Device & Lead Implantation, Removal & ManagementCardiovascular implantable electronic devices (CIEDs) and implantable cardioverter defibrillators (ICDs) are two types of implants that are used to treat heart rhythm disorders. These devices are placed under the skin and connected to the heart with thin wires. When an abnormal heartbeat is detected, the device provides an electric shock, which instructs the heart to resume a normal heartbeat. Tampa General Hospital’s Heart & Vascular Institute is a leading center for cardiovascular care. It is home to highly skilled electrophysiologists and other specialists who deliver a full range of surgical and nonsurgical treatments for heart rhythm disorders and other heart conditions. In our state-of-the-art facility, we provide implantation procedures for CIEDs and ICDs, as well as help patients manage life with these devices.
CIEDs and ICDs treat many kinds of heart arrhythmias:
- Ventricular arrhythmias, including ventricular fibrillation and ventricular tachycardia
- Supraventricular arrhythmias, including atrial fibrillation (AFib) or atrial flutter
- Cardiomyopathy, including amyloid cardiomyopathy and hypertrophic cardiomyopathy
- Inherited arrhythmias, including Brugada syndrome and Long QT syndrome
A cardiologist may also recommend one of these devices if you have had a heart attack, survived a sudden cardiac arrest or have congenital heart disease.
At TGH, our implantation procedures most often take place in our electrophysiology lab that has multiple machines to monitor a patient’s blood pressure, heart rhythm, oxygen levels and other vitals. Patients are typically given medicine to make them drowsy and a local anesthetic is administered to numb the chest. Then, the electrophysiologist will:
- Make small incisions in the chest to insert the device
- Insert the lead (a wire that monitors the heart’s electrical activity and sends impulses from the device to the heart muscle) through the incision and into a vein
- Guide the lead to the heart using a special X-ray machine called fluoroscopy
- Attach the tip of the lead to the heart muscle (the other end of the lead is attached to the device, also called a pulse generator)
- Place the generator into a pocket under the skin in the upper chest
- Conduct lead function tests to ensure the wires are working correctly
- Establish the final device settings for the patient
What to Expect
It’s important to remember that having a CIED or ICD implanted doesn’t cure the underlying heart condition; rather, it reduces your chances of going into cardiac arrest. Therefore, it’s important to have regular follow-ups with your physician and commit to leading a healthier lifestyle, including getting regular exercise.
It’s also crucial to understand how to manage your device going forward. Your electrophysiologist will discuss the basics of the CIED or ICD device and the proper follow-up care that will be needed.
These instructions may include:
- Having regular check-ups so that your cardiologist can monitor your device to see how well the wires are working and if your condition has affected the performance of the device at all
- Informing any doctors or specialists you see, including your dentist, that you have a CIED or ICD in place
- Always carrying your wallet ID card wherever you go; this card explains that you have a CIED or ICD
- Having the battery replaced every 5 to 7 years; your cardiologist will be able to check the battery level for you
For most patients, CIEDs and ICDs are safe and reliable. However, complications can occur, such as electrical malfunctions, mechanical breakage, scar tissue at the tip of the lead and infection. When this happens, your cardiologist may recommend a lead extraction, in which the troublesome lead is removed and a new one is implanted. However, in certain cases, new leads won’t be implanted immediately. For example, if you have an infection, your doctor will want to treat the infection first and then implant new leads once you’re healed. Lead extractions are a complex surgical procedure and are often only completed when the benefits far outweigh the risks.