Implantable Defibrillator - "ICD"

An implantable cardioverter defibrillator, or ICD, is a device that helps treat abnormal heart rhythms using electrical impulses.

What is an ICD?
Why do I need an ICD?
What are the risks of having an ICD?
How do I prepare for having an ICD?
What happens during an ICD procedure?
What happens after an ICD procedure?

What is an ICD?

An Implantable Cardioverter Defibrillator (ICD) is a life-saving device that helps to fix fast, abnormal heart rhythms. The ICD sends electrical impulses to the heart to slow down the fast heart rhythm and return it to normal. ICDs consist of two parts: the defibrillator and leads. The device sits under the skin on the left or right side of your chest, where it monitors your heart rhythm 24 hours a day.

Why do I need an ICD?

A healthy heart has a steady, regular rhythm. In some people, the heart’s rhythm can be disrupted and beat too fast, or too slowly. This is a disorder known as an arrhythmia, and it can occur due to:

  • Ageing
  • Inherited or genetic causes
  • Previous heart attack
  • Heart muscle or heart valve problems\
  • Viral infections of the heart

You could be at risk of an arrhythmia if you have had coronary artery disease, heart failure or problems with your heart’s structure or ‘electrical system’. If you’ve had a fast arrhythmia, or are at risk of having one, then your doctor might recommend an ICD for you.  

ICDs treat abnormally fast heartbeats with pacing and defibrillation. First, an electrical signal will be sent to slow down your fast heartbeat. If the heartbeat can’t be slowed down, then a strong electrical impulse, called a shock, is delivered. While this sounds scary, remember that it’s a necessary step to bring your heart rate back to normal and save your life.

Below, you can watch a short video from one of our specialists explaining more about ICDs .

Below, you can watch an animation explaining what happens during an ICD procedure.

What are the risks of having an ICD?

As with any surgery, there are some risks associated with defibrillator surgery - though major risks are rare. 

The most common risk for this procedure is bruising or swelling at the ICD site.

Less common risks are:

  • Movement of the ICD generator or leads
  • Infection - There are a number of things you can do to reduce the risk of infection. Read the Healthcare Associated Infections Consumer factsheet 
  • Bleeding or blood clots
  • Vein or heart valve damage, resulting from ICD leads
  • Allergic reaction to medications
  • Heart attack and stroke
  • Beeding - needing open heart surgery
  • Death from this procedure is rare

Your doctor will explain all of the risks to you in detail before you agree to the surgery - and you’re also encouraged to discuss any questions or concerns with your medical team. Your doctor will ask you to sign a consent form before you have the surgery.

How do I prepare for having an ICD?

There are a few steps you need to take to prepare for having your ICD put in, including:

  • Planning your transport home - It is your responsibility to arrange how you will get home after surgery. For information, including guidelines and tips for travelling home by car or plane after heart surgery, you can visit our travel page
  • Shower using a chlorhexidine wash for at least one day before your procedure - can be purchased from any pharmacy
  • Asking your doctor -  if you are able to take your usual medications, in particular blood thinning medication. If you take SGLT2 medicine for diabetes, you will need to stop taking them at least 3 days before your surgery. Read our Patient Information Guide on SGLT2 inhibitors for diabetes.
  • Not eating or drinking -  for at least 6 hours before the procedure
  • Sticky dots for monitoring your heart should be placed on the left and right shoulders - the risk of infection is increased if sticky dots are placed on the upper chest area where the ICD will be inserted
  • Removing any jewellery and wearing a hospital gown - immediately before your procedure

What happens during an ICD procedure?

Your defibrillator surgery takes place in the Electrophysiology Lab. Before entering the lab, you'll be attached to heart monitors and a cannula will be inserted in a vein in your arm. You will be taken to the procedure and be asked to lie on an operating table.  You will be given sedation (Midazolam/Fentanyl) to help you relax and provide pain relief throughout the procedure. During your defibrillator surgery:

  • You’ll be given a local anaesthetic - to numb the area
  • Your doctor will make an incision to create a pocket - around 5-10 centimetres long, in the upper chest below your collarbone
  • One or two leads are guided through a vein - towards the heart, and secured to the heart muscle
  • The leads are connected to the defibrillator - and your doctor tests the device to ensure that it’s working appropriately
  • The defibrillator is placed inside the pocket - the incision is closed with stitches and a dressing will be applied

Afterwards, there will be a bulge visible under the skin where the ICD has been inserted. The procedure usually takes 1-3 hours to complete.

What happens after an ICD procedure?

After your procedure, you will be moved to the hospital’s recovery area. You’ll have a special dressing over your wound and it’s important that you don’t change this for 10 days. Your doctor will give you specific instructions for managing your wound. The site of the surgery may feel tender or sore and have some bruising – this should go away after a few weeks.

During your recovery, you’ll be given information about the activities that you can and can’t do. This includes avoiding clothes that apply pressure to your wound, and not lifting anything greater than 5kg for at least one month. More information and guidelines can be found in our How to Care for Yourself after Getting a Pacemaker or Defibrillator Information Sheet.

For information, including guidelines and tips for travelling by car or plane with an ICD, you can visit our travel page.

You’ll also be required to attend regular follow-up appointments at an ICD clinic. Your medical team will give you contact information for these appointment before you leave hospital. While your ICD won’t be obvious to other people, you should try to avoid wearing tight-fitting clothes while your incision is healing (as this can irritate the skin).

As you get used to your new way of living with your ICD, here are some key points to remember:

  • Have a plan of action in case you get an electric shock from your ICD - you can find out more about what you should do if you get shocked here
  • Make sure that all health professionals you see know that you have an ICD - in case you need specific care or instructions
  • Carry identification about your ICD - in your wallet, and if possible wear a bracelet or other jewellery that indicates you have an ICD
  • Visit your doctor regularly - to have your ICD monitored
  • Be aware that strong magnetic and electrical fields may interfere with your device - find out more from your doctor about which devices you should avoid 

Finally, you should always phone your doctor about your ICD if you experience any of the following:

  • Numbness or tingling in your arm closest to your ICD
  • Two or more shocks in 48 hours
  • Loss of consciousness, either alone or before feeling a shock
  • Signs of infection where your ICD was implanted - such as redness, swelling, warmth, bleeding/drainage
  • Signs of a fever up to 8 weeks after your ICD procedure
  • Swelling of your arm on the same side of the ICD

Remember, always follow your doctor’s recommendations about any lifestyle changes and medications you need. Doing this will give you the best chance of recovering well and living a healthy, active life.

For further information about ICD's visit our resources page