The surgery required for implanting a defibrillator implant is fairly straightforward in comparison to other general surgical procedures. There are certain protocols that you should follow before your surgery and after your surgery. During the procedure you will most likely be given a sedative medicine that will not put you completely to sleep, but rather in a daze.
It is important that you do not fall asleep during the procedure so that your health team can monitor you and the device accurately. The surgical procedure that will be detailed below is very similar to the surgical procedures followed for other types of defibrillator implants and implantable medical devices like the pacemaker, implantable cardioverter defibrillator, and cardiac resynchronization therapy–defibrillator (biventricular pacemaker).
Before you go into surgery there are a few basic guidelines that you will want to follow and your doctor will go over these with you before your surgery. If you’re taking anticoagulant or antiarrhythmic medications do not stop taking your medicine unless your doctor tells you so. Be sure to ask and clarify with your doctor exactly which medications you should stop taking before your surgery as you do not want to put yourself in unnecessary risk. As with most surgeries, it is advised that you do not eat or drink anything after midnight.
It is recommended that you wear loose and comfortable clothing to the hospital. You should not wear any type of makeup or jewelry of any kind; it’s best just not to bring any of these items at all. If you are taking medications before your surgery, bring a one or two day supply of these medications with you; however, be sure that you do not take these medications without your doctor’s consent. Because you’re not put completely out during surgery you may be able to listen to music from an MP3 player, but consult with your doctor before you decide to bring and/or use any electrical devices.
When it is time to begin your surgery, you will be given a hospital gown to wear into the operating room. Make sure that you give your belongings to a family member or secure them safely in a locker. Once you’re on the hospital bed, a nurse will start an intravenous line (IV) in your arm or hand and begin delivering antibiotics to help prevent infection. Depending on where the defibrillator implant will be placed in your chest, the placement site will be shaved and cleansed with a special surgical soap. It is important that the surgical site remains sterile so that you and your health team can prevent infection.
As mentioned previously, you will not be put completely to sleep during the surgery. Instead you will feel very sleepy, yet staying still awake, while you are connected to various monitors and sensors. These monitors include a defibrillator and a pacemaker that allow your health team to monitor your heart rate and correct it appropriately if it starts to beat abnormally. You’ll also be hooked up to an electrocardiogram (EKG), which provides your health team with detailed analysis of the electrical impulses in your heart. Your blood pressure will also be monitored constantly as well as the oxygen level in your blood (using an oximeter).
For the device to be implanted doctors will use a fluoroscopy machine, which is a type of x-ray machine, that allows doctors to have a better visual of your heart. The fluoroscopy machine is used to help guide the leads of the defibrillator implant into the appropriate regions of your heart. Typically, these leads are implanted transvenously. The transvenous approach to placing the leads is also called an endocardial approach. In epicardial surgery, which is more invasive than the transvenous procedure, the defibrillator implant is placed in the upper abdomen region; also, it is fairly rare and only used if the transvenous approach is not recommended by your health team. Epicardial surgery usually requires longer recovery times as well. Most likely you will have your defibrillator implant installed using the endocardial procedure. Once the leads are placed, the defibrillator implant will be implanted into the same incision that was used to insert the lead(s). A defibrillator implant is usually placed in the left or right pectoral region of your body.
The surgery should only last two to five hours, but you will have to stay overnight for continued monitoring. You will be connected to two primary monitors; a telemetry monitor and a Holter monitor. Both of these systems monitor your heart rate and other cardiac electrical activity. Your health team will continuously monitor your cardiac activity to ensure that your heart is in good condition after the surgery and that the implanted device is working properly. Expect to receive an x-ray at some point after your surgery, so that your health team can verify the position of the device and make sure that there is no internal damage.
Although your defibrillator implant has been surgically implanted, the device still needs to be configured to suit your cardiac needs. Someone in your health team will use a programming device to accurately assess what settings your defibrillator implant should be configured to use. The data recorded from the Holter monitor will be used in addition to this assessment to determine your defibrillator’s settings. Once your defibrillator implant is programmed appropriately and you have received your temporary ID card for the specific defibrillator implant that you have, your health team will give you instructions for going home and what procedures and precautions you should follow for the coming weeks. Remember that you will not be able to drive yourself home after the surgery and to have a friend or family member take you home. The surgery for a defibrillator implant should not bring you too much concern as a patient as the procedure is performed thousands of times a month without incident. In addition, the precautions undertaken by the surgical team help eliminate possible risks and problems.
It is important that you are educated about the surgical procedure you will have. By using the information in this article and the instructions given to you by your doctor you will have a streamlined and safe operation. Remember, if you have any doubts about the health team that is treating you it is always a good idea to seek a second opinion. If you are at risk of cardiac arrest before surgery, ask your doctor about being outfitted with a wearable cardioverter defibrillator to minimize risk of heart failure before your surgery. If before surgery you notice that you may have an infection, alert your health team and surgeon about the possible complication. Having infection before your surgery anywhere in your body will most likely postpone the procedure. Of course, stay positive and make sure that you have the support of a friend or family member alongside of you for the whole process.