The implantation of ICD can be done on an inpatient or outpatient basis. It can vary depending on the selection of the surgery team based on the conditions of the patient. An IV (intravenous line) is introduced on arm or hand followed by emptying of the urinary bladder of the patient.
The implantation procedure can have the following approach:
Thoracotomy: In this situation, the chest is uncovered, and delicate, thin, oval-shaped patches made of rubber along with wire mesh are sewn on the outer side of the heart or epicardium.
Transvenous approach: From the name we understand that we need to access this through a vein. A small incision near the collarbone of the patient is made in this technique and through these the leads make their way into the heart of the patient. The lead tip is positioned right inside the endocardium or the inner wall of the heart.
Subxiphoid approach: This technique is somewhat similar to the thoracotomy procedure but here the incision is made close to the breastbone or sternum making the incision slightly towards the left.
Sternotomy: This technique is also close to thoracotomy where the chest is opened. Here the incision is made on the sternum itself or the breast bone and the leads are then directed into the heart. A sternotomy can be combined with coronary artery bypass surgery or heart-valve surgery.
The patient is placed on the back over the operating table and an ECG or EKG lead is placed to monitor the electrical activities of the heart. Large electrode pads are placed on both the front and backside of the chest.
Through the IV-line, a sedative is injected to allow the patient to relax and the patient will be in their senses during the defibrillator procedure. Insertion site is cleaned, and sterile towels and sheets are placed around the area.
Under the collarbone, a sheath or it may be referred to as an introducer is moved into the blood vessel. The ICD lead wire in also made to move through this plastic tube and reach the heart. The surgeon shall conduct tests like fluoroscopy to find out whether the leads are being placed in the best locations and the connection with the ICD is proper.
Once the ICD is properly implanted (usually under the collarbone or below the waistline), some additional testing is done to ensure that the system is working properly or not and whether it shall be effective in correcting the patient’s arrhythmia problem.
There can be cases where multiple lead wires are inserted into the blood vessels and all their positions will be checked via a fluoroscopy test.
For some time, the ECG will keep monitoring the function of the ICD while the incision in the skin is closed with a special adhesive strips or glue and sterile bandage dressing is done for the incision site.