The ICD Implantation Procedure: What to Expect Before, During, and After
Undergoing an ICD (Implantable Cardioverter Defibrillator) implantation can feel like a big step, and it's completely normal to have a lot of questions and even a few worries. You're not alone in this, and we understand that clarity and support can make all the difference. This guide is here to walk you through every stage of the ICD implantation procedure, from your preparations at home right through to your recovery. We'll explain what to expect before you arrive at the hospital, what happens during the procedure itself, and how to look after yourself in the days and weeks that follow. Our aim is to provide you with all the information you need, helping you feel more prepared and confident about the journey ahead.
Getting ready for your ICD implantation actually begins well before you step through the hospital doors. There are several important steps and considerations that your medical team will discuss with you, all designed to ensure you're as prepared and safe as possible for the procedure.
Pre-Admission Appointments and Tests
You'll usually have a pre-admission appointment a few days or weeks before your implantation. This is a really important opportunity for the healthcare team to gather all the necessary information about your health.
Reviewing Your Medical History: The doctor or nurse will go through your complete medical history. They'll ask about any existing health conditions you have, past surgeries, and any allergies. It's vital to be as thorough as possible here.
Current Medications: They'll want a full list of all medications you're currently taking, including prescription drugs, over-the-counter medicines, herbal remedies, and supplements. This is incredibly important because some medications, particularly blood thinners (anticoagulants), might need to be stopped or adjusted for a short period before the procedure to reduce the risk of bleeding. Your doctor will give you very specific instructions about which medications to stop and when. Never stop taking any prescribed medication without explicit advice from your healthcare provider.
Physical Examination: A physical examination will be carried out to check your general health. This might include listening to your heart and lungs, checking your blood pressure, and assessing your overall physical condition.
Blood Tests: You'll have blood tests to check your blood count, kidney function, and blood clotting ability. These tests help ensure you're healthy enough for the procedure and help the team plan for any potential issues.
ECG (Electrocardiogram): An ECG records the electrical activity of your heart and is a standard part of any cardiac assessment.
Chest X-ray: A chest X-ray provides an image of your heart and lungs, helping the doctors to see their size and position, which is useful for planning the ICD placement.
Echocardiogram: This is an ultrasound scan of your heart that shows its structure and how well it's pumping. It gives your medical team detailed information about your heart's function.
Preparing at Home
Once you've had your pre-admission checks, there are things you can do at home to prepare for your hospital stay and recovery.
Arranging Transport: You won't be able to drive yourself home after the procedure, so it's a good idea to arrange for a friend or family member to pick you up. If this isn't possible, discuss transport options with the hospital staff.
Packing Your Hospital Bag: Pack comfortable clothing, toiletries, any personal items that will make your stay more comfortable, and a list of your current medications (even if you've given it to them before, it's good to have it handy). Don't forget your reading glasses, a book, or anything else to help pass the time.
Understanding Fasting Instructions: You will be given strict instructions about when to stop eating and drinking before your procedure. It's usually from midnight the night before. This is crucial for your safety during the sedation or anaesthetic. If you don't follow these instructions, your procedure might have to be delayed or cancelled.
Showering: You may be asked to shower with an antiseptic soap the night before or the morning of the procedure. This helps to reduce the risk of infection.
Removing Jewellery and Valuables: It's best to leave all valuable jewellery and unnecessary items at home. You'll need to remove all metal objects, including piercings, before the procedure.
Questions to Ask: This is a good time to write down any questions you have. Don't hesitate to ask your medical team; they are there to help alleviate your concerns. Knowing what to expect can significantly reduce anxiety.
Understanding the "Why" and "How"
It's important to have a clear understanding of why you're having an ICD fitted. While this guide focuses on the procedure itself, a brief reminder of its purpose can be reassuring. An ICD is a small device implanted under the skin, usually in your chest, that monitors your heart rhythm continuously. If it detects a dangerously fast or irregular heartbeat, it can deliver an electrical impulse or shock to restore a normal rhythm, preventing serious complications. It's essentially a guardian for your heart, there to protect you.
The Day of Your Procedure: What to Expect in the Hospital
The day of your ICD implantation can feel a bit overwhelming, but knowing the routine can help. From the moment you arrive until you're ready for the operating room, the hospital staff will guide you through each step.
