Defibrillator (ICD) fitting

An implanted device that watches for a dangerous fast heart rhythm and delivers a shock or pacing to restore a normal beat, used to reduce the risk of sudden cardiac death.

✓ Medically reviewed by a GMC-registered consultant · last reviewed September 2026 · next review September 2027 · how we review

In short

An ICD is a safety net that treats a dangerous fast rhythm with pacing or a shock; it does not cure the heart condition or prevent a heart attack.
Fitting it is usually a day case or overnight stay, but it is a heart procedure with risks such as lung puncture, bleeding, infection and lead problems.
Driving stops for at least a month after fitting and for longer after a shock or for some heart conditions, and HGV/bus driving is not allowed.
Shocks can feel sudden and distressing, and some people need psychological support; most ICDs are MRI-conditional but must be checked first.

A plain-English summary. The detail — including risks and recovery — is below.

At a glance

TypeMinor heart procedure (device implant via a vein, or under the skin)

AnaestheticLocal anaesthetic with sedation, sometimes general anaesthetic

How long it takesAbout 1–2 hours, longer for combined devices (CRT-D)

Hospital stayDay case or one overnight stay

Time off workLight duties for about 4–6 weeks; driving stops for at least 1 month (longer in some cases)

When you'll see resultsThe device protects you straight away; settings are checked at follow-up

On the NHS?Available on the NHS for people at high risk of dangerous fast rhythms; private care is mainly for speed or choice

A general guide. Your surgeon will give you advice for your situation.

Best fit

Can detect and stop a dangerous fast rhythm and reduce the risk of sudden cardiac death

Pause if

Your risk of a dangerous fast rhythm is low, so the benefits may not outweigh the risks of having a device.

Main recovery point

Keep the dressing clean and dry. Some bruising and soreness is normal. A chest X-ray usually checks the leads before or soon after discharge.

Good aftercare

A written shock plan: what to do for a single shock and when a shock is an emergency.

First 24–48 hours

Keep the dressing clean and dry. Some bruising and soreness is normal. A chest X-ray usually checks the leads...

First month

Do not drive for at least a month (your team will confirm), and not at all if you hold an HGV or bus licence. Use...

Weeks 1–6

Avoid heavy lifting and vigorous arm exercise so the leads settle. Wound checks happen as advised, and a device...

If you get a shock

Follow the plan your team gives you. A single shock when you feel well usually means contacting the clinic...

Medical line illustration of implanted cardiac rhythm device for Defibrillator (ICD) fitting. — Illustration only - not a diagnosis, medical advice or a promise of result. Your anatomy and treatment plan may differ. Vuemedics does not publish before-and-after photos.

What is an implantable defibrillator (ICD)?

An implantable cardioverter defibrillator (ICD) is a small device placed under the skin, usually near the collarbone, that constantly watches your heart rhythm. If it detects a dangerous fast rhythm coming from the lower chambers, it can give pacing or an electric shock to bring the heartbeat back to normal and prevent a cardiac arrest.

Most ICDs sit near the collarbone with one or more leads passed through a vein into the heart. A subcutaneous ICD (S-ICD) has no leads in the heart at all; the lead sits under the skin over the breastbone, which suits some people. A combined device called CRT-D both resynchronises the heart (like a biventricular pacemaker) and can defibrillate, for selected people with heart failure.

An ICD is fitted either because you have already had a dangerous rhythm or cardiac arrest (secondary prevention), or because tests show you are at high risk even though it has not happened yet (primary prevention). It can also act as a pacemaker for slow rhythms.

An ICD does not cure the underlying heart condition and does not stop a heart attack. It is a safety net that treats dangerous rhythms if they happen. The decision to fit one is significant, because living with an ICD includes the possibility of receiving shocks and changes to driving.

Types, options & approaches

There may be different ways to do this. The right approach depends on the clinical question and your circumstances.

Single-chamber ICD

One lead to the lower right chamber. Senses and treats dangerous fast rhythms and can pace a slow rhythm.

Dual-chamber ICD

Two leads, to the upper and lower right chambers, giving more information about the rhythm and more pacing options.

Subcutaneous ICD (S-ICD)

The lead sits under the skin over the breastbone rather than inside the heart. Avoids leads in the veins and heart, but cannot give long-term pacing for slow rhythms.

CRT-D (defibrillator with resynchronisation)

Combines a biventricular pacemaker and a defibrillator for some people with heart failure and an electrical delay, to improve pumping and protect against dangerous rhythms.

