Subcutaneous Cardioverter Defibrillator Implantation (S-ICD)

What is a Subcutaneous Cardioverter Defibrillator Implantation (S-ICD)

Subcutaneous implantable cardioverter defibrillator is a device that identifies and corrects abnormal heart rhythms. Subcutaneous cardioverter defibrillator implantation is a surgery to place an S-ICD under the skin in the chest.

An S-ICD has a battery, a small computer (pulse generator), and a device that moves electrical currents (electrode). The S-ICD detects and corrects two types of dangerous irregular heartbeats (arrhythmias):

  • A rapid heart rhythm (ventricular tachycardia).
  • The lower chambers of the heart (ventricles) contracting in an uncoordinated way (ventricular fibrillation).

When the S-ICD detects tachycardia or fibrillation, it sends a shock to the heart that attempts to restore the heartbeat to normal (defibrillation). The shock may feel like a strong jolt in the chest.

Your health care provider may recommend S-ICD implantation if:

  • You had an arrhythmia that started in the ventricles.
  • Your heart has damage from disease or a heart condition.
  • Your heart muscle is weak.

There is another type of ICD called the traditional ICD (transvenous ICD) that you and your health care provider may consider. With a transvenous ICD, electrodes are placed through a large blood vessel and into the heart wall, and the shock is delivered directly to the heart tissue. This is different from an S-ICD. With an S-ICD, electrodes do not touch the blood vessels or heart, and the shock is absorbed through the chest. Your health care provider may recommend implantation of an S-ICD instead of a traditional ICD if:

  • You have vascular disease (blood vessel disorder).
  • You have medical conditions that increase your risk for infection.
  • You do not need a pacemaker.

Talk with your health care provider about the benefits of S-ICD.

Tell a health care provider about:

  • Any allergies you have.
  • All medicines you are taking, including vitamins, herbs, eye drops, creams, and over-the-counter medicines.
  • Any problems you or family members have had with anesthetic medicines.
  • Any blood disorders you have.
  • Any surgeries you have had.
  • Any medical conditions you have.
  • Whether you are pregnant or may be pregnant.

What are the risks?

Generally, this is a safe procedure. However, problems may occur, including:

  • Infection.
  • Bleeding.
  • Allergic reactions to medicines or dyes.
  • Failure to shock or correct the arrhythmia.
  • Swelling and bruising.
  • Blood clots.

What happens before the procedure?

Staying hydrated

Follow instructions from your health care provider about hydration.

  • Up to 2 hours before the procedure – you may continue to drink clear liquids, such as water, clear fruit juice, black coffee, and plain tea.

Eating and drinking restrictions

Follow instructions from your health care provider about eating and drinking, which may include:

  • 8 hours before the procedure – stop eating heavy meals or foods such as meat, fried foods, or fatty foods.
  • 6 hours before the procedure – stop eating light meals or foods, such as toast or cereal.
  • 6 hours before the procedure – stop drinking milk or drinks that contain milk.
  • 2 hours before the procedure – stop drinking clear liquids.

Medicines

  • Ask your health care provider about:
    • Changing or stopping your regular medicines. This is especially important if you are taking diabetes medicines or blood thinners.
    • Taking over-the-counter medicines, vitamins, herbs, and supplements.
    • Taking medicines such as aspirin and ibuprofen. These medicines can thin your blood. Do not take these medicines unless your health care provider tells you to take them.
  • You may be prescribed antibiotic medicine to take before the procedure to help prevent infection. If so, take the antibiotic as told by your health care provider. Do not stop taking the antibiotic even if you start to feel better.

General instructions

  • Do not use any products that contain nicotine or tobacco, such as cigarettes and e-cigarettes. If you need help quitting, ask your health care provider.
  • You may have blood tests.
  • You may have a test to check the electrical signals in your heart (electrocardiogram, ECG).
  • You may have imaging tests, such as a chest X-ray.
  • You may be asked to shower with a germ-killing soap.
  • Plan to have a responsible adult care for you for at least 24 hours after you leave the hospital or clinic. This is important.

What happens during the procedure?

  • To lower your risk of infection:
    • Your health care team will wash or sanitize their hands.
    • Your skin will be washed with soap.
    • Hair may be removed from the surgical area.
  • An IV will be inserted into one of your veins.
  • You will be given one or more of the following:
    • A medicine to help you relax (sedative).
    • A medicine to make you fall asleep (general anesthetic).
  • A small incision will be made on the left side of your chest near your rib cage, under your arm.
  • A pocket (pouch) will be made in the skin on the lower part of your chest. The S-ICD pulse generator will be inserted into this pocket.
  • An electrode will be placed under the skin in your chest, near your breastbone (sternum).
  • The electrode will be attached to the S-ICD pulse generator.
  • The S-ICD will be tested to make sure it is working.
  • Your incision will be closed with stitches (sutures).
  • A bandage (dressing) may be placed over your incision.

The procedure may vary among health care providers and hospitals.

What happens after the procedure?

