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ICD Treatment
What is an ICD?
An ICD (Implantable Cardioverter Defibrillator) is a type of cardiac device used in patients with potentially dangerous heart rhythms or at risk of these.
How does an ICD work?
The device sits over or under the muscle on the left side of the chest. We attach it to one or two leads that we pass down via a vein at the top of your chest into the heart. One lead goes into the bottom chamber of the heart (the ventricle), and if needed, another sits in the top chamber of the heart (the atrium).
The device monitors your heart continuously for potentially dangerous heart rhythms. If it detects one of these rhythms, the device can deliver a small electric shock which can restore the heart to its normal rhythm.
Two types of ICD:
- Transvenous ICD – We insert this device in the upper chest and pass leads down the veins into the heart.
- Subcutaneous ICD – We bury the leads and device under the skin of the chest. There are no leads in the heart at all.
We will discuss the risks and benefits of the two types with you and together decide which device is right for you.
Why do I need an ICD?
Certain heart conditions mean your heart is more likely to develop a dangerously fast heart rhythm. These include certain types of heart failure (when the heart doesn’t pump as effectively as it should) and heart muscle disease (cardiomyopathies).
These dangerous heart rhythms usually originate from the bottom chambers of the heart (the ventricles). These are ventricular fibrillation (VF) or ventricular tachycardia (VT). If your heart goes into one of these rhythms, the heart is pumping too quickly to fill correctly and cannot pump blood effectively around the body.
You may feel palpitations, light-headedness or develop chest pain. You may even lose consciousness, and it can be fatal. Having an ICD in place could be life-saving.
How is an ICD implanted?
It depends on which type of ICD you need. The procedure is usually straightforward and performed as a day case. We use either a local anaesthetic and sedation (medicine which makes you sleepy) or a general anaesthetic.
We make a small incision in the upper chest and a pocket under the skin for the generator or battery. We pass one or two leads through a vein in the chest that runs down into the heart. We position the leads in the heart. One end is then attached to a generator placed on top or below the muscle in the chest. We close the wound with sutures (stitches).
If you need a subcutaneous ICD (S-ICD), we use a general anaesthetic (i.e. you will be asleep). Beforehand, you will have an assessment to ensure that this type of device is suitable for you.
Unlike a transvenous ICD, the lead from an S-ICD is not inside the heart. But simply under the skin of your chest. We then connect the lead to a generator buried above the chest muscle.
Depending on the sutures we use, you may need them removed in 7-10 days. The hospital staff will advise you if and when you need to have your sutures removed. You will also receive a card explaining which device you have and when and where it was placed. You must carry this card with you at all times.
Some heart conditions/issues that commonly cause breathlessness include:
What are the risks of the procedure?
The main risks from the procedure depend on the type of device you are having fitted.
They include
- Infection
- Bleeding and bruising
- Scratching the surface of the lung (pneumothorax)
- Bleeding around the heart
- Relocation of the leads
We can treat almost all the complications simultaneously.
How long will it take to recover from my ICD insertion?
The wound should take a couple of weeks to heal. At least for the first week, you must keep the wound clean and dry to minimise the chances of an infection. If you have a transvenous ICD, don’t lift your left (or right if the device is right-sided) arm above your shoulder for at least six weeks.
The lead takes this long to “bed in” and become fixed. If you lift your arm too soon, you could dislodge the ICD lead from its position. This could mean that the device can’t monitor your heart rhythm or can’t deliver a shock effectively. If this happens, you may need another procedure to reposition the lead.
Will I be able to drive?
You will not be able to drive for some time after the procedure and must inform the DVLA. How long you can’t drive depends on the reason you need the device.
What is the follow-up?
After you have your ICD put in, you will have it checked after one month. We do this to ensure the device is working effectively and look for possible problems. After that, we usually check it every six months – 1 year.
If you think you’ve had a shock from your ICD or if there are any problems with your device, you should get in touch. We can then check the device and see if it has given you a shock and if it is working the way it should.
How long will the ICD last?
The ICD battery (or generator) will last around 7-10 years. After this time, it will need replacing; this is a straightforward procedure. The leads can stay in as long as they’re working effectively. Most leads never need replacing and last the rest of your life.
Book an appointment
Breathlessness can feel uncomfortable and unsettling, but we’re here to help put you at ease.
Our specialist will discuss your treatment in depth so you understand its purpose and how it will work. We are happy to answer any questions to ensure you feel comfortable with our treatment plan.
Call London Heart Clinic on 0203 303 0325 to book an appointment.
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What our patients say
After suffering from a heart condition for a number of years I was very happy to meet Dr Ahsan, from the first consultation where he believed there was a solution I have now completed the surgery and had my final consultation with him today…”
I am very grateful to have Dr Syed Ahsan as my consultant. Dr Ahsan always greets you warmly on each visit despite his busy workload. Dr Ahsan explains everything clearly and helps you to understand even the most complex medical terms…”