Box change (generator change)

When the battery runs low after several years, the device box is replaced, usually keeping the working leads.

ICD vs pacemaker

Feature	ICD	Pacemaker
Main job	Stops a dangerous fast rhythm	Stops the heart going too slow
Can it shock you?	Yes, if needed	No
Driving	Off at least 1 month, longer after a shock	Off about 1 week
HGV/bus licence	Not allowed	May be possible after assessment

Many ICDs also pace slow rhythms, so they do a pacemaker's job too. Your cardiologist will explain which device fits your risk.

Preparing for your procedure

Talk through why an ICD is recommended, and whether it is for primary or secondary prevention, so you understand the goal.
Tell the team about all medicines, especially blood thinners and antiplatelets, as some may need pausing.
Mention allergies, recent infections, fever or any skin problem near the collarbone.
You may be asked not to eat for a few hours, particularly if sedation or general anaesthetic is planned.
Arrange a lift home and someone to stay with you for the first night.
Plan for help at home, as the arm on that side must not be raised above shoulder height for several weeks.
Discuss the impact on driving and work in advance, as restrictions are longer than for a pacemaker.
Ask about emotional support, as some people find the idea of shocks worrying.

What happens

The procedure is usually carried out in a catheter lab. You will have local anaesthetic and often sedation; some people, especially for an S-ICD, have a general anaesthetic.

For a standard ICD, the cardiologist makes a small cut near the collarbone, passes one or more leads through a vein into the heart under X-ray guidance, and connects them to the device, which sits under the skin or muscle. For an S-ICD, the device sits at the side of the chest and the lead is tunnelled under the skin over the breastbone, with no leads in the heart.

The device is checked before you leave, and sometimes the team tests that it can detect and treat a fast rhythm. A standard implant usually takes about one to two hours; CRT-D devices take longer.

Most people stay a few hours or one night, have a chest X-ray to check the leads, and go home with the device already active.

Is this procedure right for me?

A good consultation should explore whether it's the right choice for you now — including reasons to wait or consider something else.

May not be suitable if…

Your risk of a dangerous fast rhythm is low, so the benefits may not outweigh the risks of having a device.
You have an active infection, especially near the device site or in the bloodstream.
Another illness means your overall life expectancy or quality would not be improved by an ICD.
You would not want shocks, which is a valid choice that should be respected and explored.
Your anatomy or need for long-term pacing affects which device type is suitable (for example, an S-ICD cannot pace slow rhythms long term).

Delay or rearrange if…

You have a current infection, fever or a skin problem near the collarbone.
Your blood is over-thinned and bleeding risk is high until adjusted.
A reversible cause of the dangerous rhythm could be treated first.
You need more time to understand and consent to living with possible shocks.
You cannot arrange the help you will need at home for the first weeks.

Alternatives to discuss

Anti-arrhythmic and heart-failure medicines to reduce the risk of dangerous rhythms.
Catheter ablation to treat the rhythm causing the risk, sometimes alongside or instead of an ICD.
A wearable defibrillator vest for a limited period while a decision is made.
Treating the underlying heart condition, which may change the level of risk.
A considered decision not to have an ICD where that fits your wishes and overall health.

Before you decide

Use this as a shared-decision checklist. The aim is not just “can this be done?”, but whether it is right for you, now, with the risks and alternatives clearly understood.

What matters most to me?

Think about symptoms, daily life, work, caring responsibilities, sport, fertility, travel, appearance and anxiety — the right choice depends on your priorities, not just the medical facts.

What are all my options?

Ask about waiting, monitoring, medicines, rehabilitation, a smaller or larger procedure, a different test, NHS referral, or a second opinion where that would help.

What would make me pause?

Active infection, pregnancy, unstable medical problems, smoking, medicines that increase bleeding, poor support at home, or feeling pressured are all reasons to slow down and get tailored advice.

What happens if I do nothing today?

For some problems, waiting is safe; for others, delay can make treatment harder. A good consultation should explain the trade-off in plain English.

Comfort, sedation or contrast choices

If local anaesthetic, sedation, contrast or pain relief is used, ask what is planned, why, and what it means afterwards.

Local anaesthetic with sedation

The usual approach for a standard ICD; you are relaxed and comfortable but not fully asleep.

General anaesthetic

Often used for a subcutaneous ICD (S-ICD) or longer combined devices, or where it is safer for you.

