Because surgery is needed to implant the ICD, this is considered an invasive treatment option. However, ICD insertion is considered minor surgery and can be performed in either an operating room or an electrophysiology laboratory. Patients may be asked to stop taking certain medications (e.g., anticoagulants) for several days prior to the surgery. They will also be asked to sign a consent form and dress in a hospital gown for the procedure. The patient’s heart rate and blood pressure and other vital signs will be monitored during the implantation.

This insertion site will be cleaned, shaved and numbed with the injection of a local anesthetic. A small cut (incision) is made in the chest wall just below the collarbone. Another incision is made in the vein just under the collarbone. The wires of the ICD are passed through the vein and attached to the inner surface of the heart. The other ends of the wires are connected to the main box of the ICD (containing the generator), which is inserted into the tissue under the collarbone and above the breast.

Once the ICD is implanted, the physician will test it several times by causing the heart to fibrillate, making sure the ICD responds properly. Because the patient is anesthetized, the patient will not feel this test. The incision is then closed by sutures (stitches), staples or surgical glue. The entire procedure may take several hours to complete.

On rare occasions, the ICD may need to be placed outside of a patient's heart. In these cases, the lead is not guided though a vein into the heart but sewn directly into the patient's heart. This type of procedure is performed in open heart surgery.

Following the procedure, a chest x-ray and electrocardiogram (EKG) will be performed to confirm the proper placement of the wires in the heart. The ICD is tested and the device is programmed based on the patient's needs. Prior to the patient’s discharge, the physician may again induce ventricular fibrillation or ventricular tachycardia. This allows the physician to program the ICD for maximum efficiency. Not all hospitals and centers perform this sort of testing.

Depending on the patient’s age and overall health, a short stay in the hospital is usually required following ICD insertion. The physician will provide specific instructions regarding wound care and the patient’s appropriate activity level immediately following the procedure. In general, patients may be instructed not to bathe or shower for at least five days after the procedure. They should also avoid contact sports, heavy lifting or vigorous exercise for several weeks, in order to avoid dislodging the wires.

In addition, the patient will receive important information from the physician about the type of ICD device that has been implanted. Most patients also will receive a card from the ICD manufacturer with information about their specific advice. It is important that patients keep this information with them at all times in case of the need for medical attention.

A follow-up visit at the physician’s office is usually scheduled for two weeks after the surgery. At this visit, patients can expect the physician to do the following:

If there are no complications, complete recovery from the procedure will take about four weeks. During that time, the wires will firmly take hold where they were placed in the heart.