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Health A-Z

Medical Content Created by the Faculty of the
Harvard Medical School

How It's Done

Before surgery, you will dress in a hospital gown and remove any jewelry and watches.

The most common location to place the ICD‘s pulse generator is below the left collarbone. The skin in this area will be shaved, cleaned and numbed with a local anesthetic. If you need more than a local anesthetic to make you feel comfortable, your doctor may use conscious sedation, a form of anesthesia that allows you to remain awake and pain-free during surgery.

A small incision will be made in the numbed area near your collarbone. Next, a small incision will be made in a vein under your collarbone. This vein will be used as the passageway for threading the ICD‘s electrode(s) into your heart. Some ICD models use one electrode, others use more.

The doctor will insert the electrode(s) into the vein and guide the electrode(s) into your heart. X-rays will confirm that the electrode(s) are positioned correctly. Wires from the electrode(s) will be connected to the pulse generator, which will then be nestled near your collarbone. Your doctor will test the ICD to make sure it is working correctly. To do this, the doctor will trigger cardiac arrhythmias on purpose, and then observe how the ICD responds. During this part of your surgery, you will receive general anesthesia to allow you to sleep through the ICD testing.

Once the doctor is sure that your ICD is working properly, the incision will be closed with stitches (sutures) or surgical staples. The entire procedure usually takes one to two hours.

After surgery, your medical team will monitor your condition closely. During this time, your doctor may use a handheld magnetic instrument to make programming adjustments in your ICD. For the next few days, you will be given antibiotics to help prevent infection. If all goes well, your hospital stay should be brief.

Before you leave the hospital, you will receive instructions about safely recuperating. In particular, you should avoid heavy lifting and other strenuous arm movements for a few weeks. These activities can dislodge or shift the position of the ICD electrodes inside your heart.

You will receive information about driving restrictions and participating in contact sports. Your doctor also will tell you how to reduce your risk of electromagnetic interference, which can affect the programming and performance of your ICD. This interference can come from anti-theft devices, surveillance equipment, cell phones, welding equipment and hospital machinery, such as magnetic resonance imaging scanners.

Before you go home, your doctor will give you information about the make and model of your ICD. Print this information on an identification card and carry it with you. You also may want to wear a medical alert necklace or bracelet that identifies you as someone with an ICD.

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From Health A-Z, Harvard Health Publications. Copyright 2007 by the President and Fellows of Harvard College. All rights reserved. Written permission is required to reproduce, in any manner, in whole or in part, the material contained herein. To make a reprint request, contact Harvard Health Publications. Used with permission of StayWell.

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