Benefits

Can detect and stop a dangerous fast rhythm and reduce the risk of sudden cardiac death
Treats a cardiac arrest automatically, wherever you are, without needing someone nearby
Can also pace the heart if it goes too slowly (except a standard S-ICD)
Records rhythm information that helps your team adjust your treatment
CRT-D devices can improve heart-failure symptoms in selected people as well as protecting against dangerous rhythms

Risks & complications

More common

Bruising, soreness or a lump at the device site for a week or two
Awareness of the device under the skin, especially in slim people
Tiredness for a few days after the procedure

Less common

A lead moving and needing repositioning
Bleeding or a blood collection (haematoma) at the site
Infection of the wound or device, which can be serious
A punctured lung (pneumothorax), sometimes needing a chest drain
Inappropriate shocks, where the device fires when it does not need to

Rare but serious

Fluid collecting around the heart (tamponade) needing drainage
Blood clot in the vein causing arm swelling
Device or lead failure needing further procedures
Death, which is a very rare complication of the procedure

Two issues matter most with an ICD beyond the usual implant risks: device or lead infection (uncommon but serious, sometimes needing the whole system removed) and inappropriate shocks, which can be frightening and may need the settings or medicines adjusting. As with any device fitted via a vein, a punctured lung is a recognised early risk. Ask your cardiologist about your own risk, how shocks will be managed, and how often the device will be checked.

Published figures to discuss

Complication and shock rates vary with your heart condition, the device type, the number of leads and the operator's experience. The notes below are cautious and qualitative because robust single figures are hard to quote across all devices and reasons for implant; CRT-D and lead procedures carry more risk than a simple ICD.

Figure	Reported range	How to interpret it	Source / confidence
Punctured lung (pneumothorax)	Recognised early risk; broadly around 1 in 100 (about 1%) for lead-based devices, similar to pacemakers in NHS information	May need a chest drain; less relevant for a subcutaneous ICD, which has no leads in the veins.	NHS — Pacemaker implantation (covers ICDs and devices)nhs.ukPublished figure
Device or lead infection	Uncommon (well under a few percent in most series), but serious	Can mean removing the whole system; report redness, swelling, oozing or fever promptly.	NHS — Pacemaker implantation (covers ICDs and devices)nhs.ukSource-linked context
Inappropriate shock	Reported in a notable minority of patients over time; varies with device, settings and rhythm	Distressing but usually manageable by adjusting settings or medicines; discuss your shock plan.	Guide sourcesClinical context

These are literature figures, not a personalised prediction. Your own risks and likely benefits depend on your circumstances, your health, and how your care is carried out and followed up.

What happens afterwards

Physical recovery is usually quick, with most people home the same day or next morning, but the arm and wound need protecting for several weeks, and the driving and lifestyle changes are a bigger adjustment than with a pacemaker.

First 24–48 hours

Keep the dressing clean and dry. Some bruising and soreness is normal. A chest X-ray usually checks the leads before or soon after discharge.

First month

Do not drive for at least a month (your team will confirm), and not at all if you hold an HGV or bus licence. Use the arm gently but do not raise that elbow above shoulder height.

Weeks 1–6

Avoid heavy lifting and vigorous arm exercise so the leads settle. Wound checks happen as advised, and a device check often takes place around 6 weeks.

If you get a shock

Follow the plan your team gives you. A single shock when you feel well usually means contacting the clinic; repeated shocks, or a shock with collapse or chest pain, is an emergency. Driving usually stops for a further period and you must tell the driving licence authority — the DVLA in England, Scotland and Wales, or the DVA in Northern Ireland.

Long term

Regular checks (in clinic or by remote monitoring) track the battery, leads and any rhythm events.

What's normal — and not a worry

Bruising and tenderness around the device that settles over a week or two
Awareness of the device, which most people get used to over time
A small scar that softens over months
Some anxiety about possible shocks, which often eases with information and support

Aftercare

Keep the wound clean and dry and follow the dressing and showering advice given.
Do not raise the arm on the device side above shoulder height for about 4–6 weeks.
Avoid heavy lifting and vigorous arm activity while the leads settle.
Carry your ICD identification card and show it at airport security and before any scan.
Keep mobile phones and strong magnets away from the device, and do not linger in shop security gateways.
Know your shock plan: what to do for a single shock and when a shock is an emergency.
Tell the driving licence authority — the DVLA in England, Scotland and Wales, or the DVA in Northern Ireland — and do not drive until your team confirms it is allowed.
Seek emotional support if you feel anxious about the device or shocks.

