During the Procedure

A implanted cardioverter defibrillator insertion may be performed on an outpatient basis or as part of your stay in a hospital. Procedures may vary depending on your condition and your physician's practices. The operation to implant the device takes about one hour.

How is implantation performed?

The procedure is performed in the electrophysiology laboratory, in the cardiac catheterization laboratory by two electrophysiologists. The patient may be given either sedation or general anesthesia.  You will be placed under the care of an anesthesiologist who will give you medication to help you relax during the procedure. A local anesthetic will be given at the site of the ICD implant, usually beneath the skin on the left side of the upper chest.

After the area is numb, the physician will create a "pocket" or space for the generator. Access to the vein under the collar bone is obtained and one or more leads (thin wire-like tubes) are advanced to the heart. The lead system will be placed in your heart, through a vein in your upper chest and guided into position with the assistance of fluoroscopy (X-ray).

Once the lead is secured in place, it is attached to the generator. While you are asleep, the device is programmed and tested to be certain that it treats your fast arrhythmia. In most cases, testing of the ICD will be performed consisting of producing a serious ventricular arrhythmia called ventricular fibrillation and observing the ICD detect and convert it with a shock.

The three inch incision will then be sutured and a dressing will be placed over it. The entire procedure will last from two to four hours.

Generally, an ICD insertion follows this process:

  1. You will be asked to remove any jewelry or other objects that may interfere with the procedure.
  2. You will be asked to remove your clothing and will be given a gown to wear.
  3. You will be asked to empty your bladder prior to the procedure.
  4. An intravenous (IV) line will be started in your hand or arm prior to the procedure for injection of medication and to administer IV fluids, if needed.
  5. You will be placed in a supine (on your back) position on the procedure table.
  6. You will be connected to an electrocardiogram (ECG or EKG) monitor that records the electrical activity of the heart and monitors the heart during the procedure using small, adhesive electrodes. Your vital signs (heart rate, blood pressure, breathing rate, and oxygenation level) will be monitored during the procedure.
  7. Large electrode pads will be placed on the front and back of the chest.
  8. You will receive a sedative medication in your IV before the procedure to help you relax. However, you will likely remain awake during the procedure.
  9. The ICD insertion site will be cleansed with antiseptic soap.
  10. Sterile towels and a sheet will be placed around this area.
  11. A local anesthetic will be injected into the skin at the insertion site.
  12. Once the anesthetic has taken effect, the physician will make a small incision at the insertion site.
  13. A sheath, or introducer, is inserted into a blood vessel, usually under the collarbone. The sheath is a plastic tube through which the ICD lead wire will be inserted into the blood vessel and advanced into the heart.
  14. It will be very important for you to remain still during the procedure so that the catheter placement will not be disturbed and to prevent damage to the insertion site.
  15. The lead wire will be inserted through the introducer into the blood vessel. The physician will advance the lead wire through the blood vessel into the heart.
  16. Once the lead wire is inside the heart, it will be tested to verify proper location and that it works. There may be one, two, or three lead wires inserted, depending on the type of device your physician has chosen for your condition. Fluoroscopy, (a special type of x-ray that will be displayed on a TV monitor), may be used to assist in testing the location of the leads.
  17. Once the lead wire has been tested, an incision will be made close to the location of the catheter insertion (just under the collarbone). You will receive local anesthetic medication before the incision is made.
  18. The ICD generator will be slipped under the skin through the incision after the lead wire is attached to the generator. Generally, the generator will be placed on the non-dominant side. (If you are right-handed, the device will be placed in your upper left chest. If you are left-handed, the device will be placed in your upper right chest).
  19. The ECG will be observed to ensure that the pacer is working correctly.
  20. The skin incision will be closed with sutures, adhesive strips, or a special glue.
  21. A sterile bandage/dressing will be applied.

Clinics for During the procedure