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An implantable cardioverter defibrillator (ICD) (also known as automatic implantable cardioverter defibrillator (AICD) is an electronic device implanted just under the skin of the upper chest, similar to a pacemaker. It is about the size of a pager and performs several functions.
It monitors your heart rhythm continuously. Upon detection of a dangerous rhythm (ventricular tachycardia (VT) and ventricular fibrillation (VF)), the device will either pace or deliver a shock to terminate the dangerous rhythm. The ICD protects patients at risk from premature deaths due to life-threatening heart rhythm. It can also pace the heart when the rate is too slow.
The AICD consists of two parts: first, a box which houses the electronics (the “device”), and second, one or more wires that connect the box to the heart muscle (the “leads”).
This is what an actual AICD looks like. The maximum diameter is around 2 to 3 inches i.e. around the length of your small or ring finger.
Shown here is what a freshly implanted AICD looks like. The incision used to implant the device is around 5 cm long. Usually it is implanted on the left side; occasionally it is implanted on the right side.
Your doctor will recommend an AICD if he thinks you are at risk of developing dangerous abnormal heart rhythms (“VT” or “VF”) and therefore at risk of sudden death. This may be because:
A specialist doctor called an Electrophysiologist will perform the procedure. The procedure will be done in the Electrophysiology Lab.
A device implant is generally a safe procedure. However, as with any invasive procedures, there are risks. Special precautions are taken to decrease your risks.
Your doctor will discuss your risk with you as every individual is different. In general however, the risk of implanting an AICD is low - only 1% or less of serious complications. These include (but are not limited to):
All of these complications are treatable. However, the most common problem with AICDs is that they may deliver unnecessary shocks; if so, your AICD may need to be re-programmed or your medication altered.
The purpose of the AICD is to protect you from sudden cardiac death due to abnormal heart rhythms; your doctor will normally only recommend one if he thinks this risk substantially outweighs the low risk of AICD implantation.
Yes. Your doctor will determine the best suitable device for you, depending on your condition.
You will return from the Electrophysiology Laboratory with pressure dressing over the site of the AICD implant. If you have any pain, please inform your nurse so you can be given enough painkillers.
You will stay overnight in the hospital and usually will be able to go home the day after the device is implanted.
A chest x-ray will be done after the device implant to check your lungs as well as the position of the device and lead(s).
The following day, an Electrophysiology Technician will confirm your AICD is working properly; this is done on the ward, from outside the body.
If there are no problems, you can expect to be discharged the following day with a return appointment in one week. You may also be given a short course of antibiotics to prevent infection.
You will need long term follow up. Initially you will be seen at four to six weeks intervals to check the AICD is functioning as intended. If there are no problems, the follow up interval may be lengthened to every three months or more.
After the AICD is implanted, you will need to keep the implant site clean and dry while the overlying skin heals. On discharge from the ward, the nurses will arrange regular dressing changes.
For two to three weeks after implantation, you should also avoid raising your arm on the side of the implant above shoulder level to avoid dislodging the lead or device. After two to three weeks have elapsed, the lead and device should be secure so that this is no longer an issue and you can move your arm normally.
There are few restrictions from having an AICD. Most sports are permitted except contact sports such as rugby where vigorous impact could damage the AICD.
Swimming is permitted but we do advise common sense precautions such as not swimming in deep water alone.
No. For your safety, a responsible adult should drive you home. Ask your doctor when you could resume driving.
The AICD is battery-powered. How often does the battery need changing and how is it changed?
Most AICDs will last around three to six years or more. We will check on the battery status during your regular clinic follow ups. Changing the battery is similar to implanting a new device except the AICD leads (the wires which connect the device to the heart) do not need to be changed.
Your doctor will discuss the results of the procedure and answer any questions you have. Be sure to ask the doctor if you can continue taking your previous medications.
You will receive specific instructions about how to care for yourself after the procedure including medication guidelines, wound care, activity guidelines, device care and maintenance, and a follow-up schedule.
Yes. Your ID card contains pertinent information about yourself, type of AICD and your physician.
This is made available quickly in the event of an emergency. If you lose your card, please ask for a replacement.
