Background Information:

What are the other Names for the Procedure?

• ICD Surgery
• Implantable Cardioverter-Defibrillator (ICD) Surgery

What is Defibrillator Implantation surgical procedure?

Defibrillator Implantation is a surgical procedure that involves placing a permanent electronic device that will perform the following functions:

• Detect and monitor the heartbeat
• Control normal heartbeat rate
• Shock the heart by sending shock impulses in case of a dangerous arrhythmia, in order to bring back normal electrical rhythm to the heart

What part of the Body does the Procedure involve?

A Defibrillator Implantation procedure involves the heart and the subclavian vein. The subclavian vein is a large vein (about the diameter of the little finger) present below the clavicle or collar bone.

Why is the Defibrillator Implantation surgical procedure Performed?

There could be various reasons for performing a Defibrillator Implantation. Some of them are:

• To prevent dangerous arrhythmia
• Defibrillate the heart, in case of irregular heartbeat or arrhythmia
• Monitor the heartbeat
• Prevent a cardiac arrest (heart attack)

What are some Alternative Choices for the Procedure?

To monitor and prevent abnormal heart beat rate, the use of a Defibrillator Implant is a good option. However, depending on the cardiac condition of the patient, the physician may alternatively suggest a pacemaker.

What are the Recent Advances in the Procedure?

The recent advances in Implantable Cardioverter-Defibrillator (ICD) or Defibrillator technology are related to increase in its accuracy of performance.

What is the Cost of performing the Defibrillator Implantation surgical procedure?

The cost of Defibrillator Implantation procedure depends on a variety of factors, such as the type of your health insurance, annual deductibles, co-pay requirements, out-of-network and in-network of your healthcare providers and healthcare facilities.

In many cases, an estimate may be provided before the procedure. The final amount depends upon the findings during the surgery/procedure and post-operative care that is necessary.

When do you need a Second Opinion, prior to the Procedure?

• It is normal for a patient to feel uncomfortable and confused with a sudden inflow of information regarding procedure and what needs to be done
• If the patient needs further reassurance or a second opinion, a physician will almost always assist in recommending another physician
• Also, if the procedure involves multiple surgeries or has many alternatives, the patient may take a second opinion to understand and choose the best one. They can also choose to approach another physician independently

What are some Helpful Resources?

http://www.bostonscientific.com/procedure/ProcedureLanding.bsci/,,/navRelId/1000.1002/method/Procedure/id/10000951/seo.serve

http://my.clevelandclinic.org/heart/services/tests/procedures/icd.aspx

http://www.mayoclinic.com/health/implantable-cardioverter-defibrillator/MY00336/DSECTION=risks

http://www.nlm.nih.gov/medlineplus/pacemakersandimplantabledefibrillators.html

Prior to Defibrillator Implantation surgical procedure:

How is the Defibrillator Implantation surgical procedure Performed?

• In a Defibrillator Implantation surgery, a long thin tube called a catheter, is inserted through the subclavian vein present below the collar bone
• The catheter contains the leads (or wires) that will be connected to the defibrillator, after it is slowly guided and placed onto the ventricle of the heart
• The leads are guided into the heart through fluoroscopic imaging
• Next, the surgeon creates a pocket-like sac between the chest muscles and the skin, in order to hold the defibrillator
• The wires, after being wedged to the ventricle, are connected to the defibrillator and placed in the pocket
• It is then closed with sutures after examining for the proper functioning of the defibrillator

Where is the Procedure Performed?

A Defibrillator Implantation surgical procedure is performed in a hospital or out-patient facility. The patient is admitted, undergoes the procedure and is discharged as per the instruction of the physician.

Who Performs the Procedure?

The procedure is performed by a cardiologist or a cardiothoracic surgeon, along with an anesthesiologist. Sometimes, a radiologist may also be involved.

How long will the Procedure take?

The surgical procedure may take anywhere between 1-2 hours. If necessary, the physician may ask the patient to wait for a longer period of time in the healthcare facility, for observation.

