Implantable Cardioverter Defibrillator

WHAT YOU SHOULD KNOW:

• An implantable cardioverter (CAR-d-o-ver-ter) defibrillator (d-FIB-ri-la-ter) is also called an ICD. It is a device that monitors your heart rate and rhythm. The ICD gives your heart a shock if you start having arrhythmias (uh-RITH-me-uhs). Arrhythmias are when your heart does not beat normally. Some arrhythmias can cause the heart to stop beating. The ICD will shock your heart so that it starts beating normally again. An ICD can make your heart beat faster if it is not beating fast enough. It can also slow your heart down if it is beating too fast.
  
  
• An ICD is made up of a generator, a programmer, and leads. The generator and the leads will be placed inside you during surgery. The generator has a metal shell with a battery and a small computer inside. The computer monitors your heart rate and rhythm. Leads are wires that have one end that attach to the inside of your heart and the other end is connected to the generator. The generator transmits information about your heart to the programmer. Surgery is needed to get an ICD. The surgery may be done when you are already a patient in the hospital or you may come into the hospital the morning of your surgery. It is possible that you may go home after the surgery.
  
  
• The leads are usually placed inside the heart. There are some instances that the leads may be placed on the outside of the heart. The generator is usually placed in a pocket under the skin in the shoulder area. It may also be placed in a pocket under the skin in the abdomen (belly).

CARE AGREEMENT:

You have the right to help plan your care. To help with this plan, you must learn about your health condition and how it may be treated. You can then discuss treatment options with your caregivers. Work with them to decide what care may be used to treat you. You always have the right to refuse treatment.

RISKS:

• There are always risks with surgery. You may bleed more than usual, get blood clots, or an infection. The leads could poke a hole in your heart, lung, or vein. Putting in the leads can cause arrhythmias. Blood may also form in the pocket where the generator is placed. This can cause pain and infection. Sometimes, the leads may disconnect and a second surgery may be needed. The leads may break. A second surgery may be needed to fix them. You could die from this surgery. Your caregivers will closely watch you for any of these problems.
  
  
• If you do not get an ICD, your heart problems could get worse and you could die. Ask your caregiver if you have any questions about your care.

GETTING READY:

The Week Before Your ICD Surgery:

• Talk about your medicines and allergies with your caregiver:
  
  
  • Tell your caregiver if you have bleeding problems. If you take medicine to thin your blood, you may be asked to stop taking before your ICD surgery. Ask your caregiver before you stop taking this or any other medicine. Tell your caregiver about any other medicines you are taking. This incudes prescription medicine, over-the-counter medicine, herbs, and vitamins.
    
    
  • If you are diabetic or have blood sugar problems, ask your caregiver for special instructions. Your caregiver may want to change your diet and medicine before and after your ICD surgery.
    
    
  • Your caregiver may want you to take antibiotics. This medicine may help prevent infection during or after ICD surgery.
  
  
• Go for tests: You may need blood tests before your procedure. Talk to your caregiver about these or other tests you may need. Write down the date, time and location for each test.
  
  
• Arrange for family support: Have a family member or friend take you to the hospital and take you home. Have someone stay with you after your surgery so that you are not alone. They can also watch you to make sure you feel okay. If you need anything, they can get it for you.

The Night Before Your ICD Surgery:

• Ask caregivers about directions for eating and drinking.
  
  

The Day Of Your ICD Surgery:

• Write down the correct date, time, and location of your surgery.
  
  
• Ask caregivers before taking your medicines today. Ask a caregiver before taking any medicines on the day of your surgery. These medicines include insulin, diabetic pills, high blood pressure pills, or heart pills. Bring a list of your medicines or the pill bottles with you to the hospital.
  
  
• Wear your glasses, dentures, or hearing aids. Do not wear contact lenses the day of your surgery. You may wear glasses. If you wear dentures or hearing aids, wear them to the hospital. Your caregiver may ask you to remove your dentures and hearing aid before the ICD surgery.
  
  
• Bring personal belongings. If you are staying in the hospital overnight, bring your personal belongings with you (bathrobe, toothbrush, hairbrush, and slippers). Do not wear jewelry or bring money to the hospital.
  
  
• Take a bath or shower before your ICD surgery. Take a bath or shower and wash your hair before your ICD surgery. You may not be able to fully bathe for a week after your ICD surgery.
  
  
• Make sure you have an informed consent. You or someone you give permission to may be asked to sign a legal piece of paper (consent form). It gives your caregiver permission to do the ICD surgery. Make sure all your questions have been answered before you sign this form.

TREATMENT:

What Will Happen?

• You will be asked to change into a hospital gown. An IV will be placed by a caregiver. You may be given medicine in your IV to help you relax or make you sleepy. You will be taken on a cart to the operating room. Depending on what you and your caregiver agree on, you may be put to sleep or will remain awake but drowsy. You will not remember much before or during your surgery.
  
  
• Caregivers will clean your neck and chest with a special soap. Sheets will be put over you to keep the surgery area clean. A lead is put into your vein near your collarbone or neck. The lead is then guided into your heart. The leads to the generator will then be sewn to the inside of your heart. Less often, the leads may be placed on the outside of your heart. The other end of the lead is attached to the generator and placed in a pocket under your skin. This pocket is usually in the shoulder area, but may also be in the abdominal area (belly). The incision is closed with stitches or staples. The surgery may last two to three hours.

What Will Happen After Surgery? You will be taken to a recovery room where you will wake up. There will be lots of noise and activity. This is normal. Caregivers will be checking on you often. You will have a bandage covering your stitches or staples. You may be able to leave when you are awake and your pain is controlled. Or, you may go to a hospital room and spend the night.

Waiting Room: This is a room where your family can wait until you are ready for visitors after the ICD surgery. Your caregivers will find your family in the waiting room to tell them how your surgery went. If your family leaves the hospital, ask them to leave a phone number where they can be reached.

CONTACT A CAREGIVER IF:

• You cannot make it to your surgery appointment on time.
  
  
• You have questions or concerns about your surgery or the ICD.
  
  
• You have a fever (increased body temperature).
  
  
• The problems for which you are getting the ICD become worse.

Copyright © 2008 Thomson Healthcare Inc. All rights reserved. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes.

The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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