Arrival and Admissions
Checking In: When you arrive at the hospital, you'll check in at the admissions desk. You'll be directed to the ward or department where you'll be prepared for your procedure.
Welcome to the Ward: A nurse will welcome you, confirm your identity, and take you to your bed area. They'll explain the routine for the day and answer any immediate questions you might have.
Further Checks: The nurse will carry out some routine checks, including your blood pressure, heart rate, temperature, and oxygen levels. They'll also review your medical history and medication list one last time to ensure everything is up to date and correct. This is also when they'll confirm that you've followed the fasting instructions.
Pre-Procedure Preparations
There are several steps the nursing team will take to get you ready for the operating theatre.
Changing into a Gown: You'll be asked to change into a hospital gown. This is standard procedure for any operation.
Personal Belongings: You'll be advised where to store your clothes and personal belongings safely. It's best to keep valuables with a family member or send them home if possible.
Hair Removal: The area where the ICD will be implanted, usually on the upper chest or just below the collarbone, will need to be prepared. This often involves carefully shaving a small patch of hair to ensure the area is clean and to allow the surgical team clear access. This minimises the risk of infection.
Skin Cleaning: The skin around the implantation site will be thoroughly cleaned with an antiseptic solution. This is a crucial step to prevent infection.
Intravenous (IV) Line Insertion: A small needle will be inserted into a vein in your arm or hand. This is called an IV line or cannula. It's used to give you fluids, medication, and the sedative before, during, and after the procedure. You might feel a brief sting as the needle goes in, but it shouldn't be painful afterwards.
Meeting Your Care Team: Before you go to the operating room, you'll meet various members of your care team.
The Cardiologist/Electrophysiologist: This is the heart specialist who will be performing your ICD implantation. They will explain the procedure again, answer any remaining questions, and obtain your final consent.
The Anaesthetist or Sedation Nurse: You'll also meet the person responsible for your comfort during the procedure. They'll discuss the type of sedation you'll receive and explain how it will help you relax and feel comfortable.
Nurses and Other Staff: Other members of the team, like the theatre nurses, might introduce themselves.
Administering Sedation
To ensure you're as relaxed and comfortable as possible during the procedure, you'll be given sedation.
Local Anaesthetic and Sedation: The ICD implantation is typically performed under local anaesthetic, meaning the area where the device is implanted will be numbed, so you won't feel any pain there. In addition, you'll receive a mild sedative through your IV line. This isn't a general anaesthetic that puts you completely to sleep, but rather a medication that makes you feel very drowsy, relaxed, and often a little sleepy. You might drift in and out of sleep, and you might not remember much of the procedure afterwards, which is completely normal.
Why Sedation?: The sedation helps to reduce anxiety and discomfort. While the local anaesthetic ensures you don't feel pain at the incision site, the sedation ensures you're calm and relaxed throughout. This also helps you to lie still, which is important for the surgeon.
How it Feels: You'll feel the medication slowly working as you become more relaxed and perhaps a little disoriented. Your anaesthetist or nurse will monitor you closely throughout to ensure you're comfortable and safe.
This preparatory stage is all about making sure you're physically and mentally ready. The team will do everything they can to ensure your comfort and safety.
During Your ICD Implantation: The Procedure Explained
Once you're in the operating room, the team will ensure your comfort and begin the procedure. While it might sound daunting, understanding the steps can help demystify the process.
In the Operating Room
Positioning: You'll be asked to lie down on a special operating table. The team will help you get into a comfortable position, usually on your back, and may use straps or cushions to help you stay still during the procedure.
Monitoring: Once positioned, several monitoring devices will be attached to you.
ECG Electrodes: Sticky pads will be placed on your chest, arms, and legs to continuously monitor your heart's electrical activity. This allows the team to see your heart rhythm in real-time on a screen.
Blood Pressure Cuff: A cuff will be placed around your arm to regularly check your blood pressure.
Pulse Oximeter: A small clip will be placed on your finger to measure the oxygen levels in your blood.
These monitors are all standard and harmless; they just help the team keep a close eye on your vital signs throughout the procedure.
