on your specific medical condition. It is crucial that you discuss all medical conditions with your healthcare provider to ensure your safety at all times.

How to Prepare for an ICD?

Before you begin the procedure, your doctor should ask you to sign a consent form that gives them permission to conduct the test. It is vital that you read the form properly and ask any questions that you may have regarding the procedure or ICD. After signing the form, you should let your doctor know of any underlying medical conditions that you may suffer from. In doing so, your doctor can take these into consideration and find a way to work around them without putting you at risk throughout the implantation procedure. 

You should also notify your medical practitioner of any medication that you are taking, regardless of whether it is homeopathic or prescription. This is because these medications can affect the process and it is important that your doctor is aware of all possibilities while completing the procedure in order to ensure your health and safety throughout it. Your doctor may order you to stop the use of certain medication types such as aspirins and similar medication that causes blood clotting before the operation in order to prevent any complications throughout the procedure.

You may have to undergo a series of blood tests and chest x-rays before the procedure in order to determine how much of a risk the implantation of the ICD is for you. Should your doctor deem it safe for you to undergo the ICD implantation, you can be sure that everything should go well with the procedure.

How and Where is the Implantable Cardioverter Defibrillator(ICD) Implanted?

Having the ICD implanted can be done while you stay in the hospital, or on an outpatient basis. It is important that you are aware of the fact that every procedure differs slightly as a result of the patients’ unique conditions and medical ailments. No two patients are exactly the same, and as a result, no procedure is the same. By enlisting the help of a great doctor, you can give yourself the best chance of the procedure going well.

The insertion process of an ICD is a pretty lengthy process and has many intricate procedures that must be followed in order to ensure the safety and health of the patients who undergo the procedures.

The procedure generally begins with patients being asked to remove any jewelry that they are wearing as this can interfere with the process. After having removed any jewelry, patients are asked to remove their clothing and are then given a hospital gown to wear. Patients generally have to go to the bathroom before the procedure begins to empty their bladders. After all of this has been completed, patients are hooked up to intravenous or IV that is connected to their hand or arm for the purpose of injecting medication or fluids should they be required during the operation.

You should then be placed on your back on the operation table and attached/connected to an electrocardiogram or ECG. This machine records the electrical activity of the heart throughout the procedure in order to ensure that your vitals such as your heart rate, blood pressure, breathing rate, and oxygen levels are stable throughout the entire process. This ensures that your doctor is able to keep you at a stable and healthy level while the treatment is administered.

Your doctor should then clean the surgical site in order to minimize or eradicate the risk of any infection while they follow the various procedures. Your hair may need to be shaved or clipped in some cases to allow for the doctor to have an easier field of view while they work on you. This is followed by large electrode pads being placed onto both the front and back of your chest. After all of this has been done, a sedative is administered via the IV in order to help patients relax. Regardless of the sedative, you can expect that you are going to be awake for the remainder of the procedure.

The ICD insertion site is then cleaned with an antiseptic soap in order to reduce the risk of any complications during or after the procedure has been completed. Sterile towels and a sheet are then placed around the cleansed area. Your doctor should then inject a local anesthetic into your skin at the insertion site. They should then wait for the anesthetic to take effect before proceeding to make a small incision in the skin at the insertion site.

After the incision has been made, a sheath or introducer is inserted into a blood vessel that is usually located beneath the collarbone. The sheath is a plastic tube that is used to lead the ICD lead wire into the blood vessel and then this wire is advanced to the heart. It is important that a patient remains still during this process in order to ensure that the catheter does not move around and cause any damage to the insertion site, as this can complicate the entire process and put the safety of said patient at risk.

The lead wire is then inserted into the blood vessel through the sheath, followed by the doctor then advancing the wires through the blood vessel and into the heart of the patient. Once the lead wire has been inserted into the heart, it is tested in order to confirm that it is in a proper location and that it works correctly. The number of wires used varies from patient to patient and varies based on the devices that your doctor has chosen based on your specific heart condition. Some devices require only one wire, where other devices may need two or even three wires. A special type of x-ray known as a fluoroscopy is displayed on a monitor and is used to position the lead wire.