  • Your blood pressure, heart rate, breathing rate, and blood oxygen level will be monitored until the medicines you were given have worn off.
  • You will be given pain medicine as needed.
  • You may have a chest X-ray to check the S-ICD.
  • You will get an identification card explaining that you have an S-ICD. You will need to keep this card with you at all times.
  • Do not drive until your heart care provider approves.

Summary

  • A subcutaneous cardioverter defibrillator implantation is a type of surgery to implant a device that corrects dangerous irregular heartbeats (arrhythmias).
  • During the surgery, a subcutaneous implantable cardioverter defibrillator (S-ICD) is placed under the skin in the chest.
  • The S-ICD electrodes rest in the chest, but they do not directly touch the heart or blood vessels.

Subcutaneous Cardioverter Defibrillator Implantation, Care After

This sheet gives you information about how to care for yourself after your procedure. Your health care provider may also give you more specific instructions. If you have problems or questions, contact your health care provider.

What can I expect after the procedure?

After the procedure, it is common to have:

  • Some pain. It may last a few days.
  • A slight bump under the skin where the subcutaneous implantation cardioverter defibrillator (S-ICD) is. You may be able to feel the device under the skin. This is normal.

Follow these instructions at home:

Medicines

  • Take over-the-counter and prescription medicines only as told by your health care provider.
  • If you were prescribed an antibiotic medicine, take it as told by your health care provider. Do not stop taking the antibiotic even if you start to feel better.

Incision care

  • Follow instructions from your health care provider about how to take care of your incision. Make sure you:
    • Wash your hands with soap and water before you change your bandage (dressing). If soap and water are not available, use hand sanitizer.
    • Change your dressing as told by your health care provider.
    • Leave stitches (sutures), skin glue, or adhesive strips in place. These skin closures may need to stay in place for 2 weeks or longer. If adhesive strip edges start to loosen and curl up, you may trim the loose edges. Do not remove adhesive strips completely unless your health care provider tells you to do that.
  • Check your incision area every day for signs of infection. Check for:
    • Redness, swelling, or pain.
    • Fluid or blood.
    • Warmth.
    • Pus or a bad smell.

Activity

  • Do not lift anything that is heavier than 10 lb (4.5 kg), or the limit that you are told, until your health care provider says that it is safe.
  • Avoid sports and any other activity that could cause a hit to the generator or leads. Ask your health care provider what activities are safe for you and when you may return to your normal activities.
  • Follow instructions from your health care provider about exercise and sexual activity restrictions after your procedure.

Electric and magnetic fields

  • Tell all health care providers, including your dentist, that you have a defibrillator. They need to know this so they do not give you an MRI scan, which uses strong magnets.
  • When using your cell phone, hold it to the ear that is on the opposite side from the defibrillator. Do not leave your cell phone in a pocket over the defibrillator.
  • If you must pass through a metal detector, quickly walk through it. Do not stop under the detector, and do not stand near it.
  • Avoid places or objects that have a strong electric or magnetic field, including:
    • Airport security gates. At the airport, tell officials that you have a defibrillator. Your defibrillator ID card will let you be checked in a way that is safe for you and will not damage your defibrillator. Also, do not let a security person wave a magnetic wand near your defibrillator. That can make it stop working.
    • Power plants.
    • Large electrical generators.
    • Anti-theft systems or electronic article surveillance (EAS).
    • Radiofrequency transmission towers, such as cell phone and radio towers.
  • Do not use amateur (ham) radio equipment or electric (arc) welding torches.
  • Some devices are safe to use if they are held 12 inches (30 cm) or more away from your defibrillator. These include power tools, lawn mowers, and speakers. If you are not sure if something is safe to use, ask your health care provider.
  • Do not use MP3 player headphones. They have magnets.
  • You may safely use electric blankets, heating pads, computers, and microwave ovens.

General instructions

  • Do not take baths, swim, shower, or use a hot tub until your health care provider approves. You may need to take sponge baths until your health care provider says that you may bathe or shower.
  • Do not drive until your health care provider approves.
  • Always keep your defibrillator ID card with you. The card should list the implant date, device model, and manufacturer. Consider wearing a medical alert bracelet or necklace that says that you have an S-ICD.
  • Do not use any products that contain nicotine or tobacco, such as cigarettes and e-cigarettes. If you need help quitting, ask your health care provider.
  • Have your defibrillator checked as often as told by your health care provider. Most S-ICDs last for 4–8 years before they need to be replaced.

Contact a health care provider if:

  • You feel one shock in your chest.
  • You gain weight suddenly.
  • You have a fever.
  • You have severe pain, and medicines do not help.
  • You have redness, swelling, or pain around your incision area.
  • You have pus or a bad smell coming from your incision area.
  • You have fluid or blood coming from your incision.
  • Your incision area feels warm to the touch.
  • Your heart feels like it is fluttering or skipping beats (heart palpitations).
  • You feel increased anxiety or depression.

Get help right away if:

  • You feel more than one shock.
  • You have chest pain.
  • You have problems breathing or have shortness of breath.
  • You have dizziness or fainting.

Summary

  • After the procedure, you may have some pain, see a bump under your skin, and feel the device under your skin.
  • Check your incision area every day for signs of infection.
  • Be careful around electric and magnetic fields.
  • Always keep your defibrillator ID card with you.
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