Sterile Environment: The area where the ICD will be implanted will be thoroughly cleaned again with an antiseptic solution. Sterile drapes will be placed over you, covering everything except for the small area where the doctor will be working. This is to maintain a sterile field and prevent infection. You'll still be able to breathe comfortably under the drapes.
Local Anaesthetic Application: Before the procedure begins, the doctor will inject local anaesthetic into the skin and tissues around the implantation site. This will completely numb the area. You might feel a sharp sting or burning sensation as the anaesthetic is injected, but this quickly passes, and after that, you shouldn't feel any pain during the procedure itself. You might still feel pressure or tugging, but no sharp pain.
The Implantation Process
The actual implantation of the ICD involves two main parts: placing the leads (wires) into your heart and then connecting them to the device itself, which is placed under your skin.
Creating the Pocket: The doctor will make a small incision, usually about 5-8 centimetres long, in the skin just below your collarbone, typically on the left side, though sometimes the right. This incision will be carefully made through the layers of tissue to create a small "pocket" under your skin or muscle. This pocket is where the ICD device will sit.
Accessing the Vein: The doctor will then carefully locate a large vein in the upper chest, usually the subclavian vein or cephalic vein. They'll use a special needle to access this vein.
Inserting the Leads: This is a crucial part of the procedure. One or more thin, insulated wires, called "leads," will be carefully guided through the accessed vein and threaded down into the chambers of your heart. The number of leads depends on the type of ICD you're receiving (e.g., one lead for a single-chamber device, two for a dual-chamber, or three for a biventricular device if you're also having cardiac resynchronisation therapy).
Guidance with X-rays: Throughout this process, the doctor uses a special X-ray machine (fluoroscopy) to visualise the leads' path and ensure they are positioned correctly within your heart chambers. You won't feel anything during this part, but you might see the X-ray screen or a shadow of the equipment.
Securing the Leads: Once the leads are in the correct position, a small screw-like tip at the end of each lead is gently anchored into the heart muscle. This ensures the leads stay in place.
Testing the Leads: The leads are then tested to ensure they are working properly. This involves sending tiny electrical impulses through them to check how well they can sense your heart's rhythm and how effectively they can pace the heart if needed. You might be asked to take a deep breath or hold your breath during these tests, but you won't feel pain. Sometimes, during lead testing, you might feel a brief, very fast heartbeat or a slight flutter, but this is normal and short-lived.
Connecting and Placing the ICD:
Once the leads are successfully placed and tested, they are connected to the ICD device itself.
The ICD device is a small metal box, about the size of a pocket watch. It's then carefully inserted into the pocket that was created under your skin or muscle.
Final Testing: With the device and leads in place, the team will perform some final tests. They might induce a very brief, controlled abnormal heart rhythm to ensure the ICD correctly detects it and delivers a therapy (either a low-energy impulse or a higher-energy shock) to restore a normal rhythm. This is a vital safety test, confirming the ICD is working as intended. While you are sedated and the area is numb, you may still feel a sensation if a higher energy shock is delivered, but it is very brief. This part of the test is carefully controlled and closely monitored.
Closing the Incision: Once all tests are complete and the team is satisfied with the device's function, the doctor will close the incision. This is usually done with dissolvable stitches under the skin and then either skin glue or non-dissolvable stitches or staples on the surface. A sterile dressing will be applied to the wound.
The entire procedure typically takes between one to three hours, though it can vary depending on the complexity and the number of leads being implanted. Throughout, the team will be talking to you (even if you're drowsy), monitoring your comfort, and keeping you safe.
Immediately After Your ICD Implantation: Recovery in Hospital
The moment your ICD is implanted, a new phase of care begins. Your immediate recovery will happen in the hospital, where the medical team can closely monitor you.
Coming Round from Sedation
Transfer to Recovery: After the procedure is complete, you'll be gently moved from the operating table to a recovery area or back to your ward bed.
Drowsiness and Disorientation: As the sedation wears off, you'll likely feel very drowsy and a bit disoriented. It's common to drift in and out of sleep. This is completely normal, and the nurses will be there to ensure your comfort and safety.
