Pediatric implantable cardioverter defibrillator (ICD)

What is pediatric implantable cardioverter defibrillator (ICD)?

An implantable cardioverter defibrillator (ICD) is a small device that has wires that go to the heart. The device constantly monitors the heart’s electrical activity.

If your child's heart activity becomes abnormal, the ICD can react in two ways.

1. It can send rapid, but gentle, electrical pulses to the heart to restore a healthy rhythm.

2. It can deliver a powerful shock that briefly stops the heart and allows it to restart back into a normal rhythm.

What are the benefits of a pediatric implantable cardioverter defibrillator (ICD)?

An ICD monitors and controls your child’s heart rhythm at all times, even while they sleep. ICDs react to problems with your child’s heartbeat within seconds. Not only can the ICD save your child’s life, but it also allows them to enjoy all types of childhood activities without fear of having an arrhythmia attack. There are no medicines that work as well as an ICD.

What are the side effects of a pediatric implantable cardioverter defibrillator (ICD)?

Your child might feel sore for a week after surgery. They should be completely healed and ready to go back to normal activities within eight weeks.

About 10% to 15% of adolescents feel depressed after ICD placement. Though this might seem surprising, we think it’s because some adolescents might have been in denial about their heart condition.

Once the device goes into their body, they realize:

• “This is serious. My condition is real.” Our child life specialists and psychologists provide support and coping strategies to those who feel depressed or upset after their surgery.

What are the risks of a pediatric implantable cardioverter defibrillator (ICD)?

Sometimes, the ICD can misunderstand what’s going on inside your child’s heart. It may send an electrical charge when it shouldn’t. If the ICD mistakenly goes off, your child will feel pain, but only for a second.

In addition, there are risks associated with any type of surgery. Though it’s very rare, the surgery might cause an infection, damage a blood vessel, or damage the heart. We do everything possible to take all precautions necessary to make sure the ICD won’t cause your child any harm.

What to expect with a pediatric implantable cardioverter defibrillator (ICD) placement

You’ll meet doctors who specialize in treating heart rhythm abnormalities (called electrophysiologists), anesthesiologists and nurses at Children's Health who all work together to perform the procedure and can answer any questions before and after surgery.

What to expect before a pediatric implantable cardioverter defibrillator (ICD) placement

Typically, a child will be in the ER or hospitalized after having a life-threatening arrhythmia attack. Other children may have a family history of life-threatening arrhythmia. We’ll talk to you and your family about how an ICD can prevent future attacks.

The surgery will take about two hours. Your child will be given anesthesia before surgery. This mixture of medicines helps relax their body, reduce anxiety, control pain and prohibit movement.

Our team will let you know when your child should stop eating or drinking before their surgery. Having an empty stomach before surgery helps prevent your child from vomiting during surgery. This is important because vomiting could cause your child to breathe food or liquid into their lungs.

What to expect during a pediatric implantable cardioverter defibrillator (ICD) placement

• For children who weigh more than 55 pounds - We put the device under their collarbone and use a needle to put the wires into the big blood vessel under the collarbone and down into your child’s heart. You can see the device under the skin, but it doesn’t stick out too much.

• For smaller children under 55 pounds - We put the device in the abdomen because the blood vessels under the collarbone aren’t big enough yet. Then we make a small incision at the bottom of the breastbone and put the wires on the outside of the heart.

After surgery we will do an X-ray to make sure the device is placed properly. Most children stay in the hospital overnight so we can make sure they aren’t having any post-procedure complications.

What to expect after a pediatric implantable cardioverter defibrillator (ICD) placement

The recovery is fairly quick. Your child might feel sore for about a week or so.

Your child will have a follow-up appointment in two weeks to make sure the incision site is healing. The site should be completely healed in six to eight weeks. While it’s healing, we ask that your child not lift more than 10 pounds, carry a backpack or play sports. Your child will come in for follow-up appointments during the first month or two. During the appointments, the ICD will be checked to be sure it is working well for your child.

We’ll also give you a small electronic box (a transmitter) to take home. The transmitter sends electronic signals to the hospital from your child’s ICD so we can monitor how the ICD is working and can make changes if needed.

Four times a year, the transmitter sends us a detailed report about your child’s heart pattern and activity. We review this information and will update you on your child’s treatment plan.

How do I prepare my child for a pediatric implantable cardioverter defibrillator (ICD) placement?

We know that surgery can sound scary to children. Letting them know that this device can save their life can help. We can help your child understand what we’re doing and why it’s necessary. Our arrhythmia nurses can show your child the device before surgery and explain how it works.

What questions should I ask my provider about a pediatric implantable cardioverter defibrillator (ICD) placement?

• How does the ICD get placed?

• How does the ICD work?

• What's the follow-up?

• Why does my child need this?

• Does my child still have to take their arrhythmia medication?

• What are my child’s activity restrictions with an ICD?