If your child is prone to life-threatening abnormal heart rhythms, your child's doctor may suggest a medical device called an implantable cardioverter defibrillator (ICD). This is a small battery-powered device that's surgically placed under the skin to monitor heartbeats. It's connected to one or two flexible wires that run through veins to reach the heart. If the ICD senses that the heart is beating too quickly, too slowly or irregularly, it sends a pulse of electricity to the heart to restore a normal rhythm.
When the ICD assists the heart in any way, the information is recorded in the device's memory, allowing your child's doctor or nurse to review it at any time.
An ICD may be recommended for children who have any of the following:
- A history of ventricular tachycardia, ventricular fibrillation or cardiac arrest
- An increased risk of sudden cardiac death due to previous heart surgery or heart failure
- An inherited defect of the heart's electrical system that may increase their risk for dangerously fast heart rhythms
Preparing for ICD implantation
A surgical procedure is necessary to place an ICD. You will be instructed as to the time you and your child need to be at the hospital, but be prepared to arrive early in the morning. Also, be ready to spend at least one night in the hospital.
We recommend that you contact UCSF Child Life Services for help with preparing your child emotionally for the hospital experience. By talking to your child in developmentally appropriate ways about the procedure, encouraging questions and listening to worries, you can lessen fears and create a sense of safety.
Because patients receive general anesthesia (a fully sleep-like state) for the procedure, your child should not eat or drink anything for eight hours before the ICD surgery. You will receive instructions about this that you should follow exactly. It's extremely important that your child's stomach is empty when the procedure begins.
If your child appears ill or has a fever, cold, cough, vomiting, diarrhea or diaper rash, or was recently exposed to chicken pox, the procedure may be postponed for your child's own safety. Please contact us us right away if you notice any symptom that might be a concern.
Sometimes blood thinner medications are stopped for a period of time before the ICD placement procedure. If your child takes aspirin, warfarin or another blood thinner, please discuss this with the doctor. Avoid giving ibuprofen – which you may know as Advil or Motrin – during the week before the procedure.
The day of the procedure
Shortly after you arrive at the hospital, a nurse will check your child's temperature, pulse and blood pressure, and give your child pajamas or a hospital gown to wear while in the hospital.
Depending on your child's age, size and the type of ICD being used, the procedure will be performed either in the operating room or in the electrophysiology lab's procedure room. The surgery generally takes four to six hours. During this time, you'll receive updates on your cell phone or through a pager that we provide.
The area where the ICD will be implanted – usually under the skin of the chest – will be washed with a yellow antiseptic soap. In addition to general anesthesia, the area where the ICD will be implanted is numbed through the injection of a local anesthetic (a medication that blocks pain signals). Nurses and doctors will closely monitor your child at all times.
The ICD has two main parts: the leads and the generator. The leads are thin wires connecting the generator to the heart. The leads can be attached to the heart's surface or passed through a vessel within the heart. The generator is a small metal case containing a battery and a microcomputer, which is the "brain" of the ICD, programmed to monitor, record and respond to your child's heartbeats.
At the end of the procedure, stitches are placed just under the skin to seal the wound and a dressing is placed over the wound. Your child's body will gradually absorb the stitches as the wound heals.
Recovery in the hospital
When the procedure is finished, your child will first be taken to the recovery room and then to a hospital room. Patients usually feel sleepy, which is helpful since we want them to lie in bed for several hours. When awake, patients can drink clear liquids and eventually have something to eat. In most cases, patients can go home the following morning.
Prior to leaving the hospital, you'll receive a temporary identification card with the model and serial number of your child's ICD. This is important information. Within a few weeks, you'll receive a permanent card in the mail from the device manufacturer. Keep the card with you and your child at all times.
Before taking your child home, please make sure you've received the following materials from your child's doctor or nurse:
- ICD informational brochure
- Detailed post-op instructions
- Follow-up appointment information
Recovery at home
To ensure a smooth recovery, follow your child's post-op instructions precisely. The following information will also help.
The bandage covering the ICD will be removed the day after the procedure. Your child will go home with dry gauze and tape over the surgical site. Some skin glue may be apparent on the incision. Absorbable sutures are located beneath the skin and won't need removal.
It's important to keep the wound clean and dry. Do not apply ointments or creams. You may give your child a sponge bath, but avoid the incision site.
Although your child may be given antibiotics as a precaution, you'll still need to watch for signs of infection. These include redness, swelling, increased pain, drainage or a fever. If any of these occur, notify your child's doctor immediately.
Before leaving the hospital, discuss activity guidelines and restrictions with the doctor or nurse. Be sure to ask any specific questions you have about activities your child enjoys. In general, patients should avoid strenuous activities for six weeks. During this time, patients with ICDs implanted in the chest also need to avoid lifting the elbow above the shoulder on the implant side.
Make sure all of your child's health care providers, including the dentist, are aware of the ICD, as it could affect selection of diagnostic or treatment methods.
Problems with an ICD due to electrical interference are rare. You don't need to worry that your child's ICD will be affected by the use of household appliances, such as microwaves, computers, hair dryers, power tools, radios, TVs and electric blankets, or by the electronics in your car. Cell phones and other small digital devices are unlikely to interfere with ICD function, but avoid holding them directly over your child's ICD.
A few things, however, can cause interference. These include powerful magnets, such as those used for MRI scans; heavy-duty electrical equipment, such as arc welders; and certain surgical instruments.
When traveling, someone with an ICD should not pass through airport metal detectors and should also avoid the handheld wand metal detector; these devices contain strong magnets that may interfere with the ICD. Instead, ask security personnel to check your child by hand. You may need to show them a device identification card.
The ICD manufacturer is often a good source of information for patients and families. The company's toll-free phone number should be listed on the back of the device ID card, or you can visit its website.
Your child's first follow-up appointment will take place one to two weeks after the procedure. This appointment should be made with the Pediatric Heart Center at UCSF Benioff Children's Hospitals or with your referring physician.
At the clinic, a doctor and nurse will examine your child's incision site and check the ICD settings. Be sure to ask any questions you or your child have about ICDs or related matters.
After this checkup, the doctor will determine how often your child needs to have follow-up appointments in the future.