Monitoring Continues: Your vital signs – heart rate, blood pressure, oxygen levels, and temperature – will continue to be monitored closely. The nurses will regularly check the dressing on your incision site for any bleeding or swelling.
Pain Management: Once the local anaesthetic starts to wear off, you might begin to feel some discomfort or mild pain at the incision site. Please tell your nurse if you're in pain, as they can give you pain relief medication. It's much easier to manage pain if it's addressed early.
Initial Hours Post-Procedure
Rest and Immobility: For the first few hours, you'll be encouraged to rest quietly. You might be asked to limit movement of the arm on the side where the ICD was implanted. This helps to prevent the newly placed leads from dislodging, which is known as lead displacement. The nursing staff will guide you on how much movement is safe.
Fluids and Food: Once you're fully awake and feeling less nauseous (which can sometimes be a side effect of sedation), you'll gradually be offered sips of water, then light food. Start slowly and see how you feel.
Checking the Incision Site: Nurses will regularly check your incision site. It's common to see a small amount of bruising or swelling around the area. This is generally normal, but they'll be looking for anything unusual.
Chest Discomfort: Some people report feeling a dull ache or pressure in their chest, which is usually related to the lead placement and the healing process. Again, pain relief can help with this.
First Evening/Overnight Stay
Observation: You'll typically stay in the hospital overnight for observation. This allows the medical team to continue monitoring your heart rhythm and general condition.
ICD Function Check: Before you're discharged, the ICD will be checked again using a special programmer. This non-invasive check ensures the device is functioning correctly and is programmed optimally for your specific needs. It's a quick and painless process.
Lead Displacement Precautions: You'll be given specific instructions on how to move your arm and shoulder on the side of the implant to protect the leads. This usually involves avoiding raising your arm above shoulder height or making vigorous movements for several weeks. This is to allow scar tissue to form around the leads, securing them in place. The nursing staff will demonstrate safe movements.
Early Mobilisation: Once stable and comfortable, you'll be encouraged to get out of bed and take short walks around the ward. Gentle movement is good for recovery and helps prevent complications like blood clots.
Information and Questions: The nurses will provide you with information about wound care, medication, and what to expect during your recovery at home. This is another excellent opportunity to ask any questions you have.
The hospital stay is a vital part of your recovery, allowing for close monitoring and ensuring the initial healing process gets off to the best start. The team is there to support you every step of the way.
Caring for Your Incision and Early Recovery at Home
Leaving the hospital with your new ICD is a significant milestone. While you'll be feeling much better, the recovery process continues at home, with a focus on caring for your incision and gradually returning to your normal activities.
Incision Care
Proper care of your incision site is paramount to prevent infection and ensure good healing.
Keeping it Dry: You'll usually be advised to keep the incision site dry for the first 5-7 days after the procedure. This often means sponge baths instead of showers, or carefully covering the area with a waterproof dressing if you do shower, as advised by your nurse. Do not soak the wound in a bath until it's fully healed.
Dressing Changes: You'll likely leave the hospital with a sterile dressing over your incision. Follow the instructions given by your nurse about when and how to change this dressing. Some dressings are designed to stay on for several days, while others might need to be changed daily. Always wash your hands thoroughly with soap and water before and after touching the dressing.
Monitoring for Infection: It's really important to keep a close eye on your incision for any signs of infection. These include:
Increased redness or warmth around the incision.
Swelling that gets worse.
Pus or fluid discharge from the wound.
Increasing pain at the site.
Fever or chills.If you notice any of these signs, contact your hospital or GP immediately. Don't wait.
Sutures or Staples: Your incision might be closed with dissolvable stitches under the skin, or non-dissolvable stitches or staples on the surface. If you have non-dissolvable stitches or staples, you'll be given an appointment to have them removed, usually by a practice nurse at your GP surgery, about 7-10 days after your procedure.
Bathing and Creams: Once the incision is fully healed and closed (usually after 10-14 days), you can usually return to showering normally. Avoid applying any creams, lotions, or ointments directly to the incision site until it's completely healed, unless specifically instructed by your doctor.
Scarring: Over time, the incision will heal, leaving a small scar. This will gradually fade, but it will always be there. Protecting the scar from direct sunlight for the first year is important, as sunlight can make the scar more prominent.
