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Guidelines for Implantable Defibrillators

An implantable cardioverter-defibrillator, or ICD, is a small device about the size of a small cell phone that is placed inside of the chest. This device helps with a number of heart arrhythmias. Heart arrhythmias are irregular heartbeats that are either too fast or too slow. The ICD repairs the problem by delivering a shock to the heart when necessary through wires that connect the device to the heart. This shock brings the heartbeat back to normal.

  1. Determining the Need

    • Doctors determine the need for an ICD by running a number of different sorts of diagnostic tests. These tests often include a combination of any of the following procedures: electrocardiography (ECG), echocardiography, electrophysiology study (EPS), holter monitoring and an event recorder. If diagnostic tests show any abnormalties related to heart arrhythmia, typically an ICD will be implanted, according to the Mayo Foundation for Medical Education and Research.

    When an ICD Can Help

    • Individuals diagnosed with arrhythmias need the device. Persons considered to be the most qualified for an ICD device include those with ventricular tachycardia, in addition to those who have fainted because of ventricular tachycardia. Other candidates who are ideal for implantation of this device include those who have survived cardiac arrest.

    Implantation Guidelines

    • The device is typically implanted in the chest through a procedure that requires a short stay in the hospital. If all goes well, the procedure lasts no more than three hours. The patient is given a mild numbing medication for the area and a sedative to keep him in a relaxed state. Once the area is numb, leads are threaded through veins beneath the collarbone to the heart. This insertion is done with the guidance of an X-ray. The leads are then connected to the bottom of the heart, and the other end of the lead is connected to the actual device. The device is then implanted under the skin through a minor surgical procedure, according to the Mayo Foundation for Medical Education and Research.

      After this part of the procedure has been completed, the doctor must program the ICD. At this point the patient will be under general anesthesia so the doctor can deliver shocks to the heart without the patient's knowledge since the multiple shocks delivered for testing can be painful. The device can be programmed to treat fast heartbeats, slow heartbeats, and can be used to record heart activity to monitor the occurrence of a patient's arrhythmia. Once the device is programmed, the patient usually remains in the hospital for two to three days. Before being released from the hospital, the ICD will be checked just to make sure it is working to the doctor's satisfaction. After the initial insertion of the device, no more surgical procedures are generally required, but follow-ups with the physician are important to ensure the ICD continues to work properly, says the Mayo Foundation for Medical Education and Research.

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