Implantable Cardioverter Defibrillator Procedure

If your child is prone to life-threatening rapid heart rhythms, your doctor may suggest that he or she have a medical device called an implantable cardioverter defibrillator (ICD). While not a cure for dangerously fast heart rhythms, an ICD provides treatment for this condition by constantly monitoring the heart rhythm, and treating an abnormal and life-threatening change in the rhythm.

An ICD may be recommended for children who have the following:

Dual chamber ICD

Illustrations courtesy of Medtronic.

Developed in the 1980s, an ICD senses when the heart is beating too fast and delivers a brief jolt of energy directly to the heart to restore a normal heart rhythm. An ICD also can pace the heart when the heart rhythm is too slow or assist the heart in beating in a regular fashion. 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.

The device consists of a lightweight metal case that encloses a battery and computer circuitry. The device monitors the heart rhythm constantly via one or two leads, which are flexible wires placed in the heart and connected to the ICD. An ICD is most commonly placed under the skin in the upper chest during a surgical procedure called an implantation.

Preparation

Plan to arrive early the morning of the procedure. You will be contacted and instructed about the specific time you and your child need to arrive at the hospital. Please be prepared to spend at least one night in the hospital.

We recommend that you contact our Child Life Services department to help prepare your child for his or her hospital experience. By preparing your child for the procedure and listening to your child's feelings, you can help your child know what to expect and lessen fears.

Because patients are given general anesthesia for the procedure, your child should not eat or drink anything for eight hours before the ICD surgery. Your doctor will tell you exactly when your child should stop eating solid foods and drinking clear liquids. It is extremely important that your child have an empty stomach before receiving sedation for the procedure.

If your child appears ill, has a fever, cold, cough, vomiting, diarrhea, diaper rash or has recently been exposed to chicken pox, the ICD procedure may be postponed. Please call your doctor's office prior to the scheduled procedure date to discuss any symptoms your child may have.

Sometimes blood thinner medications are stopped prior to the ICD procedure. If your child takes aspirin, warfarin or other blood thinners, please discuss this with your doctor. Avoid giving ibuprofen for the week before the procedure.

Procedure

Before the procedure, a nurse will check your child's temperature, pulse rate and blood pressure and will give your child pajamas or a hospital gown to wear while in the hospital.

Sedation will be given to your child before and during the ICD surgery. During the ICD implantation, you will be contacted on your mobile phone or through a pager that we provide in order to give you updates.

Depending on your child's age, size and the type of ICD to be implanted, the procedure will be performed either in the operating room or in the electrophysiology (EP) lab procedure room. The procedure usually takes four to six hours.

The area where the ICD will be implanted — either in the chest or abdomen — will be washed with a yellow antiseptic soap. Your child will be covered with sterile drapes. He or she will have general anesthesia to ensure comfort. In addition, the doctor will inject a local anesthetic to numb the area where the ICD will be implanted. Nurses and doctors will closely monitor your child at all times.

The ICD is made of two main parts: the leads and the generator. The leads are thin wires that connect the heart with the generator. The leads can be attached to the surface of the heart or passed through a vein inside the heart. The lead is then attached to the generator. The generator is a small metal case that includes a battery and a microcomputer, which is the "brain" of the ICD. The generator is placed under the skin in the upper chest.

At the end of the procedure, stitches are placed under the skin to seal the wound and a dressing placed over the wound. The stitches will be absorbed as the wound heals.

Recovery

After the ICD is implanted, your child will first be taken to the recovery room and then to a hospital room. Your child may feel sleepy and will be asked to lie in bed for several hours. When awake, your child can drink clear liquids and later have something to eat. In most cases, your child will return home the following morning.

Prior to leaving the hospital, you'll receive a temporary identification card that contains important information about the model and serial number of your child's ICD. Within several weeks, you'll receive a permanent card in the mail from the device manufacturer. This card should be kept with you and your child at all times.

Before you and your child go home, please make sure you receive the following materials from your child's doctor or nurse:

  • ICD informational brochures
  • Follow-up appointment information

At-Home Recovery

Please adhere to the following instructions to ensure your child has a smooth recovery.

Wound Care

The dressing over the ICD will be removed the day after the procedure. Your child will go home with loose, dry gauze and some tape over the surgical site. There will be some skin glue on the incision to help with healing. Absorbable sutures are located beneath the skin and do not need to be removed.

The best treatment is to keep the wound clean and dry. No ointments or creams should be used. Sponge baths are allowed, but the ICD site should be kept dry. If your child is allowed to shower, the surgical area should be kept away from the shower head and the incision should not be allowed to get soaked.

Although your child will be given antibiotics during and after the procedure, it is important to watch for signs of infection. These signs include redness, swelling, increased pain, drainage or fever. If these occur, please notify your child's doctor immediately.

Activities

Limit any strenuous activities for six weeks. During this time, it is important for patients with ICDs implanted in the chest to avoid lifting the elbow above the shoulder on the side of the ICD. Before leaving the hospital, discuss activity guidelines and restrictions with the doctor or nurse.

Interference with the Device

Inform your child's doctors and dentist that he or she has an ICD.

Microwave ovens and other appliances that are in good repair will not interfere with your child's ICD. Computers, hair dryers, power tools, radios, televisions, stereos, electric blankets and cars also won't interfere with an ICD.

A few things, however, might cause interference. These include very strong magnets such as those used for MRI scans, heavy-duty electrical equipment such as arc welders, and certain surgical instruments.

When traveling, a patient with an ICD should not go into any metal detectors at the airport and the hand-held wand metal detector should not be used, since they are strong magnets and may interfere with the ICD. Instead, the patient should be hand-searched at the airport. Your child may need to show a device identification card to security personnel.

Cell phones and other small electronic devices are unlikely to interfere with ICD function but avoid holding them directly over your child's ICD.

The manufacturer of the ICD is often a good source of information for patients and families. The manufacturer's toll-free phone number should be listed on the back of the device identification card or you can visit the manufacturer's website.

Follow-up Appointments

Your child's first follow-up appointment should occur one to two weeks after the procedure. This appointment should be made with the Pediatric Heart Center at UCSF Benioff Children's Hospital or with your referring physician.

At the clinic appointment, the doctor and nurse will examine your child's wound and check the ICD settings. Feel free to ask any questions you or your child may have concerning ICDs.

Your doctor will determine future follow-up appointments.

 

Reviewed by health care specialists at UCSF Benioff Children's Hospital.

Related Information

UCSF Clinics & Centers

Heart Center

Arrhythmia Center
1825 Fourth St., Sixth Floor
San Francisco, CA 94158
Phone: (415) 514-2783
Fax: (415) 353-4144

Condition Information

Our Experts

Ronn Tanel
Dr. Ronn Tanel,
pediatric cardiologist and electrophysiologist
Akash Patel
Dr. Akash Patel,
cardiologist and electrophysiologist
Walter Li
Dr. Walter Li,
pediatric cardiologist and electrophysiologist