START HERE
Your subcutaneous defibrillator (s-icd) checklist
Keep this page with your medication plan and discharge instructions.
Before you arrive
- Read the “Getting ready” section. Use the medicine and food-and-drink plans recorded there; blank lines must be completed by your team before you use them.
- Complete the tests in your appointment instructions. Bring your current medicine list, identification and insurance information.
- Arrange an adult to drive you home and stay with you the first night.
Procedure date / arrival time:
Facility / check-in location:
Before you leave the facility
- Make sure you have your medication restart plan, wound-care and activity instructions, written driving-clearance plan, and booked follow-up details. Read the shock action plan before going home.
- Keep the “Your recovery” and “When to get help” sections available at home. Call 911 for the emergency symptoms listed there.
Follow-up appointment or timeframe / booking instructions:
Practice phone: ____________________
After-hours number / route: ____________________
Keep the instructions together
Your personalized medication, anesthesia and discharge instructions take priority over general template wording. The team should record the current documents below and resolve any conflicting instructions before you leave.
Medication / anesthesia plan title and date:
Discharge instructions date:
UNDERSTANDING YOUR PROCEDURE
Your subcutaneous
defibrillator (S-ICD)
Before and after a new S-ICD implant
What the S-ICD does
A subcutaneous implantable cardioverter-defibrillator (S-ICD) watches for dangerously fast rhythms from the heart’s lower chambers and can deliver a shock to stop them. The battery unit sits at the left side of the chest, often between muscle layers. Its electrode runs under the skin near the breastbone; no wire goes through a vein or inside the heart.
A standalone S-ICD does not provide ongoing pacing for a slow heartbeat, antitachycardia pacing (ATP), or cardiac resynchronization. It may provide brief pacing after a shock. It does not replace your heart medicines or prevent every cardiac emergency.
On the day
You receive anesthesia to keep you comfortable; general anesthesia or another anesthesia plan may be used. The team creates a pocket at the side of the chest and places the electrode under the skin through small incisions near the breastbone. The system is checked and may be tested with a controlled shock while you are anesthetized. Antibiotics are given around the procedure.
The team checks the device, incisions and recovery before discharge. You may go home the same day or stay overnight. This guide is for a new standalone S-ICD, not a transvenous ICD, a substernal/extravascular ICD, lead removal or a generator-only replacement.
Benefits and risks
The S-ICD can reduce the risk of sudden death from dangerous ventricular rhythms; it is not a cure for the underlying heart disease. Risks include pain, bleeding or a blood collection, infection, skin erosion, movement of the device or electrode, unwanted shocks, failure to deliver needed treatment, anesthesia complications and another procedure. Serious complications, including death, are possible.
Getting ready
Medicines and fasting
Use the written plan below. Blood thinner and antiplatelet instructions depend on your medication, kidney function, bleeding risk and any recent coronary stent. Do not copy an AF ablation hold plan or stop these medicines on your own. A missing or conflicting procedure-day plan needs clarification before you change a dose.
Blood thinner / antiplatelet plan
Food and drink plan
SGLT2 medicines
GLP-1 medicines
Additional preparation
- Bring allergy information with the items on your “Start here” checklist.
- Report fever, an active infection, or broken/infected skin near the planned implant before coming for the procedure.
- Wear a loose, front-opening shirt. Do not shave the implant area yourself.
Recovering at home
What is usually expected
Soreness, bruising and a small stable swelling can occur at the side-chest pocket and near the breastbone incisions. You may feel the device under the skin. These should improve, not become increasingly painful, red or swollen. Follow the discharge medication list; an ICD by itself does not mean you must start a blood thinner.
Wound care and movement
Walk gently and use your arm for comfortable daily activities. Avoid pressure or rubbing over the device. Use the wound-care plan below for your dressing and shower timing. Do not soak the incision until it has healed.
Driving clearance date OR review date / responsible team:
Return-to-work date / restrictions if needed:
Any handwritten exceptions must be completed by the implant team. Never drive while dizzy, faint, or impaired by sedating medicine. Commercial driving and a history of fainting require a separate plan.
Follow-up and remote monitoring
Wound / device appointments or timeframes / booking instructions:
For monitor setup or connection problems, use the manufacturer support number supplied with the monitor. For symptoms, use the emergency and same-day warning signs in this guide. Keep your device ID card with you and show it to medical and dental staff.
Everyday life & when to get help
If you receive a shock
Stop what you are doing and sit or lie down safely.
- Call 911 now for more than one shock in a row, or a shock with chest pain, trouble breathing, fainting, ongoing dizziness or feeling unwell. Do not drive yourself.
- One shock and feeling completely well: contact the device clinic promptly the same day, using the after-hours route if needed. Record the time, symptoms and what you were doing. Send a remote transmission if your device team instructs you to; do not assume it has been seen. If you cannot reach the team promptly, seek urgent medical assessment.
- After any shock, do not drive again until the device team reassesses and clears you.
If someone collapses and is unresponsive and not breathing normally, call 911, start CPR and use an AED as instructed. Do not wait for the implanted device to treat them.
Phones, magnets and medical tests
- Keep phones, magnetic earbuds and other small magnetic electronics at least 6 inches (15 cm) from the ICD. Use the opposite ear and do not store a phone in a chest pocket over the device.
- Do not place magnets or magnetic therapy products over the implant; a magnet can stop the ICD from delivering a needed shock. Strong industrial magnets and certain equipment need device-specific advice.
- Most ordinary household appliances, including microwaves in good working order, can be used normally.
- Tell the imaging team about your ICD before any MRI. Many patients can have MRI under a special protocol, but the complete device-and-lead system must be checked and the device may need programming. Do not assume it is safe without that check.
Call 911
- Severe or sudden trouble breathing, severe chest pain, fainting, or stroke symptoms such as facial droop, arm weakness or trouble speaking.
- Heavy bleeding that does not stop with firm pressure, or rapidly expanding painful swelling with weakness or faintness.
Do not drive yourself. The remote monitor is not an emergency alert system.
Contact the device clinic the same day
- Beeping or vibration from your device, even if you feel well; it may be an alert that needs prompt checking.
- Fever or chills; increasing redness, warmth, pain or swelling; drainage; wound opening; or visible device/lead material.
- New or returning dizziness or near-fainting, or new swelling near the device or electrode track.
- Growing swelling or bleeding around the implant, even if you otherwise feel well.
Use the clinic’s after-hours contact route if needed. If you cannot reach the team and symptoms are worsening, seek urgent assessment; use 911 for severe symptoms.
Tell the device team if fear of shocks, anxiety or low mood is interfering with sleep or daily life. Support and treatment are available.
Follow your personalized medication and recovery plan. This guide supports, but does not replace, the consent discussion or your implant team’s instructions.