Your implantable cardioverter-defibrillator implant

An Implantable Cardioverter-Defibrillator (ICD) is a device (like a big pacemaker) that monitors the heart’s rhythm to detect and treat dangerous fast heart rhythms. These rhythms are ventricular tachycardia (VT) and ventricular fibrillation (VF). The device does not stop these abnormal rhythms starting.

VT and VF are abnormal heart rhythms that come from the main pumping chambers of the heart. These rhythms can cause palpitations, black-outs, shortness of breath and can result in the heart being unable to pump blood.

In many ways, an ICD is like a pacemaker in that it will stop your heart going too slowly. However, because it is also designed to treat VT and VF, they are slightly larger than a normal pacemaker.

How does the ICD treat VT and VF?

There are 2 ways that the ICD treats VT and VF:

1. If the VT is not too rapid, it can pace the heart quickly to try and re-gain control. This can be very successful in stopping VT and you may not even be aware that it had occurred.
2. VF and very fast VT are treated by an electric shock. The shock is delivered by the device direct to the heart. A shock, although very brief, can be uncomfortable.

What happens before the procedure?

You will need to attend pre-assessment clinic beforehand. This will be done either in the Cardiac Catheter lab or in a pacing pre assessment clinic.

Female patients

If you are or think you might be pregnant please ring the Catheter lab on 020 8321 2618. For women aged up to 56 years, a pregnancy test will be carried out on your arrival on the day of your procedure.

Eating and drinking

Please follow the instructions given in your confirmation letter about when to eat and drink before your appointment. It is important that you stick to these. We will remind you of the times in your pre assessment.

Medication

For your pre admission appointment we will ask you to bring in a list of all your current medications. We will then advise you of any medications you need to stop before the procedure.

Warfarin and other anticoagulants

You may need to stop taking warfarin or other anticoagulants (such as apixaban, rivaroxaban, edoxaban or dabigatran) before your procedure. This depends on the type of procedure planned and your specific medical history; your Consultant will discuss this with you.

On the day of your procedure please take the rest of your medication. As the procedure may take an hour you may prefer to take your diuretic (water tablets) after the procedure.

Please bring all of your medication with you (including your diabetic medication or other specialist inhalers or creams).

Preparing to come to hospital

Shaving- Please do not shave or remove the hair from your chest, arms or legs before coming to hospital. If needed, this will be done for you in hospital.

Hygiene- It is important to have a shower or bath before coming into hospital. Please ensure your nail polish is removed and that you are not wearing lots of make-up.

As you will be in hospital for at least 6 hours, please make sure you bring something to read or listen to with headphones. You will also need to bring slippers and a dressing gown. You will need loose clothing to go home.

Coming in to hospital

Please arrive promptly as stated the time on your letter. A number of tests will happen when you arrive so you are ready for your pacemaker. These will be done by the nurse. You may need to repeat some of the questions asked in the pre assessment.

After this one of the specialist heart doctors performing the test will come and see you to consent you for the procedure. They will explain the risks and the benefits of the test and what it entails. You will receive an information booklet detailing this information prior the procedure. Please take the time to read this before you attend.

We will try not to keep you waiting but sometimes this cannot be avoided. We are the only catheter suite in the hospital so if there are emergencies, there can be delays to your case. We will do our best to keep you up to date and will always be happy to discuss things if you have concerns.

During the procedure

You will be brought into the catheter lab by one of the members of the team. In the room you will meet the team looking after you - nurses, radiographer, physiologists and doctors.

You’ll be asked to lie on the x-ray table, and one of the team will stick ECG stickers on you. Each member of the team will introduce themselves and explain their role in the lab. A safety check will be carried out and you will hear your name and other information about the case. You will also notice that all staff are wearing hats and facemasks - this is completely normal.

Once the team are ready, we will expose the shoulder where the ICD will be inserted. This will be cleaned with a sterile liquid which is very cold. Lots of drapes will be draped over you and your face maybe covered whilst we set up, but this soon will be removed.

The doctor will inject local anaesthetic (usually below your collar bone) and make a small cut. You might feel some pressure but no pain.

The leads will be passed through a main vein in the chest and into the heart. The leads are secured in position and checked to ensure they are working correctly.

The wound is then closed using stitches and a special type of medical glue.

After the procedure

After the test, we will take you back to the day ward, where you will be able to have some food and drink when you feel ready.

After 4 hours you will have a chest x-ray and a final check on your ICD before you go home. The cardiac physiologists will spend some time with you going through your pacemaker, your ICD Identification (ID) card and what to do.

After these tests the doctor will review all of these and come and speak to you.

Going home

Most patients are able to go home on the day of the test.

