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How is an ICD Implanted?
Whether the pulse generator is placed in the chest or abdominal wall, the skin needs to be incised. Some doctors prefer to place the pulse generator immediately below the skin, while others prefer to place them under a muscle. In either case, a "pocket" is created to bury the pulse generator, most often under the left collar bone.
First, 2 leads are usually introduced through a vein, and placed in the right atrium and right ventricle, respectively. Their position is verified by x-ray, before testing to ensure that they are in close contact with the heart muscle.
The ICD implantation procedure is usually performed under general anesthesia, although deep sedation might suffice. Your doctor will discuss this with you. The pulse generator is implanted in the chest wall or in the abdominal wall, depending on the model chosen. This decision depends on either that the:
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the SA node may fire too slowly, or
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the electrical signal cannot propagate normally from the atria to the ventricles.
The leads are connected to the pulse generator, which is then placed in the pocket. Before the incision is closed, your doctor will perform a defibrillation test. This important test, performed under general anesthesia or deep sedation, involves deliberately triggering VF to ensure that the ICD is capable of defibrillating the heart with a single shock. When all tests have been completed with satisfactory results, the pocket and skin incision are closed with stitches.