Before your procedure

Lift home arranged and someone to stay the first night
Loose, front-opening tops that do not press on the device
ICD identification card kept safe
Help arranged for lifting and chores for several weeks
Driving stopped and the driving authority informed (DVLA in England, Scotland and Wales; DVA in Northern Ireland)
Written shock plan and clinic contact number to hand
Make and model of device noted for future MRI scans

Scars and how they heal

A standard ICD leaves a scar a few centimetres long near the collarbone, with a noticeable bump where the device sits, as ICDs are a little larger than pacemakers. An S-ICD leaves a scar at the side of the chest and a smaller one near the breastbone. Scars are pink and slightly raised at first and usually fade over several months.

⚠ Get urgent help if…

Several shocks close together, or a shock followed by collapse, chest pain or breathlessness — treat as an emergency
A single shock when you otherwise feel well — contact your clinic for advice
Spreading redness, swelling, heat, oozing or a wound that opens at the device site
A high temperature, shivering or feeling generally unwell after the procedure
Fainting, severe dizziness or a return of your heart symptoms
Swelling of the arm on the device side
Persistent twitching of the chest muscle in time with the heartbeat

Who to contact: your clinician, clinic or test provider first (keep their number to hand). For urgent advice when you can't reach them, call NHS 111. In an emergency, call 999.

General guidance — it doesn't replace the specific advice your surgeon gives you.

Results & realistic expectations

A well-functioning ICD lowers the risk of dying from a dangerous fast rhythm by treating it automatically if it happens. Many people never receive a shock; for them, the device is a safety net that has done its job by being ready. The device records rhythm events that guide your ongoing treatment.

An ICD does not cure the underlying heart disease, does not prevent a heart attack, and does not stop every dangerous event. Some people receive shocks that are appropriate but distressing, and a few receive inappropriate shocks that need settings or medicines adjusted. Honest discussion of these realities is part of good consent.

How long it lasts

An ICD battery typically lasts several years, often around 5 to 8 depending on the device and how much therapy it delivers, after which the box is replaced in a smaller procedure while working leads are usually kept. Leads can last many years but occasionally fail or fracture and may need replacing or extracting in a specialist centre. Lifelong follow-up, often partly by remote monitoring, tracks the battery, leads and rhythm events.

Related tests, treatments or support

An ICD is sometimes combined with resynchronisation pacing (CRT-D) when heart failure and an electrical delay are present. People with an ICD often also take heart-failure or rhythm medicines, and some go on to have catheter ablation to reduce how often dangerous rhythms and shocks occur. Your cardiologist will explain how these fit together.

Follow-up & long-term care

You will usually have a wound check in the first weeks and a device check around 6 weeks, then regular checks in clinic or by remote monitoring. Any shock should prompt contact with your team as advised, and your driving status is reviewed after a shock or device change. Report wound problems, fever or returning symptoms promptly.

Attend routine device checks, in clinic or by remote monitoring, to track battery, leads and any events.
Plan for a box change every several years when the battery runs low.
Keep your ICD identification card and your written shock plan up to date.
Always tell radiology staff before any MRI and confirm the device is MRI-conditional.
Tell the driving authority (the DVLA in England, Scotland and Wales, or the DVA in Northern Ireland) about shocks and device changes, and follow driving advice.
Mention the ICD before any surgery, diathermy or physiotherapy.

Repeat, follow-on and what comes next

A box change is expected every several years when the battery runs low; this is planned, not a failure.
Leads can fracture or fail and may need adding to, replacing or extracting in a specialist centre.
Settings are often adjusted to reduce inappropriate shocks; this is normal management.
Some people later need a different device type as their heart condition changes.

Ask what happens if the result is unclear or needs repeating, and what is included if further tests or follow-up are needed.

What good aftercare looks like

A written shock plan: what to do for a single shock and when a shock is an emergency.
Clear wound-care and arm-movement instructions and a named contact for problems.
A device identification card and recorded make and model for MRI and security.
A planned device check and a clear follow-up or remote-monitoring schedule.
Access to psychological support, as anxiety about shocks is common and treatable.
Clear driving guidance (from the DVLA in England, Scotland and Wales, or the DVA in Northern Ireland), including after any shock.