For the use of subcutaneous ICDs, one or two small incisions are made close to the top and bottom of the sternum and breast bones. The lead wire is then burrowed underneath the skin alongside the sternum and lead from the sternum all the way to the incision that is located on the left side of the chest. After this has been completed, the ICD generator is then slipped underneath the skin through the incision that has been made just below the collarbone for traditional ICDs and on the left side of the chest for S-ICDs. Upon the completion of the generator has been inserted, the lead wire is then attached to the generator.

The placement of an ICD varies for different individuals and is generally based on which of their hands is the dominant one, so as to avoid the device getting in the way of any movement. Should you be a right-handed individual, the device is usually placed in the upper left of your chest area. S-ICDs are usually placed on the left side of the chest, close to the heart, as this is where they have been found to have the best results. Should you be left-handed, or have any contradiction to having the device implanted on the left side of your chest, a traditional ICD can be placed in the upper right-hand side of your chest area.

The ECG device is used to monitor the ICD functionality once it has been inserted in order to make certain that it is functioning properly and does not have any complications down the line. Your doctor may choose to carry out a number of tests in order to ensure that the device is functioning properly. This is done to ensure the safety of the patient.

After the procedure has been completed, the incision is then closed. The incision can be closed in a variety of ways, with sutures, adhesive strips, and adhesive glue being the most popular methods for closing it. Upon the closure of the incision, the doctor generally applies a sterile bandage or dressing in order to protect the wound from becoming infected and allowing it to heal properly.

What Occurs After You Have an Implantable Cardioverter Defibrillator Implanted?

After the operation has been completed, it is most likely that patients are going to be taken to a recovery room in the hospital where the nurses should observe and monitor their vital signals. An ICD is a small device, and due to this, you should not feel any discomfort as a result of having one implanted. However, should you notice that you feel any chest pain or tightness at the incision site, you should inform the nurse on duty of this immediately.

Once you have completed the required period of bed rest, you may be allowed to leave your bed with the help of a nurse. When this occurs, the nurse or doctor on duty should give you a first-time check-up. This involves them checking your blood pressure while you are in different positions such as while you are lying in bed, sitting, and standing. It is important that you do not make any sudden movements, and that you move in a slow manner while getting up to prevent the feeling of dizziness that may occur as a result of you being in bed for a long period of time.

Based on the doctor who conducted the operation, you may be required to wear a sling once the operation has been completed. This should be the case for longer than a day or so, so you do not have to worry about being on the sidelines for too long. Should the insertion site be sore, your doctor may administer some pain medication to you should they deem it necessary to do so.

Once you have recovered, an x-ray is generally done in order to determine whether or not your lungs and heart are stable. This is a crucial step in the recovery process, as it ensures that there are no potential risks of you experiencing any issues with the placement of the device. Your doctor should regularly visit your hospital room in order to check up on you and make certain that you are doing well. Patients should ask their doctor any questions that they have regarding the device so that they are aware of how to properly look after both themselves and the device once they leave the hospital.

Once your blood pressure, breathing, pacing, and heart rhythm are all stable, and you are alert and aware of everything that is going on around you, you may be taken to a hospital room where you do not need to be constantly monitored.

Should you be an outpatient, you may be allowed to leave after you have completed the recovery process; however, it is common to spend at least a single night in the hospital after having the procedure completed in order to ensure that you are healthy and that there are no complications that could possibly affect you.

How Long Do Defibrillator Batteries Last For?

In general, the lifespan of a defibrillator battery is about six to eight years. This depends on how much energy it uses in order to regularly pace the heart, and also varies based on whether the device needs to apply a shock to the heart of the patient. Every device has an indicator that is able to signal to the patient when there are about three months of battery life remaining. This allows for patients to organize an appointment with their doctor to have the batteries changed. A battery change for a defibrillator is an outpatient procedure that generally takes about an hour to complete. When your doctor replaces the batteries, the procedure that they follow generally consists of them:

• Disconnecting the wires from the device
• Changing the generator and battery
• Reconnecting the wires and placing the generator back in place

The Bottom Line

Should you have any serious heart complications, you should not worry too much, as the implantation of an ICD can do wonders for your health. The placement of the device is in your chest so that it can be as close to the heart as possible; however, the placement does vary based on the patient. Regardless, you can be assured that your doctor is going to do the best that they can to accommodate your specific needs and ensure that you get the best possible treatment.