Defibrillators What to Expect If You Need an ICD or WCD

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Talk with your healthcare provider about whether a defibrillator is right for you based on your health and other factors. The conversation will likely include the following topics:

• Types of defibrillators
• Medicines that may help you
• Other heart treatments (including ablation ) you have had in the past
• Pacemaker therapy and whether you need it
• Other health conditions you have

Discussions with your provider should cover the benefits and risks of cardioverter defibrillators. Watch for signs of complications.

When you talk with your healthcare provider about surgery to place an ICD, be sure you understand what to expect before, during, and after the surgery.

Before you have surgery to implant an ICD, your provider will review the list of prescription and over-the-counter medicines and supplements you take. They may tell you to stop taking certain ones. Discuss any over-the-counter medicines or supplements you take. You will be asked to avoid eating or drinking for a few hours before the procedure.

The surgery is usually done in a hospital. Before the surgery, you will receive medicines to relax you and numb the area where the device will go. You may also receive antibiotics to prevent infections. The procedure varies, depending on the type of device.

• A transvenous ICD is usually placed under your breastbone or along your ribs. In infants, it can be placed in the stomach area. The healthcare provider threads one or two sensor wires, or leads, through the blood vessels into the chambers of your heart. A monitor is used to guide the wires and put them in the right place.
• A subcutaneous ICD is implanted just under the skin of the chest below your armpit. The single lead wire runs under the skin instead of through a blood vessel.
• A CRT-D is implanted under the skin, usually on the left upper side of your chest on top of the muscle layer. Sometimes it is placed under the muscle.

Once the device is in place, the healthcare provider tests it and then closes the incision, or surgical cut.

After surgery to implant a defibrillator device, you may have to stay in the hospital overnight so your healthcare provider can check your heart and make sure your device is working well. Your providers may also help you get up and walk around.

The day after the surgery, an X-ray exam will confirm that the device and wires are in place. An electrocardiogram (ECG or EKG) will assess your heart rhythm. Your healthcare provider will check the device’s programming before you leave.

Make a plan to get a ride home. After getting an ICD, SICD, or CRT-D, you will not be able to drive a car legally for some time. Discuss driving restrictions with your provider.

Your healthcare provider will give you instructions to follow as you heal at home, including information about these topics:

• What medicines you need to take
• How to care for your incision: Check it often, and keep the area clean and dry. Ask your provider about showering and bathing.
• When to return to normal activities: Your provider will probably ask you to avoid heavy lifting, high-impact sports, or stretching for 4 to 6 weeks. Most people return to other daily activities, except for driving, within a few days of having surgery.
• How to keep wires from moving: Your provider may ask you to use caution or avoid heavy lifting, intense physical activity, stretching your arms, or raising them above your head. These activities could shift the device or pull a wire out of place.
• How remote monitoring works: Your provider will arrange for a monitor box to be placed at your home to monitor your heart and the new device.

Call your provider if any swelling or bleeding occurs or if you develop a fever following surgery to place an ICD.

Finally, be sure to attend all follow-up appointments. Typically, the first appointment is one month after surgery, with follow-up visits at least every 6 months. Ask about living with an ICD and what to do if you feel an electric pulse or a shock from your device.

The placement procedure for ICDs is considered safe overall. But, like any medical procedure, the surgery could lead to complications. Complications including the following could occur during or after surgery, or from the device itself.

• Allergic reaction to the device or medicines used during the procedure
• Swelling or bruising where the device was placed
• Unnecessary shocks from the device
• Bleeding from the site where the device was placed
• Reactions to the medicines used to help you relax or sleep during the surgery
• Tissue scarring around the wires or device
• Damage to blood vessels, the heart, or nerves
• Depression or anxiety
• Device problems, such as if the defibrillator stimulates muscles other than the heart, or if wires break, do not work, or get pulled out of place. This can lead to blocked blood vessels or heart valves, or to a wire poking through the heart muscle or the skin of the chest.
• Fluid trapped around the heart, causing pericarditis, a type of heart inflammation
• Fluid or air trapped around the lungs, leading to lung conditions called pleural disorders.
• Heart problems, including arrythmias or a heart attack
• Infection of the device’s wires or the device itself can spread, causing problems in other parts of the body. Call your healthcare provider right away if you develop a fever in the days and weeks after the procedure.
• Pacemaker syndrome, which develops when a pacemaker or transvenous ICD delivers pacing therapy to only one of the heart’s two ventricles , causing the heart to pump out of sync and blood to flow in the wrong direction. Symptoms include fatigue , breathing problems, and low blood pressure.
• Venous thromboembolism, or blood clot , may form and block blood flow. Your healthcare provider may give you blood thinning medicine to lower this risk.

The risks that come with a subcutaneous ICD are generally less serious than the risks that come with a transvenous ICD or a CRT-D, but some problems have been reported:

• Discomfort where clothing or other items rub the surgery site
• Irritation from the lead wire
• Unnecessary shocks from the device
• Damage to tissues such as tendons, muscles, nerves, or skin near the surgical site
• Depression or anxiety
• Device movement
• Infection

Learn more about steps you can take to stay safe when living with an ICD.

No surgery is needed for wearable devices, but there are a few risks:

• Rash
• Depression or anxiety
• Shocking people who touch you: WCDs make a warning sound before a shock so anyone who’s touching you can move away.