Managing Pain and Discomfort
Expected Discomfort: It's normal to experience some pain, soreness, or tenderness around the incision site for several days or even a couple of weeks after the procedure. You might also feel some bruising and swelling.
Pain Relief: Over-the-counter pain relievers like paracetamol (acetaminophen) or ibuprofen can help manage this discomfort. Your doctor or nurse will advise you on what's safe to take, especially if you're on other medications. Take pain relief as prescribed or advised; don't wait for the pain to become severe.
Shoulder and Arm Discomfort: You might also feel some discomfort or stiffness in your shoulder and arm on the side of the implant. This is normal and related to the muscle manipulation during the procedure. Gentle, advised arm movements can help, but always adhere to your lead precautions.
Activity Restrictions and Precautions
The most critical aspect of early recovery is protecting the newly implanted leads until they are securely anchored by scar tissue.
Arm and Shoulder Movement: For the first 4-6 weeks (or as advised by your medical team), you must limit specific movements of the arm on the side of your ICD.
Avoid raising your arm above shoulder height. This means no reaching for high shelves.
Avoid vigorous arm movements such as pushing, pulling, lifting heavy objects (anything heavier than a kettle of water), or repetitive arm movements like vacuuming or gardening.
No stretching or sudden jerking movements of the arm.
Do not extend your arm fully behind you, for example, when reaching for a seatbelt.
These precautions are extremely important to prevent the leads from dislodging, which could require another procedure to reposition them.
Driving: You will not be allowed to drive for a specific period after your ICD implantation. In the UK, this is typically one month for a standard ICD implantation if you hold a Group 1 license (car or motorcycle). If you have a Group 2 license (bus, coach, or lorry), the restrictions are much longer, potentially six months to a year, and often depend on the underlying heart condition and if you've experienced any shocks. Always follow the specific advice given by your cardiologist and the DVLA guidelines. You must inform the DVLA (Driver and Vehicle Licensing Agency) about your ICD implantation.
Returning to Work: When you can return to work will depend on the nature of your job. If your job involves heavy lifting or strenuous arm movements, you might need more time off. Discuss this with your doctor. Most people return to light duties within 2-4 weeks.
Sexual Activity: You can usually resume sexual activity when you feel comfortable. Gentle movements are generally safe. If you have concerns, talk to your doctor or nurse.
Follow-Up Appointments
First Check-Up: You'll have a follow-up appointment, usually within a few weeks of your discharge. During this appointment, the doctor or nurse will check your incision, review your recovery, and perform a full check of your ICD using the programmer. They'll ensure the device is working correctly and make any necessary adjustments to its settings.
Remote Monitoring: Many ICDs now offer remote monitoring, where the device can send information about your heart rhythm and ICD function directly to your clinic via a home monitor. Your team will explain if this is available to you and how it works.
Early recovery is a time for patience and gentle care. Listen to your body, follow all instructions from your medical team, and don't hesitate to contact them if you have any concerns.
Life After Your ICD Implantation: Looking Ahead
An ICD implantation is a significant event, but it's also a starting point for a life where your heart is continuously monitored and protected. Adapting to life with an ICD involves understanding ongoing care, potential sensations, and knowing where to find support.
Understanding ICD Shocks
It's natural to be concerned about the possibility of receiving a shock from your ICD. It's important to understand what a shock means and what to do if one occurs.
Purpose of a Shock: An ICD delivers a shock (defibrillation) only when it detects a dangerously fast or irregular heart rhythm (ventricular tachycardia or ventricular fibrillation) that could be life-threatening. Its job is to reset your heart's rhythm back to normal.
What a Shock Feels Like: People describe ICD shocks differently. Some describe it as a sudden, hard thud or kick in the chest, like being hit by a horse, or a sudden jolt. It's a very brief sensation, usually lasting less than a second. It can be uncomfortable or even painful, but it passes very quickly. You might feel dizzy or lightheaded just before or after a shock.
What to Do if You Receive a Shock:
Stay Calm: While it can be frightening, try to remain as calm as possible.
Sit Down or Lie Down: If you receive a shock, sit or lie down immediately.
Inform Someone: If someone is with you, tell them you've received a shock.
