Implantable cardioverter defibrillator

An implantable cardioverter defibrillator (ICD), sometimes referred to as an automated implantable cardioverter defibrillator (AICD), is a small device that monitors your heart rhythm and can deliver a shock if an irregular heartbeat is detected. Implanted under the skin in or near the chest, it’s used to treat certain heart conditions to ensure an adequate supply of blood and oxygen to the brain and other body parts.

There are two types of ICDs:

• Subcutaneous: Placed under the skin below the armpit, it has a sensor called an electrode that runs along the breastbone and doesn’t touch the heart.
• Traditional: Placed in the chest, it has leads that attach to the heart.

The ICD is always in watchful mode and will respond if your heart rate is too fast or too slow.

• Fast heart rate: The ICD sends electrical pulses or an electric shock to slow your heart rhythm to normal. 
• Slow heart rate: The ICD sends electrical pulses to speed up your heart rate.

An ICD is the recommended treatment for people who have certain heart conditions such as:

• Ventricular tachycardia: A condition where your heart beats too fast starting in the lower chambers, called the ventricles.
• Ventricular fibrillation: A condition where your heart beats irregularly in the ventricles.

Talk to your doctor if you have any of the following symptoms:

• Chest pain—called angina 
• Fast heartbeat—more than 100 beats per minute 
• Fatigue or weakness 
• Irregular heartbeat—called arrhythmia 
• Pounding or flip-flopping heart—called heart palpitations 
• Shortness of breath 
• Slow heartbeat—fewer than 60 beats per minute 
• Unexplained confusion, dizziness, nausea, or fainting

Your provider will recommend one or more tests to determine if an ICD is the best option for you. Tests may include an echocardiogram, electrocardiogram, Holter monitor, or exercise stress test.

Before your ICD surgery, your provider will explain how it’s done and give you time to ask questions. Your care team will review your medications with you, discuss your health history, and let you know how to prepare for surgery. In general, ICD is considered a minor procedure.

Each ICD surgery is done differently, but you can expect the following:

• Your surgery will be done at a hospital or surgery center. 
• An IV (intravenous) line will be placed in your vein so anesthesia can be administered. Most patients are awake during the procedure. 
• Your doctor will make a small incision in your collarbone and place the device. Your Penn Medicine care team will be by your side to make sure you are comfortable during the procedure. 
• The procedure takes a few hours.

Recovering from an ICD procedure involves taking it easy for a few weeks, avoiding strenuous activities, and keeping the incision site clean and dry to prevent infection. Regular follow-up appointments will ensure the device is functioning properly, and your doctor may adjust the ICD settings as needed. Over time, you’ll gradually return to normal activities, but it’s important to follow your doctor’s guidelines to avoid complications.

The risks of ICD surgery are low, but like any medical procedure, there are some potential risks that could include the following:

• Abnormal heart rhythms
• Bleeding, bruising, or pain after the implantation procedure
• Blood clots could form, causing swelling
• Device malfunctions, such as a broken lead, would require another procedure

Complications including infection, lung collapse, or a tear in the heart, though rare, are possible. Your Penn Medicine team is skilled and experienced and will do everything possible to provide the best care during and after your surgery.

Living with an implantable cardioverter defibrillator

After you’ve recovered from surgery, your provider will discuss steps you can take to ensure the best possible outcome with your ICD.

• Carry an ID card: Keep a copy of the American Heart Association ICD Identification (ID) Card in your wallet for emergencies. It’s important for any medical professional to know you have a heart device before providing treatment.
• Go to your regular checkups: Your doctor will keep an eye on your device and make any necessary adjustments. They might also ask you to send updates from your device between visits.
• Keep your healthcare team informed: Let all your doctors, dentists, physical therapists, and other providers know about your ICD so they avoid recommending any tests or treatments that could affect it.
• Be cautious around certain devices: Some electronics with strong magnetic fields, like metal detectors, may need extra care. Ask your doctor which devices to avoid or use carefully.
• Follow your medication plan: If your doctor prescribes heart medication, be sure to take it exactly as directed.

Why choose Penn Medicine?

Our doctors remain at the forefront of cardiovascular practices and techniques. We offer expert diagnosis and treatment for a wide range of heart conditions. When you work with our health-care teams, you can expect:

• Researchers dedicated to scientific discoveries: Penn Heart & Vascular uses heart and vascular research to develop new clinical devices and treatments for heart-related diseases.
• Care close to home: Penn Medicine doctors meet with patients in satellite locations across the southeastern Pennsylvania and New Jersey regions allowing convenient consultations, second opinions, and pre- and post-operative care right in your community.