Subcutaneous Implantable Cardioverter Defibrillator

Medically reviewed by Drugs.com. Last updated on May 4, 2025.

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AMBULATORY CARE:

What you need to know about a subcutaneous implantable cardioverter defibrillator (S-ICD):

An S-ICD is a small device to treat heart arrhythmias. Subcutaneous means the device is placed under your skin. This type of ICD does not use wires placed in the vein or heart. The device has a generator that is attached to a lead (wire). The ICD monitors your heart rhythm at all times. The generator sends electrical shocks if an abnormal rhythm is detected. Some arrhythmias may cause your heart to stop beating suddenly. The device can give a shock to make your heart start beating again.

How to prepare for S-ICD insertion:

• Your healthcare provider will tell you how to prepare for the procedure. You may be told not to eat or drink anything after midnight on the day of your procedure. Arrange to have someone drive you home and stay with you after the procedure.
• Tell your provider about all medicines you currently take. Your provider will tell you if you need to stop any medicine for the procedure, and when to stop. Your provider will tell you which medicines to take or not take on the day of your procedure.
• Tell your provider about all your allergies, including antibiotics. You may be given an antibiotic through your IV to help prevent a bacterial infection.
• Make arrangements at home and work, if needed. You will not be able to lift anything heavy for several days after the procedure. Someone may need to help you around the house during this time. Ask your provider when you can return to work after the procedure. You may need to arrange for time off.

What will happen during S-ICD insertion:

• You may be given general anesthesia to keep you asleep and free from pain during the procedure. You may instead be given moderate sedation, and local anesthesia to numb the area. You may still feel pressure or pushing during the procedure, but you should not feel pain.
• Your provider will make incisions at the bottom of your breastbone. A larger incision will be made a few inches below your left armpit. The generator will be placed under your skin through the incision under your armpit. The lead will be tunneled over your breastbone. An x-ray may be used to make sure the ICD is in the correct place.
• Your provider will test the ICD to make sure it will work when you need it. The incision will be closed with stitches. A bandage will be placed over your incision to protect the area and prevent an infection.

What to expect after S-ICD insertion:

• You will be taken to a recovery room where you will rest until you are awake.
• You will be on a heart monitor. A heart monitor is an EKG that stays on continuously to record your heart's electrical activity.
• You may be able to leave when you are awake and your pain is controlled. You may go to a hospital room to spend the night.

Risks of an S-ICD:

You may bleed more than expected. You may develop an infection around your heart or in the incision areas. The device may cause the skin over it to erode (break down) over time. Your ICD may not shock your heart when it needs it. It may also shock when it should not.

Call your local emergency number (911 in the US), or have someone call if:

• You have any of the following signs of a heart attack:
  • Squeezing, pressure, or pain in your chest
  • You may also have any of the following:
    • Discomfort or pain in your back, neck, jaw, stomach, or arm
    • Shortness of breath
    • Nausea or vomiting
    • Lightheadedness or a sudden cold sweat
• You become weak, dizzy, or faint.
• You feel lightheaded, short of breath, and have chest pain.
• You cough up blood.
• You have trouble breathing.

Drugs used to treat this and similar conditions

Seek care immediately if:

• Your arm or leg feels warm, tender, and painful. It may look swollen and red.
• Your stitches or staples come apart, or you have heavy bleeding from the incision area.
• The skin around your stitches or staples is red, swollen, or draining pus or fluid.
• You feel a shock from your ICD.

Call your doctor or cardiologist if:

• You have a fever.
• Your feet or ankles swell.
• You have chills, a cough, and feel weak or achy.
• You have questions or concerns about your condition or care.

Medicines:

You may need any of the following:

• Heart medicine may be given to strengthen or control your heartbeat.
• Prescription pain medicine may be given. Ask your healthcare provider how to take this medicine safely. Some prescription pain medicines contain acetaminophen. Do not take other medicines that contain acetaminophen without talking to your healthcare provider. Too much acetaminophen may cause liver damage. Prescription pain medicine may cause constipation. Ask your healthcare provider how to prevent or treat constipation.
• Take your medicine as directed. Contact your healthcare provider if you think your medicine is not helping or if you have side effects. Tell your provider if you are allergic to any medicine. Keep a list of the medicines, vitamins, and herbs you take. Include the amounts, and when and why you take them. Bring the list or the pill bottles to follow-up visits. Carry your medicine list with you in case of an emergency.

Care for the incision area:

• Care for the incision area as directed. Wear loose-fitting clothing over the area. Do not get the area wet until your healthcare provider says it is okay. When it is okay to bathe, do not scrub the area. Just let water run over it. Dry the area and put on new, clean bandages as directed. Change your bandages when they get wet or dirty. Do not put powders or lotions over your incision. Check the area every day for signs of infection, such as swelling, redness, or pus.
• Do not lift anything heavier than 10 pounds, or as directed. Ask your healthcare provider when you can lift heavy objects.

Safety instructions:

Talk to your healthcare provider about driving and playing sports after you have an ICD placed. The following are general safety instructions:

• Wear medical alert jewelry or carry a card that says you have an S-ICD. Ask your healthcare provider where to get these items. Tell all healthcare providers, including dentists, that you have an S-ICD.
• Stay away from magnets or machines with electric fields. These can interfere with how your ICD works. You will get specific safety information based on the type of ICD you have. You will need to keep cell phones and headphones away from your ICD. General examples of machines to avoid include car engines, welding machines, and electronic body fat scales. You may also need to avoid electrolysis, medical alert systems, or electric fences.
• Tell airport security you have an S-ICD. You may need to be searched by hand when you go through a security gate. The security gate or handheld wand could harm your ICD.
• Keep an ICD diary. You may not notice the low-energy shocks from your ICD, or they may feel like a flutter in your chest. The high-energy shocks are very short. They may feel like thumping or a painful kick in the chest. Record when you get a shock and what you were doing before you got the shock. Keep track of how you felt before and after the shock, and how many shocks you received. Write down the day and time of each shock. Bring the diary with you when you see your healthcare provider or cardiologist.
• Plan ahead for device replacements. The battery should last 5 to 10 years. You will need to have a replacement when the battery runs out.

Follow up with your doctor or cardiologist as directed:

You will need to have your ICD checked often to make sure it is working correctly. Your ICD may have a remote monitor that you will take home with you. The monitor sends information from your ICD to your doctor's office regularly. Your doctor may review the information with you during your visits. Write down your questions so you remember to ask them during your visits.

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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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