What do you need to tell your Physician before the Procedure?

It is very important to provide the following information to your healthcare provider. This enables your healthcare provider in assessing the risks for the surgical procedure and helps avoid unnecessary complications.

• Provide a complete list of medications you are currently, taking to your physician. This information is useful for a variety of reasons. For example, it can help your healthcare provider prevent complications due to a drug interaction
• If you are allergic to any specific medication or food items
• If you are taking blood thinners, such as aspirin, warfarin, herbal supplements, or any other such medications
• If you or your family members, have a history of bleeding disorders, or if there is a tendency to bleed more than normal
• If you have diabetes, high blood pressure, chest pains, or have previously suffered from a heart attack
• If you have ever been diagnosed with blood clots in your leg (deep vein thrombosis) or lung (embolism of lung)
• If you have a history of frequent bone fractures (this may affect bone-healing, if bones are involved as part of your procedure)
• A list of all previous surgical procedures you have undergone, like for example: Removal of appendix, gallbladder, or any other part, of your body; surgical repair of any body part, such as hernia repair, perforation of bowel wall, etc.

What Preparations are needed, prior to the Procedure?

• No particular preparations are needed prior to the procedure
• However, the physician may evaluate the patient’s medical history to gain a comprehensive knowledge of the medications that are being taken currently
• Some of the medication may increase the patient’s chances of bleeding and hence the physician may recommend them to stop such medications for a period of time before performing the procedure
• Sometimes, blood test might be performed to determine if the patient has a bleeding tendency or any other medical conditions that prevents them from undergoing the procedure
• Avoid application of any cosmetics, deodorant, or topical medicines on the area, prior to the procedure
• It is advisable to quit smoking and the use of any nicotine based products, for a while, before the surgery
• Consumption of alcoholic drinks must also be avoided for a period of time, as instructed
• The patient must avoid eating or drinking at least 8 hours prior to the surgical procedure, depending on when the procedure is arranged
• For persons suffering from diabetes, it is important that the blood sugar stays within the normal range; if not their diabetologist may have to control blood sugar by recommending insulin and/or a combination of oral medicines
• A physician will request your consent for Defibrillator Implantation surgical procedure using an Informed Consent Form.

What is the Consent Process before the Procedure?

• A physician will request your consent for the Defibrillator Implantation procedure using an Informed Consent Form.
• Consent for the Procedure: A “consent” is your approval to undergo a procedure. A consent form is signed after the risks and benefits of the procedure, and alternative treatment options, are discussed. This process is called informed consent.
• You must sign the forms only after you are totally satisfied by the answers to your questions. In case of minors and individuals unable to personally give their consent, the individual’s legal guardian or next of kin, shall give their consent for the procedure.

What Tests are needed, before the Defibrillator Implantation surgical procedure?

Before the Defibrillator Implantation procedure, the patient must have all or some of the following tests, as determined by their physician:

• Routine blood and urine analysis
• Electrocardiogram (ECG)
• Chest x-ray
• Echocardiography
• Holter monitoring
• Event recorder

The physician may suggest further tests depending on the health of the patient and their medical history.

What are some Questions for your Physician?

Some of the basic questions that you might ask your physician are as follows:

• What is a Defibrillator Implantation procedure?
• Why is this procedure necessary? How will it help?
• What does the procedure involve?
• Do I have to carry it with me all the time? Can it be replaced or removed?
• Will the implant cause any problem?
• How soon should I get it done? Is it an emergency?
• Who are the medical personnel involved in this procedure?
• Where is the procedure performed?
• What are the risks while performing the procedure?
• What are the complications that might take place, during recovery?
• How long will it take to recover? When can I resume normal work?
• Are there any lifestyle restrictions or modifications required, after the procedure is performed?
• Are there any follow-up tests, periodic visits to the healthcare facility required, after the procedure?
• Is there any medication that needs to be taken for life, after the procedure?
• How many procedure have you (the physician) performed?
• What are the costs involved?

