ICDimplantation

Implantable cardioverter-defibrillator implantation is the surgical placement of a device that monitors heart rhythm and can deliver pacing or shocks to terminate life-threatening ventricular arrhythmias. The system typically includes leads placed into the heart and a generator implanted under the skin, usually in the chest. Some devices lack transvenous leads and rely on a subcutaneous configuration.

Indications for ICD implantation include primary prevention for patients at high risk of sudden cardiac death due to reduced left ventricular function or cardiomyopathy, and secondary prevention for individuals who have survived ventricular fibrillation or sustained ventricular tachycardia. Additional indications exist for inherited arrhythmia syndromes and certain congenital heart diseases. Candidate selection depends on overall prognosis, comorbidities, and the likelihood that the device will improve survival or quality of life.

Pre-procedure evaluation involves risk assessment, imaging as needed, planning of venous access, and management of antiplatelet or anticoagulant therapy. Patients are counseled about the planned device, potential risks, and lifestyle implications. Prophylactic antibiotics are typically given, and arrangements for follow-up and remote monitoring are discussed.

The procedure is usually performed under local anesthesia with sedation. Venous access is established (commonly via the subclavian or axillary vein), leads are placed in the heart, and the generator is positioned in a chest wall pocket. The system is tested to verify sensing and appropriate therapy. Subcutaneous ICDs offer an option when pacing is not required, avoiding transvenous leads.

Risks include infection, lead dislodgement or fracture, pneumothorax, bleeding, venous thrombosis, and inappropriate shocks. Postoperative care focuses on wound care, device programming, activity guidance, and regular device checks or remote monitoring. The device generally enhances survival in approved indications, with battery life typically spanning several years and replacement required when depleted.