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Procedure

Implantable Cardioverter-Defibrillator (ICD) Implantation

Continuous protection from life-threatening arrhythmias

An implantable cardioverter-defibrillator (ICD) is a small device placed under the skin of the upper chest that continuously monitors heart rhythm and delivers therapy — pacing, a cardioversion shock, or a defibrillation shock — the moment a dangerous arrhythmia is detected. ICDs are the most effective therapy available for preventing sudden cardiac death in patients at high risk. The procedure is performed at Cedars-Sinai by an electrophysiologist with whom Dr. Kedan coordinates closely.

What's Included

  • Pre-procedure imaging and risk assessment
  • Conscious sedation and local anesthesia
  • Implantation of generator and lead(s) under fluoroscopic guidance
  • Intra-procedural testing of sensing and pacing thresholds
  • Overnight observation in most cases
  • Device interrogation before discharge
  • Long-term remote monitoring set-up

How It's Performed

The procedure is performed at Cedars-Sinai in an electrophysiology lab. Under local anesthesia and conscious sedation, a small pocket is created under the skin of the upper chest below the collarbone. One or more thin leads are guided through a vein into the heart under live X-ray imaging, and the device generator is connected and tucked into the pocket. The whole procedure typically takes 1 to 2 hours.

How to Prepare

  • Nothing to eat or drink for 8 hours before the procedure.
  • Take or hold blood thinners exactly as the procedural team directs.
  • Arrange a driver and overnight support at home.
  • Continue heart-failure and antiarrhythmic medications unless told otherwise.
  • Bring a complete medication list and any prior device cards.

What to Expect After

Most patients stay overnight and go home the next day. Avoid raising the arm on the implant side above shoulder level for 4 to 6 weeks while leads heal in place. Driving restrictions apply temporarily and follow state guidelines. Dr. Kedan coordinates lifelong device follow-up — typically remote interrogation every 3 months and an in-person check annually — and adjusts medications to optimize long-term protection.

Indications

  • Survivor of cardiac arrest from ventricular fibrillation or sustained VT
  • Severely reduced ejection fraction (typically 35% or below) on optimal medication
  • Hypertrophic cardiomyopathy with high-risk features
  • Inherited arrhythmia syndromes with high sudden-death risk
  • Sustained ventricular tachycardia with structural heart disease
  • Documented or suspected catecholaminergic polymorphic VT
  • Selected congenital heart disease patients

Common Questions

Frequently Asked Questions

What is an ICD?
An implantable cardioverter-defibrillator is a small device placed under the skin of the upper chest that continuously monitors your heart rhythm. If it detects a dangerous arrhythmia — typically sustained ventricular tachycardia or ventricular fibrillation — it can deliver pacing, a synchronized cardioversion, or a defibrillation shock to restore normal rhythm and prevent sudden cardiac death.
How is it different from a pacemaker?
A pacemaker primarily prevents the heart from going too slow. An ICD does that too, but its essential job is to treat dangerously fast rhythms with shocks or rapid pacing. Most modern ICDs also include full pacemaker functionality.
Where is the procedure done?
At Cedars-Sinai in an electrophysiology lab. Dr. Kedan coordinates the procedure with the electrophysiology team and remains involved in pre- and post-procedural care and long-term follow-up.
How long does it take?
Typically 1 to 2 hours. Most patients stay overnight and go home the next day.
Is it painful?
You receive local anesthesia and conscious sedation during the procedure. The implant site is sore for several days afterward and easily managed with simple pain medication. The shock, if ever delivered, feels like a sudden kick in the chest and lasts a fraction of a second — startling but life-saving.
How do I prepare?
Fast for 8 hours before the procedure, take or hold blood thinners exactly as the procedural team directs, arrange a driver and overnight support, and bring a complete medication list.
What are the risks?
Risks include bleeding at the implant site, pneumothorax (collapsed lung from lead placement), infection, lead dislodgment, and very rarely a perforation requiring drainage. Most procedures are uneventful, and risks are reviewed in detail during informed consent.
How long does the battery last?
Typically 7 to 10 years depending on usage. Generator changes — replacing the battery while keeping the existing leads — are a much simpler procedure than the initial implant.
What does follow-up look like?
Dr. Kedan coordinates lifelong device monitoring — typically remote interrogation every 3 months and an in-person check annually. Settings are adjusted over time to balance protection against unnecessary therapy.
How do I schedule one?
ICD implantation follows a thorough clinical evaluation. Call Cardiolucent at (310) 304-5555 to begin the conversation.

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Medical Disclaimer

The information on this site is for general educational purposes only and is not medical advice, diagnosis, or treatment. Reading this site does not create a doctor–patient relationship. Always consult a qualified healthcare professional for personal guidance. If this is an emergency, call 911. Mentions of medications, devices, or procedures are informational and not endorsements. Full medical disclaimer.

†Some listed indications involve investigational/off-label use. Learn more.