What you can expect

Before the procedure

If you're having an ICD implanted, you'll likely be asked to avoid food and drinks for at least 8 hours before the procedure.

Talk to your doctor about any medications you take and whether you should continue to take them before the procedure to implant an ICD.

During the procedure

A specialist will insert an IV into your forearm or hand and give you a medication called a sedative to help you relax.

You will be given general anesthesia (fully asleep).

During surgery, the doctor guides one or more flexible, insulated wires (leads) into veins near your collarbone to your heart using X-ray images as a guide. The ends of the leads attach to your heart. The other ends attach to a device (shock generator) that's implanted under the skin beneath your collarbone. The procedure usually takes a few hours.

Once the ICD is in place, your doctor will test it and program it for your specific heart rhythm needs. Testing the ICD might require speeding up your heart and then shocking it back into a normal rhythm.

Depending on the problem with your heartbeat, your ICD could be programmed for:

• Low-energy pacing. You may feel nothing or a painless fluttering in your chest when your ICD responds to mild changes in your heartbeat.
• A higher energy shock. For more-serious heart rhythm problems, the ICD may deliver a higher energy shock. This shock can be painful, possibly making you feel as if you've been kicked in the chest. The pain usually lasts only a second, and there shouldn't be discomfort after the shock ends.

Usually, only one shock is needed to restore a normal heartbeat. Sometimes you might have two or more shocks during a 24-hour period.

Having three or more shocks in a short amount of time is called an electrical or arrhythmia storm. If you have an electrical storm, you should call 911 or seek emergency medical help to see if your ICD is working properly or if you're having abnormal heartbeats.

If necessary, the ICD can be adjusted to reduce the number and frequency of shocks. You may need medications to make your heart beat regularly and decrease your risk of an ICD electrical storm.

After the procedure

You'll usually be released on the day after your procedure. You'll need to arrange to have someone to drive you home and help you while you are recovering.

The area where the ICD is implanted can be swollen and tender for a few days or weeks. Your doctor might prescribe pain medication. Aspirin and ibuprofen aren't recommended because they may increase your risk of bleeding.

You'll need to avoid abrupt movements that raise your left arm above your shoulder for up to eight weeks so the leads don't move until the area has healed. You may need to limit your driving, depending the type of ICD received. Your doctor will give you instructions on when it's safe to return to driving and other daily activities.

For about four weeks after surgery, your doctor might ask you to avoid:

• Vigorous, above-the-shoulder activities or exercises, including golf, tennis, swimming, bicycling, bowling or vacuuming
• Heavy lifting
• Strenuous exercise programs

Your doctor will probably tell you to avoid contact sports indefinitely. Heavy contact may damage your device or dislodge the wires.

Long-term precautions

Problems with your ICD due to electrical signals (electrical interference) are rare. Still, take precautions with the following:

• Cellular phones and other mobile devices. It's safe to talk on a cellphone, but avoid placing your cellphone within 6 inches (about 15 centimeters) of your ICD site when the phone is turned on. Although unlikely, your ICD could mistake a cellphone's signal for a heartbeat and slow your heartbeat, causing symptoms such as sudden fatigue.

• Security systems. After surgery, you'll receive a card that says you have an ICD. Show your card to airport personnel because the ICD may set off airport security alarms.

  Also, hand-held metal detectors often contain a magnet that can interfere with your ICD. Limit scanning with a hand-held detector to less than 30 seconds over the site of your ICD or make a request for a manual search.

• Medical equipment. Tell doctors, medical technicians and dentists that you have an ICD. Some procedures, such as magnetic resonance imaging (MRI), magnetic resonance angiography (MRA), and radiofrequency or microwave ablation may not be recommended if you have an ICD. Your doctor can tell you if you need an alternative test.
• Power generators. Stand at least 2 feet (0.6 meters) from welding equipment, high-voltage transformers or motor-generator systems. If you work around such equipment, your doctor can arrange a test in your workplace to see if the equipment affects your ICD.
• Headphones and wireless chargers. Headphones may contain a magnetic substance that can interfere with your ICD. Keep headphones and wireless chargers at least 6 inches (about 15 centimeters) from your ICD.
• Magnets. These might affect your ICD, so it's a good idea to keep magnets at least 6 inches (15 centimeters) from your ICD site.

Devices that pose little or no risk to your ICD include microwave ovens, televisions and remote controls, AM/FM radios, toasters, electric blankets, electric shavers and electric drills, computers, scanners, printers, and GPS devices.

Driving restrictions

If you have an ICD to treat ventricular arrhythmia, driving a vehicle may pose risks to yourself and others. The combination of arrhythmia and shocks from your ICD can cause fainting, which would be dangerous while you're driving.

Many countries have driving restrictions for people with ICDs. If your ICD was implanted due to a previous cardiac arrest or ventricular arrhythmia, your doctor may recommend waiting several months before driving or operating a vehicle. If you have a shock, with or without fainting, tell your doctor and follow his or her recommendations. In most cases, you'll be discouraged from driving until you've been shock-free for several months.

If you have an ICD but have no history of life-threatening arrhythmias, you can usually resume driving about a week after your procedure if you've had no shocks. Discuss your situation with your doctor.

You usually can't get a commercial driver's license if you have an ICD.