You will be given lots of information before you leave. One vital piece of information will be your pacemaker’s ID card. You will need to make sure you have this with you at all times.

Before you go home, we will ask you to walk up and down the ward a few times just to make sure you are okay. You will need someone to take you home and stay with you over night. 

Looking after your wound

There may be a small amount of swelling over the pacemaker and you will develop a small scar under the collar bone.

The area will be sore for a couple of days and you may notice a bruise.

You should keep your wound dry and clean until it is healed. A dressing may have been applied; you can take this off after 3 days.

The glue is waterproof and will flake off by itself after about 5 to 10 days. Do not wet the area for 2 days after the procedure; after 2 days you can wet the wound briefly in the shower.

Getting back to normal

Once you get home, please rest for the rest of the day but keep moving your arm gently to prevent your shoulder becoming stiff. Do not raise your arm above your shoulder.

For 4 weeks avoid putting strain on the wound so you will need to avoid lifting heavy objects and taking part in sports.

You will receive an appointment for another Pacing Check in clinic. This will be around 4 to 6 weeks after your implant.

You should immediately contact us if you experience the following:

• A fever or Chills
• The wound becomes red or sore
• There is discharge from the wound
• Fainting/ Light headedness
• Breathlessness
• Chest Pain
• Thumping in the chest

Please call the Cardiac Catheter Lab (8am to 6pm, Monday-Friday) on 020 8321 2618. At other times, please call Coronary Care Unit on: 020 8321 6944/6582.

Work

You should be able to return to work after the wound has healed and it feels comfortable. People recover at different times so please discuss 

this with your Team. Having an ICD case might affect your profession; the team will explain this to you.

Driving

The DVLA rules are revised periodically.  Please visit the DVLA website to view the most up to date guidance.  Guidelines also include details of when you should inform the DVLA of your heart condition and how to do so. However in brief:

• Implantation of an ICD means that you cannot hold a vocational (group 2) driving licence.
• If you have an ordinary driving licence then you must not drive for:

1. six months if your ICD was implanted following an episode (or presumed episode) or VT or VF. You must also inform the DVLA.
2. one month if the ICD was implanted for purely preventative reasons (i.e. your doctor thinks you may be at risk of VT or VF but have not had an event yet). In this case you do not need to inform the DVLA.

NOTE: IF YOU RECEIVE SHOCKS FROM YOUR DEVICE THE DVLA WILL IMPOSE ANOTHER PERIOD OF A DRIVING BAN.

Sport

Being active is good for your health but it is advised that you do not play contact sports. Please discuss this with your specialist cardiac team.

Complications

With all procedures there is a small amount of risk, the cardiologists will weigh all the information and speak to you about these before the procedure.

Common complications include:

• Bruising around the wound will affect about twenty people in a hundred but will only affect about one of those seriously. This might delay your discharge home or require further treatment. The lump will gradually disappear and does not normally require any treatment.
• Displacement (movement) of the lead(s) in the heart. If this happens you will need to return, so that the leads can be put back where they should be. This complication occurs in about three in a hundred cases for upper chamber leads and about one in a hundred for lower chamber leads.

Rare complications include:

• A small pneumothorax (An area of your lung may collapse). In most cases this will fix itself. However, in some cases, it may be necessary to insert a chest drain to remove the air. This affects around one person in a hundred who has this procedure.
• Fluid in the lining of the heart may occur when one of the pacing wires goes through the wall of the heart. In most cases no harm is done but, at times, the fluid may need to be drained away. Fluid may be seen in about five in a thousand cases but drainage is only needed in one in a thousand cases.

Later complications can include:

• Infection of the pacemaker and the wires. This may result in the whole pacemaker system needing to be removed. This happens in less than one in a hundred cases. Antibiotics are usually given to counteract this at the time the pacemaker is inserted.
• Lead displacement (movement) or fracture happens when the pacemaker wire/lead becomes detached from the lining of the heart or breaks. This means that not all the power from the battery can reach the heart. This can cause the battery to run down early, or a lead fracture, which causes a break in the electrical connections. This happens in about four in a thousand cases each year. However, these problems can usually be detected in the pacing clinic before they cause any harm.
• Skin erosion or ‘tethering’ means that the skin gathers over the pacemaker site or occasionally the stitch line re-opens. These complications affect about five in a thousand cases. Both complications may be related to a low grade infection, meaning that an urgent visit to the pacing clinic is needed.

Please feel free to ask your doctor about any of these complications. Please remember that the risks of a procedure are always balanced by the potential benefits.

Contact details:

Cardiac Catheter lab: 020 8321 2618
Monday to Friday 8am to 6pm

Coronary Care Unit: 020 8321 6944/ 6582