Defibrillator (ICD)

What is a defibrillator?

A defibrillator is a small metal can that is placed in the body, usually below the left shoulder and is connected to a wire or wires that lead into the heart muscle. The defibrillator is able to stimulate the heart and generate a heart beat if the heart is going too slowly in the same way a pacemaker does, but in addition the defibrillator is able to monitor the heart for rapid heart rhythms that may be life threatening and deliver an electric shock to try to reset the heart beat (defibrillation).

Who needs a defibrillator ?

Defibrillators are offered to patients who have a higher than average risk of developing life threatening rhythm problems. This can be after a heart attack, where the heart muscle is weakened or where a inherited condition makes life threatening rhythm problems more likely. There are many other reasons why a doctor may recommend a defibrillator.

What happens during a defibrillator implant?

The procedure is usually done under local anaesthetic with sedation, and this will be discussed with you.

A small cut is made in the skin just under the left shoulder, and a small wire is passed into one of the veins that runs towards the heart.

Small thin tubes called sheaths are inserted into the vein and then defibrillator leads are inserted through these. The defibrillator wires and moved using the X-Ray camera. Depending on what type of defibrillator is being fitted, wires are placed in the top and bottom chambers of the heart on the right hand side.

The leads are tested once they are placed and then connected to the defibrillator itself.

The defibrillator is placed in a pocket underneath the skin and the skin closed with a suture. This is usually absorbable, so you do not need to have the stitches removed.

If you are feeling well, you will often be allowed home the same day.

What are the risks ?

Defibrillator implantation, like any medical procedure, carries with it risks, thankfully these are uncommon. The risks for any individual person depend on many factors and will be discussed in detail. The main risks include: Infection of the defibrillator system, collapsed lung (this can occur as the vein that leads to the heart from the shoulder runs close to the top of the lung on the left side – if it does occur, it often requires no treatment, but in some cases, may require a tube to be placed in the chest to allow the chest to re-expand), the leads may move – requiring a further procedure to replace them, there may be some discomfort, there may be bleeding or bruising and rarely there can be problems with blood clots forming in the arm. Thankfully, the majority of patients undergoing defibrillator implantation do so without any complication.

The defibrillator is a sophisticated computer, but it may deliver a shock to the heart even when a shock is not required, this is called an inappropriate shock and may be uncomfortable, this is thankfully rare with modern defibrillators.

It is very important that you understand all the risks and the benefits of having the procedure, and this will be discussed with you in detail and any appointment.

Where are the procedures done ?

The defibrillator implant procedures can be performed in Spire Shaw Fair Park hospital in Edinburgh, and BMI Ross Hall Hospital in Glasgow. The consultations to discuss management and outpatient care before and after the procedure can be offered in any of the clinics in Dundee, Edinburgh or Glasgow.