At the Heart Institute, ICDs are done by a cardiologist who specializes in the electrical system of the heart. This specialty is called Electrophysiology. There are several Electrophysiology doctors working at the Heart Institute.
The Electrophysiology doctors work as a team in caring for all patients who are having ICD surgery. This means, depending on the booking schedule, the doctor who does your ICD surgery may not be the same doctor you first saw in clinic.
What Are the Risks of an ICD Implant?
ICD procedures are considered to be very safe however, with any invasive procedure, there can be complications.
- Excessive bleeding
- Infection at the implant site
Rarely, the heart or lung can be punctured. If this were to happen, you would be treated immediately.
Occasionally, while everything is still healing, an ICD lead may slip out of position inside the heart. If this occurs, it will be seen in the x-rays and other checks that you have after your procedure. Although this usually causes no harm, you will probably need a second operation to fix it.
Before you are discharged, the nurse will review any signs or symptoms to watch for that may mean there is a problem.
Before Your Procedure
Please use the Patient Responsibility Checklist to help you prepare for your admission to the Day Unit at the Heart Institute.
Day of Procedure
Expect to be at the Heart Institute for eight to 12 hours. Plan to arrive at the Day Unit according to the instructions you received the night before.
The Day Unit is located on the first floor. Take the elevators from the main lobby at the Heart Institute up to the first floor. When you get to the first floor, follow the green hearts on the floor to the Day Unit.
You will be in the Day Unit ar ea until you are ready to go for your ICD surgery and you will come back to the Day Unit once your procedure is completed. The actual ICD surgery will take place in a special room called the Electrophysiology Lab. Before you go for your implant, the doctor will come and meet with you in the Day Unit. This will be a good time to ask any final questions you may have.
Only one friend or relative will be able to sit with you while you are waiting because space is limited. During your procedure, your relative/friend will be able to wait in the lounge area. Once you are back and recovering, the staff will call them back in to sit with you until you are ready to go home.
Once you are in the Day Unit, the final preparations for your procedure will start. You will change into a hospital gown. You may have a small intravenous tube placed in your arm. The implant area will be clipped of hair and cleaned.
In the Electrophysiology Lab
There will be a team of doctors, nurses and lab technologists involved in your procedure. All staff will be wearing gowns, masks and special lead aprons.
Your chest area will be washed with a cold solution and sterile sheets will be placed over you. It is important that you don’t move or touch the top of the sheets once they are in place. A nurse will be available to assist you if you have any concerns during your procedure.
During your procedure, you will receive medications in your intravenous that will make you feel very relaxed. You might even fall into a light sleep. Additionally, to make sure you stay comfortable, you will receive pain medications in your intravenous as needed.
A local anesthetic will be administered to the area below your collarbone to numb the area where the ICD will be inserted.
Once the anesthetic has taken effect, the doctor will make a small incision. Using a special Xray, the ICD leads will be threaded in to your heart through a vein in your chest. You will not feel any pain, but you may feel some pressure as the veins are entered. The generator is then put into place just under the skin. Tell the nurse immediately if you feel any discomfort or have any concerns. It is very important you remain as still as possible during the procedure.
Once the procedure is finished, the incision will be closed with special stitches. You will not need to have them removed. They will dissolve on their own. If you are having a standard ICD implant, the whole procedure will probably take one to two hours to complete. If you are having a CRT-ICD, the procedure will take two to four hours.
After Your Procedure
After your procedure, you will be taken back to the Day Unit on a stretcher or bed. You may be hooked up to a heart monitor that will keep track of your heart rate and your blood pressure. Shortly after your procedure, you will go for a chest X-ray to check your ICD placement.
You may experience some discomfort at the incision site. If you are uncomfortable, tell your nurse and you can be repositioned and given a pain medication to make you more comfortable.
While you are recovering, it is important to avoid moving your affected arm; in particular, you must not raise this arm above your head because that could displace the ICD leads.
You may experience some bruising and discolouration around the insertion site. If you were on a blood thinner before your procedure, this may be particularly noticeable.
You may eat and drink as normal when you return to the Day Unit. Your nurse will assess and assist you as necessary. If you are feeling okay, the nurse will bring you a light snack and something to drink.
Once you are feeling better, you will be able to go home.
You must have someone pick you up at the hospital and drive you home. The day you arrive home, you will need someone to stay with you during the day and overnight.