Call Your Clinic/Emergency Services:
If you receive a single shock and feel well afterwards: Contact your ICD clinic or hospital as soon as possible, within 24 hours. They will likely want you to come in for an urgent device check.
If you receive multiple shocks (more than one shock in a short period), if you lose consciousness, or if you feel unwell after a shock: Call for an ambulance (999 in the UK) immediately. This indicates a more serious rhythm problem that needs urgent medical attention.
"Phantom" Shocks: Some people occasionally report feeling as though they've had a shock when they haven't. This can be due to anxiety or muscle twitching. If you're unsure, it's always best to contact your clinic.
Fear of Shocks: It's completely normal to feel anxious about potential shocks. Discuss these feelings with your medical team. They can offer reassurance and strategies to cope. Remember, the ICD is there to save your life, and a shock means it's doing its job.
Having an ICD usually means you can return to most of your normal activities, but there are a few things to be aware of.
Electromagnetic Interference (EMI): Most everyday electrical devices are safe to use. However, some items that produce strong electromagnetic fields can temporarily interfere with your ICD.
Safe Devices: Most household appliances (microwaves, TVs, radios, computers, hair dryers), electric blankets, and mobile phones (keep at least 15cm/6 inches away from the ICD, use the opposite ear) are generally safe.
Items to Use with Caution/Avoid:
Magnets: Strong magnets can temporarily turn off your ICD. Keep magnets (including some speakers, magnetic closures on bags, or therapy magnets) away from your chest.
Power Tools: Tools like arc welders, chain saws, or powerful drills can sometimes create EMI. If you use them, maintain distance and talk to your doctor.
Metal Detectors: Walk through airport security gates at a normal pace and avoid lingering. Inform security staff about your ICD. You may request a manual pat-down instead of a wand detector, as the wand can temporarily interfere if held directly over your device. You'll receive an ICD identification card to show security personnel.
Medical Procedures: Always inform any healthcare professional (dentist, other specialists) that you have an ICD before any procedure, especially if it involves electrocautery, MRI (many modern ICDs are MRI-compatible, but it needs checking), or radiation therapy.
Exercise and Activity: Once your incision has fully healed and the lead precautions are lifted (usually after 4-6 weeks), your doctor will advise you on suitable exercise. Most people can return to regular activities, but contact sports or activities that involve heavy impact to the chest area (like rugby or certain forms of martial arts) might need to be avoided. Always discuss your exercise plans with your cardiologist.
Follow-Up Care: Regular follow-up appointments with your cardiologist or ICD clinic are essential. These checks, typically every 6-12 months (or more frequently if needed), ensure your device is working optimally and its battery life is monitored. The battery usually lasts 5-10 years, and a replacement procedure will be scheduled when it runs low.
Support Groups and Emotional Well-being: Adjusting to an ICD can have emotional impacts. It's normal to feel anxiety, fear, or even depression. Talking about your feelings with family, friends, or a counsellor can be very helpful. Many heart charities and hospitals offer support groups where you can connect with others who have similar experiences.
Continuing Your Journey: Support and Resources
We understand that having an ICD means carrying vital medical information. While this guide has focused on the procedure itself, knowing that your medical details are accessible in an emergency can bring immense peace of mind. Our range of ICD Medical ID Cards are designed to clearly display your condition and emergency contacts, ensuring that first responders and medical professionals have the critical information they need quickly. We offer various styles and designs to suit your preference, all created with clarity and durability in mind.
Resources and Further Support:
British Heart Foundation (BHF): A leading UK heart charity providing extensive information, support, and resources for people with heart conditions. Visit their website at www.bhf.org.uk or call their Heart Helpline.
Pumping Marvellous Foundation: The UK's patient-led heart failure charity, offering support and resources for people living with heart failure, which often goes hand-in-hand with ICD implantation. Visit www.pumpingmarvellous.org.
Your ICD Clinic/Hospital Team: Always your primary point of contact for any specific questions about your device, your recovery, or your health. They are the experts in your individual care.
NHS Website: Provides general information about ICDs and other heart conditions: www.nhs.uk.
Remember, you're not on this journey alone. There's a wealth of support and information available to help you live well with your ICD.
