IN THE PRESS
Procedures - Automatic Implantable Cardioverter Defibrillators (AICD)
Why is the doctor performing this procedure?
What is an AICD?
There are different kinds of AICDs, but they all have 2 parts: electrodes (thin flexible wires) and a generator. The electrodes or "leads" sense or watch the heart's electrical activity. The generator is the battery power source and the "brains" of the AICD. It is a small metal can about the size of a deck of cards. The generator stores information about any arrhythmias you have. The generator also keeps track of how often it needs to give your heart a shock. Some AICDs also function as pacemakers for heart rates that are too slow or too fast.
What happens during implantation of an AICD?
The newer AICD units can be implanted without major surgery. The procedure is performed under local anesthesia, but sometimes it is done under general anesthesia. You will be hooked up to an intravenous (IV) line and will receive sedation. Before the doctor makes an incision, your upper chest will be cleaned and your torso draped. Your arms may be loosely strapped to prevent movement during the testing of the AICD.
The doctor will make an incision in your upper chest area below the collarbone. A wire will be inserted through a vein into your heart. Sometimes more than one wire is used. The doctor will create a "pocket" in your chest, where the AICD is inserted. The AICD is connected to the wires. The doctor will test the AICD by creating an arrhythmia and then observing whether the AICD delivers the required therapy. Later that day, or the next day, your AICD system will be checked and tested again with a computer called a "programmer." This procedure is called "noninvasive programmed stimulation" or "pre-discharge testing." You will receive sedation. The doctor will provoke an arrhythmia to see if the device works. The AICD will deliver a shock (defibrillation). The staff will fine-tune the equipment.
Recovery time after implantation of newer AICD units is quite short. Hospital stays are rarely longer than 3 or 4 days and there is quick return to prior activity levels. People with AICDs must continue to follow their doctor's recommendations regarding medication, diet, and exercise.
Prior to discharge, you will be shown how to examine your incision site. You should look for signs of infection each day such as increased redness, increased tenderness, swelling around the incision, drainage from the incision. You should also report a fever over 100°F that lasts longer than 24 hours. You will also receive instructions on your AICD.
Do AICD batteries wear out?
Your doctor will open the pocket of skin where the pulse generator is located to replace your AICD pulse generator. The old pulse generator will be unplugged from the leads. The leads are checked to make sure they are still working properly. Then they are connected to the new AICD pulse generator. A test is preformed to make sure the new system is working properly.
Once the doctor knows the AICD is working properly, he/she will stitch the pocket of skin closed. The entire procedure takes about an hour. It is considered a minor operation, and you should be able to return to normal activities soon.