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 AICD 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 AICD, which is inserted into the tissue under the collarbone and above the breast. Once the AICD is implanted, the physician will test it several times by causing the heart to fibrillate, making sure the AICD 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 takes about an hour.
Immediately following the procedure, a chest x-ray will be taken to confirm the proper placement of the wires in the heart. Patients will rest for several hours and their vital signs will be closely monitored. The AICD’s programming may be adjusted using a magnetic wand that is passed over the chest, during which the patient will not feel anything different.
After the initial operation, the physician may induce ventricular fibrillation or ventricular tachycardia prior to the patient’s discharge. This allows the physician to program the AICD for maximum efficiency.
Depending on the patient’s age and overall health, a short stay in the hospital is usually required following AICD insertion. The physician will provide specific instructions regarding 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.
The AICD is implanted into the chest of the patient during a minor surgical procedure (not open-heart surgery). A short stay in the hospital is usually required and some patients may need to take medications that help the heart maintain a normal rhythm (antiarrhythmics). Once the AICD is in place, it runs on batteries for about four to seven years, depending on how often an electric shock is discharged. AICD batteries will not run out unexpectedly. Physicians can detect when the battery is running low during a routine office visit.
People with AICDs need to be careful in certain situations.
Serious complications from the surgery occur in less than 1 percent of cases. These include:
- Severe bruising or bleeding
- Formation of a blood clot
- Torn blood vessel
- Punctured lung or heart muscle
- Heart attack
- Introduction of air into the space between the lung and chest wall