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Generally, a patient who will undergo an ICD implantation surgery will be asked by the doctors to do or not to do things before the surgery, which are mentioned below-

• The doctors will tell the patient about the medications which he has to take and which he has to stop taking before the surgery. The patient will receive specific instructions.

• In case, the patient is diabetic, he must ask the doctor how to adjust his diabetes medications.

• The patient must strictly stop eating or drinking anything after midnight eve of the surgery. If he is required to take medicines, then he must take it with a sip of water only.

• Once at the Cath Lab, the nurse will place an intravenous line (IV) into the arm or hand of the patient, so that he receives medications and fluids when the surgery is on.

• He will be given an antibiotic to prevent the occurrence of any infection and through the IV, the patient will be supplied with medications to make him relax and drowsy at the time of surgery, which will not put him into a complete sleep. 

• Then the nurse will connect the patient to several monitors, which will allow the doctors to check his heart rhythm, blood pressure, the oxygen level of his blood and other necessary measurements. 

• Next, the left side of the patient’s chest from his neck to his groin will be shaved and cleansed with a special soap and sterile drapes will be used to cover him from his neck to his feet. 

• To stop the contact between the patient’s hands and the sterile drapes, a soft strap will be placed across his waist and arms.

There are two ways of implanting an ICD into the body - the most common approach is the Endocardial or Transvenous approach. The procedure starts by giving local anesthesia, but in some cases, general anesthesia may be given to the patient. Now, the doctor will make a small incision under the collarbone and the leads are placed into the patient’s veins and are guided inside the heart chamber. The generator is placed under the skin in his upper chest, which is attached to the leads.

Rarely it happens, that the doctor finds it necessary to adapt the Epicardial (Outside the heart) approach to implant the ICD. Then, this approach requires an open heart surgery where the leads are sewn onto the heart.

There are minimally invasive approaches too, for example, robotic-assisted surgery to lessen the trauma associated with such type of surgery. It’s up to the doctor to decide whether this approach is necessary for the patient or not.

After the surgery, the patient is asked to stay overnight at the hospital because on the very next morning, the patient will have an X-ray to ensure that the ICD leads are in proper position and the ICD will be programmed to ensure it is functioning properly. The patient will be informed about the type of ICD and leads implanted, the date of implantation and the doctor who has performed the surgery. Approximately after 3 months from the date of surgery, the patient will receive his permanent identification card with relevant information, which he needs to carry with him all the time to get medical attention.

In the hospital

• After the procedure, you may be taken to the recovery room for observation or returned to your hospital room. A nurse will monitor your vital signs.

• Tell your nurse right away if you feel any chest pain or tightness, or any other pain at the incision site.

• After the period of bed rest has been completed, you may get out of bed with help. The nurse will help you the first time you get up and will check your blood pressure while you are lying in bed, sitting, and standing. Move slowly when getting up from the bed to avoid any dizziness from the period of bed rest. You will be able to eat or drink once you are completely awake.

• Your arm may be in a sling for a day or so. How long you will need to wear a sling will depend on your provider. Some people are asked to wear it at night while they sleep after the first couple of days but can take it off during the day.

• The insertion site may be sore or painful, and pain medicine may be given if needed.

• After the procedure, a chest X-ray is often done to check the lung and make sure the systems are stable.

• Your doctor will visit you in your room while you are recovering. The doctor will give you specific instructions and answer any questions you may have.

• Once your blood pressure, pulse, and breathing are stable and you are alert, you will be taken to your hospital room.

• Arrange to have someone drive you home from the hospital after your discharge.

At home

• You should be able to return to your daily routine within a few days. Your doctor will tell you if you need to take more time in returning to your normal activities.

• Avoid lifting or pulling on anything for a few weeks. You may be told to limit movement of the arm on the side that the ICD was placed, based on your doctor's preferences.

• You will most likely be able to resume your usual diet unless your doctor tells you differently.

• Keep the insertion site clean and dry. You will be given instructions about bathing and showering.

• Your doctor will give you specific instructions about driving. You will not be able to drive until your doctor says it's OK. These limitations will be explained to you if they are applicable to your situation.

• You will be given specific instructions about what to do the first time your ICD delivers a shock. Calming yourself with slow deep breaths can be helpful if you are anxious after a shock.

• Ask your doctor when you will be able to return to work. The nature of your job, your overall health, and your progress will determine how soon you may return to work.

• After implantation, your ICD will require regular evaluation to evaluate its function and battery status and to check for any significant events stored by the device. Your doctor will tell you when and how this is done.

• A home monitor may be provided to you that can communicate with your ICD wirelessly. Information about ICD function can then be related to your doctor over the internet.

Tell your doctor right away if you have any of the following:

• Fever or chills

• Increased pain, redness, swelling, or bleeding or other drainages from the insertion site

• Chest pain or pressure, nausea or vomiting, profuse sweating, dizziness or fainting

• Palpitations

• ICD shock

• If your device generator feels loose or like it is wiggling in the pocket under the skin

Your doctor may give you other instructions after the procedure, depending on your particular situation.

Like any other surgical procedures, ICD implantation to has some risks associated with it, which include-

• Infection at the implant site

• Medications provided during the procedure may cause allergic reactions

• Swelling, bleeding or bruising at the place where ICD was implanted

• Veins, where ICD leads are placed, may get damaged

• Bleeding around the heart, which is life-threatening

• Leakage of blood through the heart valve where the ICD lead is placed

• The collapse of the lung, medically known as pneumothorax

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