Non-thoracotomy Lead Systems and Implantable Cardioverter Defibrillators

The newest lead systems for ICDs do not require the placement of patches and wires inside the chest on the outside of the heart. Instead, lead wires are inserted through a large vein in your chest and positioned on the inside of your heart. There are no incisions made through your chest wall. This is called a non-thoracotomy approach.

Insertion of the ICD and lead wires will take place in the operating room. The procedure is performed under general anesthesia. A small incision is made in your upper chest area. One or more lead wires are then placed through a large vein which leads directly to your heart. The lead wires are responsible for sensing what rhythm the heart is in and delivering the electrical shocks for any ventricular arrhythmias, and pacing the heart if your cardiologist determines that you need this function. The pulse generator is inserted under the skin of your abdomen or your upper chest. The lead wires are placed underneath the skin and connected to the pulse generator. The incisions are then closed and dressings are applied. You will then be taken to your hospital room.

You should not raise the arm on the side of your body where the incisions were made for four weeks. This prevents the lead wires from moving out of place until the tips have time to implant in your heart muscle. You should stay in bed overnight. Plan to be discharged home within the next few days. You will be prescribed antibiotics for a short time to prevent any infections in the incisions. Follow-up care is the same for the surgically implanted cardioverter defibrillator. Please refer to the information on ICDs for further information.