During the Defibrillator Implantation surgical procedure:

What kind of Anesthesia is given, during the Procedure?

During the procedure, the patient is administered local anesthesia with or without sedation. However, in some cases, general anesthesia may be administered. When general anesthesia is necessary, the procedure is usually performed at a hospital surgery facility.

How much Blood will you lose, during the Procedure?

Since the procedure involves inserting a catheter in the vein and is minimally invasive, the amount of blood lost is minimal.

What are the possible Risks and Complications during the Defibrillator Implantation surgical procedure?

The possible risks or complications that may arise during the surgery are:

• Excessive bleeding
• Infection
• Accidental injury to the neighboring tissue or bone
• Cardiopulmonary complications
• Bruising, where the leads are placed

What Post-Operative Care is needed at the Healthcare Facility after the Defibrillator Implantation surgical procedure?

At the healthcare facility, generally there is no requirement for any post-procedure care, unless any complications arise.

After the Defibrillator Implantation surgical procedure:

What are the possible Risks and Complications after the Defibrillator Implantation surgical procedure?

Post Defibrillator Implantation surgical procedure, the following complications may arise:

• Infection in the surgical wound
• Migration, or movement of the wires
• Hemothorax (bleeding in the chest cavity or lungs)
• Pneumothorax (air in the chest cavity or lungs)
• Bleeding around the heart
• Blood leakage through the heart valve
• Swelling or bleeding where the leads are placed

What is the Prognosis after the Surgery?

The prognosis after the procedure is generally excellent.

When do you need to call your Physician?

Do contact your physician/surgeon if you notice any of the following symptoms:

• Pain around the surgical wound
• Swelling and redness
• Bleeding or drainage
• Chest pain
• Shortness of breath
• Fever
• Dizziness
• Muscle ache
• Cold sensation in the arms
• Numbness in the arms and feet
• Pain in the arms
• Signs of Infection
• If any new symptom or discomfort is observed

What Post-Operative Care is needed at Home after the Defibrillator Implantation surgical procedure?

At home, the following post-operative care is recommended, after a Defibrillator Implantation procedure:

• Complete the course of medication
• Avoid strenuous exercises
• Use warm compress to relive the incisional pain
• Wash the incision site with mild soap, while bathing
• Resume normal/regular daily activity (under advice by the physician)
• Avoid taking non-prescribed medications

How long does it normally take to fully recover, from the Procedure?

It takes about 2-3 weeks to completely recover from the procedure.

Additional Information:

What happens to tissue (if any), taken out during the Procedure?

The procedure does not involve the surgical removal of any tissue.

When should you expect results from the pathologist regarding tissue taken out, during the Procedure?

Since no tissue is removed during the procedure, a pathologist does not get involved in the care of the patient.

Who will you receive a Bill from, after the Defibrillator Implantation surgical procedure?

It is important to note that the number of bills that the patient may receive depends on the arrangement the healthcare facility has with the physician and healthcare providers.

Sometimes, the patient may get a single bill that includes the healthcare facility charges and the physician charges. Alternatively, the patient might get multiple bills depending on the healthcare provider involved. For instance, the patient may get a bill from:

• The hospital or outpatient facility
• The physician who performs the procedure
• An anesthesiologist (if anesthesia was administered)
• A radiologist (if radiological tests are performed during the procedure)

The patient is advised to inquire and confirm the type of billing, before a Defibrillator Implantation surgical procedure is performed. 

Thanks and Gratitude:

We sincerely acknowledge and thank Dr. Douglas J. Jones for reviewing the article. His valuable input and feedback has helped enrich the contents of this article.

Douglas J. Jones, MD FACS
Board Certified General Surgeon and Faculty Member
University of Illinois, College of Medicine at Urbana-Champaign
506 S. Mathews Ave., Urbana, IL 61801, USA