Before the Procedure
- If you have diabetes, ask the scheduling nurse how to adjust your diabetes medication(s).
- If you take an anticoagulant (“blood thinner”), such as Coumadin (warfarin), ask the scheduling nurse for specific guidelines about taking it on the day of the procedure.
- Do not eat or drink anything after midnight the night before the procedure.
- Continue to take all of your medications as prescribed on the day of the procedure, but take them with only small sips of water.
- Do not bring valuables to the hospital.
You will receive an instruction sheet that describes how to prepare for the procedure. Here’s an overview of those instructions.
What time should I report for my procedure?
The day before your scheduled procedure, please call 800.223.2273 and ask for Pager Number 21215, the EP scheduling nurse. Please call between 3:00 p.m. and 5:00 p.m. to find out what time you should arrive.If your procedure is scheduled for a Monday, please call the Friday before.
If your procedure is scheduled after a holiday, please call the last business day before the holiday.
Please do not call the Cleveland Clinic Operator or the Admitting Office for information about your procedure. We will notify you if there are any changes to your schedule.
Should I take my medications?
If you take Coumadin, the results of your INR test (a blood test to evaluate the blood clotting) must be within a suitable range before the implant procedure can be performed. You will likely need to stop taking anticoagulant medications, including aspirin or warfarin (Coumadin), a few days before the procedure.
Your doctor may also ask you to stop taking other medications, such as those that control your heart rate.
Do not stop taking any of your medications without first consulting with your healthcare provider. Ask your doctor which medications you should stop taking and when to stop taking them.
If you have diabetes, ask the nurse how to adjust your diabetes medications or insulin.
Can I eat before the procedure?
Eat a normal meal the evening before your procedure. However, DO NOT eat, drink or chew anything after midnight the night before your procedure. This includes gum, mints, water, etc. If you must take medications, take them with small sips of water. When brushing your teeth, do not swallow any water.
What should I wear?
- When getting ready, please do not wear makeup and remove nail polish.
- Wear comfortable clothes when you come to the hospital. You will change into a hospital gown for the procedure.
- Please leave all jewelry (including wedding rings), watches and valuables at home.
- The clothing you are wearing that morning will be returned to the person who accompanies you.
What should I bring?
You will not need a robe or toiletries when you first arrive. You may pack these items and have a family member keep your bag until after the procedure.
Bring a one-day supply of your prescription medications. Do not take these medications without first asking your doctor or nurse.
You may bring guided imagery tapes or music and the appropriate player.
What happens before the procedure?
Before the procedure begins, a nurse will help you get ready. You will be given a hospital gown to change into. You may keep your clothes in a locker or you may give them to a family member.
You will lie on a bed and the nurse will start an intravenous (IV) line in a vein in your arm or hand. The IV is used to deliver medications and fluids during the procedure.
To prevent infection and to keep the device insertion site sterile:
- You will receive an antibiotic through the IV at the beginning of the procedure.
- One side of your chest will be shaved.
- The area will be cleansed.
- You will be covered from your neck to feet with sterile drapes.
- A soft strap may be placed across your waist and arms to keep your hands from touching the sterile area.
Will I be awake?
A medication will be given through your IV to relax you and make you feel drowsy, but you will not be asleep during the procedure.
Monitors During the Procedure
Several monitors will be used during the procedure to constantly check things like your heart rhythm and blood pressure.
Defibrillator/pacemaker/cardioverter: Attached to one sticky patch placed on the center of your back and one on your chest. This allows the doctor and nurse to pace your heart rate if it is too slow, or deliver energy to your heart if the rate is too fast.
Electrocardiogram or EKG: Attached to several sticky electrode patches placed on your chest, as well as inside your heart. Provides a picture on the monitors of the electrical impulses traveling through the heart.
Blood pressure monitor: Connected to a blood pressure cuff on your arm. Checks your blood pressure throughout the procedure.
Oximeter monitor: Attached to a small clip placed on your finger. Checks the oxygen level of your blood.
Fluoroscopy: A large X-ray machine will be positioned above you to help the doctors see the leads on an X-ray screen during the procedure.
How is the device implanted?
The ICD is usually implanted using the endocardial (transvenous) approach. During the procedure, a local anesthetic (pain-relieving medication) is injected to numb the area.
Small incisions are made in the chest where the lead(s) and device are inserted. The lead is inserted through the incision and into a vein, then guided to the heart with the aid of the fluoroscopy machine. The tip of the lead is attached to the heart muscle, while the other end is attached to the pulse generator. The generator is placed in a pocket created under the skin in the upper chest.
When the endocardial approach is used, the hospital recovery time is generally 24 hours.
Endocardial (transvenous) approach
Epicardial (surgical) approach
In rare cases when the endocardial approach cannot be used, the epicardial (surgical) approach is used. With this approach, you are put to sleep with general anesthesia. The generator is placed in a pocket created under the skin in the lower abdomen.
The hospital recovery time for this approach is generally 3 to 5 days, although minimally invasive techniques may be used that can result in a shorter hospital stay and quicker recovery time.
Your doctor will determine which is the best implant procedure approach for you.
How are the leads tested?
After the leads are in place, they are tested to make sure they are in the right place and working properly. This lead function test is called “pacing.” During the test, small amounts of energy are sent through the leads into the heart muscle. This energy causes the heart to contract. You will be asleep for several minutes during the lead function test.
Once the leads have been tested, the doctor will connect them to the device. The rate and settings of your device are determined by your doctor. After the implant procedure, the doctor uses an external device (programmer) to make the final device settings.
What will I feel?
With the endocardial approach: You will feel a burning or pinching sensation when the doctor injects the local numbing medication. Then, the area will become numb. You may feel a pulling sensation as the doctor makes a pocket in the tissue under your skin for the device. Please tell your doctor what symptoms you are feeling. You should not feel pain. If you do, tell your nurse right away.
How long does the procedure last?
The device implant procedure may last from 2 to 4 hours.
- Have someone available to drive you home after the procedure.
- Your doctor will discuss your medications, home-going instructions and follow-up schedule.