What happens during an implantable cardioverter defibrillator procedure?
Generally, an implantable cardioverter defibrillator (ICD) insertion -- the implantation of an electronic device used to help regulate electrical problems with the heart -- follows this process:
  • An intravenous (IV) line will be started in your hand or arm prior to the procedure for injection of medication and to administer IV fluids, if needed.
  • You will be placed on your back on the procedure table.
  • You will be connected to an electrocardiogram (ECG or EKG) monitor that records the electrical activity of the heart and monitors the heart during the procedure using small, adhesive electrodes. Your vital signs (heart rate, blood pressure, breathing rate, and oxygenation level) will be monitored during the procedure.
  • Large electrode pads will be placed on the front and back of the chest.
  • You will receive a sedative medication in your IV before the procedure to help you relax. However, you will likely remain awake during the procedure.
  • The ICD insertion site will be cleansed with antiseptic soap.
  • Sterile towels and a sheet will be placed around this area.
  • A local anesthetic will be injected into the skin at the insertion site.
  • Once the anesthetic has taken effect, the physician will make a small incision at the insertion site.
  • A sheath, or introducer, is inserted into a blood vessel, usually under the collarbone. The sheath is a plastic tube through which the ICD lead wire will be inserted into the blood vessel and advanced into the heart.
  • It will be very important for you to remain still during the procedure so that the catheter does not move out of place and to prevent damage to the insertion site.
  • The lead wire will be inserted through the introducer into the blood vessel. The physician will advance the lead wire through the blood vessel into the heart.
  • Once the lead wire is inside the heart, it will be tested to verify proper location and that it works. There may be one, two, or three lead wires inserted, depending on the type of device your physician has chosen for your condition. Fluoroscopy (a special type of x-ray that will be displayed on a TV monitor) may be used to assist in testing the location of the leads.
  • The ICD generator will be slipped under the skin through the incision (just below the collarbone) after the lead wire is attached to the generator. Generally, the generator will be placed on the non-dominant side.
  • The ECG will be observed to monitor ICD function.
Mehrdad Ariani, MD
Cardiology (Cardiovascular Disease)

Cardiologist Dr. Mehrdad Kevin Ariani explains what happens during an implantable cardioverter defibrillator (ICD) procedure. Watch Dr. Ariani's video for tips and information on heart health.

The ICD procedure usually takes 1 to 2 hours. You’ll be relaxed but awake. Here’s what will happen:

1. Monitoring and local anesthetic.
  • Devices will be attached to keep track of your heart rate and breathing.
  • The doctor will inject numbing medication in the site where the pulse generator will be inserted. The injection usually feels like a pinprick with some burning, and only lasts a few seconds. After that, your chest will be numb and you should feel no pain.
2. Incision. The doctor makes a small incision (cut) in the skin below your collarbone. This makes a small “pocket” for the pulse generator.

3. Inserting the leads. The doctor inserts a needle into a vein in your upper chest, and inserts each lead through the needle. Using x-ray “video” guidance, the lead is threaded through the vein into your heart. You won’t feel this, since blood vessels don’t contain nerves.

4. Testing the leads. The medical team takes electrical measurements to make sure each lead is placed correctly. Each lead will be moved and retested until it is in the perfect place.

5. Attaching the pulse generator. The pulse generator is connected to the leads and inserted under your skin, into the “pocket” beneath your collarbone.

6. Programming the ICD. The medical team then programs the ICD to treat your heart rhythm problem. You’ll probably hear them calling numbers to each other as they do this. They might also ask you to take some deep breaths.

7. Closing the incision. Your doctor will close the surgical cut with a few stitches, and you will be moved to recovery.
Theodore A. Monitz, MD
Cardiology (Cardiovascular Disease)
Placing an implantable cardioverter defibrillator (ICD) does require a minor surgical procedure usually done in our cardiac catheterization/electrophysiology laboratory. You will be given some medication before the procedure to help you relax. You will receive a local anesthetic to numb the area near your upper chest and shoulder so that your doctor can place the defibrillator without feeling any pain. You may also receive antibiotics to prevent infection. Your doctor will thread the defibrillator wires through a vein and localize this with an x-ray machine so he can see that the wires are placed properly in your heart. Once the wires are in place, your doctor will make a small cut in your chest or abdomen and will slip the small defibrillator metal box under the skin. This box should be the size of a large half dollar coin or slightly bigger. The box has a battery, pulse generator, and computer. Once this is in place, your doctor will test it and you will be given medications to help you sleep during this testing so that you don't feel any of the electrical pulses. Your doctor will then close the small incision. The entire procedure takes approximately one-two hours and you will be sent back to the recovery area for observation, usually overnight.
Piedmont Heart Institute
Placing an implantable cardioverter defibrillator (ICD) requires minor surgery, which usually is done in a hospital. You'll be given medicine right before the surgery that will help you relax and may make you fall asleep.
Your doctor will give you medicine to numb the area where he or she will put the ICD so you don't feel any pain. Your doctor also may give you antibiotics to prevent infection.
First, your doctor will thread the ICD wires through a vein to the correct location in your heart. An x-ray "movie" of the wires as they pass through your vein and into your heart will help your doctor place them.
Once the wires are in place, your doctor will make a small cut into the skin of your chest or abdomen. He or she will then slip the ICD's small metal box through the cut and just under your skin. The box contains the battery, pulse generator, and computer.
Once the ICD is in place, your doctor will test it. You'll be given medicine to help you sleep during this testing so you don't feel any electrical pulses. Then your doctor will sew up the cut. The entire surgery takes a few hours.
This answer from the National Heart, Lung and Blood Institute has been reviewed and/or edited by Dr. William D. Knopf.

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.