An Implantable Cardioverter-Defibrillator (ICD) is typically implanted through a minimally invasive procedure. Here's a breakdown of the ICD implantation process:
1. Preparation:
- The patient will be asked about their medical history and current medications.
- Blood tests and an electrocardiogram (ECG) will be performed.
- The patient will be instructed not to eat or drink anything for several hours before the procedure.
- The area where the ICD will be implanted (typically the left or right shoulder area) will be cleaned and shaved.
2. Anesthesia:
- Local anesthesia is typically administered to numb the area where the incision will be made.
- In some cases, sedation may also be given to help the patient relax.
3. Incision and Pocket Creation:
- The clinician makes a small incision (cut) in the skin, usually near the shoulder.
- A pocket is created under the skin and muscle to hold the ICD generator.
4. Lead Placement:
- One or more leads (thin, insulated wires) are inserted into a vein.
- Using X-ray guidance (fluoroscopy), the leads are advanced through the vein and into the heart chambers.
- The leads are positioned in specific locations within the heart to detect abnormal heart rhythms and deliver electrical therapy when needed.
5. Generator Connection and Testing:
- The leads are connected to the ICD generator.
- The clinician tests the ICD to ensure it can properly detect and correct abnormal heart rhythms. This may involve inducing a fast heart rhythm and verifying that the ICD delivers appropriate therapy (pacing, cardioversion, or defibrillation).
6. Pocket Closure:
- Once the ICD is functioning correctly, the generator is placed into the pocket created earlier.
- The incision is closed with sutures or staples.
7. Post-Procedure Care:
- The patient will be monitored for a few hours or overnight.
- Instructions will be provided on wound care, activity restrictions, and follow-up appointments.
- The patient should avoid strenuous activities that could strain the incision site for a period of time.
- Regular follow-up appointments with a cardiologist are essential to monitor the ICD's function and battery life.
In summary, ICD implantation involves creating a pocket under the skin, threading leads through a vein into the heart, connecting the leads to the generator, testing the device, and closing the incision.
