PACEMAKER/DEFIBRILLATORImplantable cardioverter/defibrillator is commonly referred to as an ICD. This device continuously monitors the heart for rhythm and is implanted in patients who have had ventricular fibrillation (VF) or ventricular tachycardia (VT) or patients who are felt to be at risk for these sometimes fatal rhythms. These devices can also act like a standard pacemaker and pace the heart if it is too slow. When an abnormally fast rate is detected by the ICD, it either electrically paces the heart very fast or delivers a small electrical shock to the heart to convert the heart back to normal rhythm. If a shock is delivered it will be felt by the patient as a strong jolt in the chest. If you feel a shock call your cardiologist immediately. If you experience multiple shocks, admission to the hospital is usually required. The device is implanted in an operating room under deep sedation. Patients are discharged the following day. The incision is like the insertion of a regular pacemaker.

Pre procedure instructions:
Lab work will need to be completed several days prior to the procedure. Do not eat or drink after midnight the night before. Take all your medications the morning of the procedure with a sip of water. You need someone to drive you home or make arrangements for transportation. Wear clothing that is easy to get on and off.

Post procedure instructions:
You may be given a prescription for a mild pain reliever. You may not shower for 48 hours after the procedure and you need to keep it clean and dry. Avoid excessively extending the arm above shoulder level for four weeks.  A one week follow up appointment will be needed for your device at your pacer clinic.

What to expect:
An IV will be started for fluids and medications. A mild sedative will be given through the IV by an anesthesiologist. You will also have adhesive skin electrodes applied to the chest and then attached to a heart monitor. A 2-inch incision is made under the collarbone. The pacer wires are then inserted into a vein and advanced through that vein under fluoroscopic guidance into the heart. The other end of the pacer wire is then attached to the generator that is implanted under the skin at the incision site. The site is then sutured or surgical glue will be used to close the incision. You will be discharged the following day from the hospital after a chest x-ray and your ICD is checked by the pacer rep.