Extravascular ICD

An extravascular (EV) implantable cardioverter-defibrillator (ICD) is a device placed inside the body to detect and correct abnormal heart rhythms in the lower heart chambers (ventricles). It’s used to treat a type of arrythmia called ventricular tachycardia or ventricular fibrillation that causes the heart to beat too fast, which can lead to sudden cardiac arrest. An EV ICD implant can provide pacing or a shock to break one of these arrhythmias and restore normal rhythm. Using an innovative, minimally invasive surgery, the device is implanted with electrical leads placed close to the heart without placing them directly in the heart or blood vessels.

Penn Medicine Cardiology includes expert electrophysiologists who specialize in treating issues related to the heart’s electrical system. We use the latest methods and technologies, such as EV ICDs, to treat people with cardiac arrythmias. Known for our groundbreaking cardiac treatments, we use minimally invasive techniques whenever possible to help people recover faster and return to their regular daily activities quickly.

Extravascular ICDs are surgically implanted in the body with an electrical lead placed beneath the breastbone. The lead connects to a generator that is implanted along your left ribs. Together, these devices can monitor your heart for dangerous arrhythmias and correct them with rapid pacing or an electrical shock, restoring the normal heartbeat.

The EV ICD avoids placing leads inside the blood vessels and heart, which lowers the risk of certain complications, including blood stream infection, heart perforation, and injury to blood vessels.

Different types of ICDs, including EV ICD, subcutaneous ICD (implanted under the skin), and traditional (intravascular) ICDs, are used to treat arrythmia, ventricular tachycardia, and those with damaged or weakened heart muscles. An electrophysiologist will evaluate whether an extravascular ICD is right for you. They’ll perform a physical exam, review your health history, and consider results from tests like an electrocardiogram (ECG), Holter monitor, or stress test.

You may be a particularly good candidate for an extravascular ICD if you are young and have a history of blood stream infections.

Your doctor will discuss the best ICD approach for you and address your questions and concerns to be sure you are confident in the treatment plan before proceeding with an extravascular ICD implant.

Your doctor will provide instructions on how to prepare for the surgery, including which medications to avoid. You will need to fast after midnight. You’ll want to arrange for a driver to pick you up and stay home with you for several hours to monitor your initial recovery.

An EV ICD implant procedure typically lasts under two hours and includes these steps:

• You’ll receive anesthesia to be sure you are asleep and pain-free.
• Your surgeon will make small incisions to place the device.
• Once the device is properly positioned, it’ll be adjusted to the proper settings and tested to be sure it’s working properly.
• Your surgeon will close the incisions and perform any additional tests of the device.
• You’ll move to a recovery area for monitoring and may go home the same day or the next day. Your surgical team will provide you with home-care instructions and a recovery timeline.

Most people recover quickly and well from EV ICD implant surgery. There are some guidelines to keep in mind during recovery:

• You may experience some soreness or pain at the surgical site for a few weeks. Your doctor will create a pain management plan for you with a combination of prescription drugs and over-the-counter medications.
• Your doctor will provide guidelines on when you can return to your regular daily tasks, such as driving. You may need to limit strenuous activities for a while longer to ensure proper healing.
• An extravascular ICD procedure is generally considered safe, though as with any surgery there can be risks. They include bleeding, infection, soreness at the site, and swelling. Talk with your doctor if you have any pain or other symptoms that do not resolve as expected.

Your EV ICD device is designed as a permanent implant. You’ll continue to have regular appointments with your cardiology team to monitor your heart health and with an electrophysiologist to check that your EV ICD is working as it should. The battery in your device usually lasts for many years and can be replaced, as needed, in a minor outpatient procedure.

You may have special requirements to ensure your EV ICD continues to work well in various circumstances. For example, there may be interactions with other devices that emit electrical signals such as medical equipment, or mobile devices. Though interactions are rare, it’s important to review any limitations or other recommendations with your doctor and follow their guidelines.

We strive to bring the most advanced and effective treatments to each of our cardiac patients. Extravascular ICDs are one of the latest techniques available to detect and correct abnormal heart rhythms and help prevent cardiac arrest.

When you come to Penn Medicine for cardiology care, you can expect:

• Expert treatment close to home: We were one of the first cardiology centers in the country to offer extravascular ICD implants. For those who live within the southeastern Pennsylvania and New Jersey regions, you can take advantage of our world-class care at convenient locations.
• Research that you can count on: Our expert cardiology surgeons, electrophysiologists, and other cardiac providers work closely with Penn Medicine researchers to adopt the latest technologies that help save lives. We participate in clinical trials to advance our knowledge with a focus on minimally invasive methods that help you heal faster.
• Compassionate care for the heart: We have deep experience in a variety of cardiac arrythmia treatments and have pioneered many innovative procedures that have been adopted worldwide. Our goal is to find the right treatment that can help you regain and maintain your heart health.