What affects the cost

Costs vary a great deal between people and providers, and we don't publish prices. What matters is understanding what drives the cost and making sure your quote is complete. The main things that affect it:

The type of device (single, dual chamber, subcutaneous S-ICD or CRT-D), which differ in complexity and price
The cardiologist's (operator's) fee and the catheter-lab and facility fees
Whether sedation or a general anaesthetic and an anaesthetist are used
Length of stay (day case versus overnight)
Imaging and tests before and after, such as ECG, echocardiogram and chest X-ray
Follow-up device checks and remote monitoring
The cost of managing a complication or an inappropriate shock if one occurs

Make sure your written quote includes

The cardiologist's fee and which device is included
Catheter-lab, facility and overnight-stay charges
Sedation or anaesthetist fees
Pre-procedure tests and the post-procedure chest X-ray
Follow-up device checks and remote monitoring arrangements
What happens, and what is charged, if a complication or inappropriate shock occurs
The cancellation policy

On the NHS? ICDs are provided on the NHS for people who meet national high-risk criteria; private care is generally chosen for speed or choice of consultant rather than a different device.

You're entitled to your total cost in writing — including reports, follow-up and what happens if the result is inconclusive — before you decide.

Choosing a specialist safely

Check the surgeon is on the GMC Specialist Register for this area.
Make sure they work at a CQC-registered service, and look for membership of the relevant Royal College or professional body.
You're entitled to time to consider and to have your questions answered before you agree — the surgeon who looks after you should explain it, not a salesperson.
Be wary of pressure: time-limited offers or deposits taken before you've had time to think are red flags, not bargains.
You're entitled to your total cost in writing — including any follow-up — before you decide.

How Vuemedics verifies every consultant →

Questions to ask your medical professional

Take this to your consultation. A good surgeon will welcome every one of these.

Is this ICD for primary or secondary prevention, and what does that mean for me?
Would a lead-based ICD or a subcutaneous (S-ICD) device suit me better, and why?
What is my personal risk of complications such as lung puncture, infection and lead problems?
How likely am I to receive shocks, and what is my plan if I get one?
How will this affect my driving and work, and for how long?
Is the device MRI-conditional, and can shocks be turned off later if I ever wish?
Are you on the GMC Specialist Register for this area, and which Royal College or professional body are you a member of?
Will you be the surgeon who carries out my procedure, and who looks after me afterwards?
What are the risks for someone like me, and how often do your own patients have a problem or need it repeated or redone?
What does a realistic result look like — and what can this procedure not achieve?
What are my options, including waiting, doing nothing for now, or choosing a different approach?
Can I have written information, results and aftercare instructions in a format I can use, including any accessibility or communication support I need?
What is the total cost in writing, including any follow-ups, and how much time do I have to decide?

Frequently asked questions

Is an ICD available on the NHS?

Yes. ICDs are fitted on the NHS for people at high risk of dangerous fast rhythms, following national criteria. Private care is mainly for speed of access or choice of consultant, not a different device.

What does a shock feel like?

People often describe an appropriate shock as a sudden, strong thump or kick in the chest. It is brief but can be distressing. Your team will give you a plan for what to do if you receive one.

How long before I can drive?

For an ordinary licence you usually cannot drive for at least a month after the device is fitted, and longer after a shock or for certain conditions. HGV and bus drivers are not allowed to drive with an ICD. You must tell the driving licence authority — the DVLA if you live in England, Scotland or Wales, or the DVA if you live in Northern Ireland.

Can I have an MRI scan?

Often yes. Most modern ICDs are 'MRI-conditional', meaning a scan can be done under set conditions after the device is checked. The make and model must be confirmed, and older devices may not be suitable.

Will phones, security gates or kitchen appliances affect it?

Keep mobile phones and strong magnets a short distance from the device and do not linger in shop security gateways. Tell airport staff and show your card. Most household equipment is fine if kept a little away from the device; ask your team about specific items.

Can the device be switched off near the end of life?

Yes. The shock function can be deactivated if shocks are no longer wanted, for example in end-of-life care. This is an important conversation to have with your team in advance.

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How we made this page

Medically reviewed by a GMC-registered consultant. Written in plain English, checked against NHS, NICE, GMC and relevant Royal College / specialist-society guidance, and kept under review. No clinic paid to appear on this page, and we publish no pricing. This is general information to help you prepare — it is not a substitute for advice from your own clinician. How we review our guides →

Source hierarchy: UK regulator and NHS/NICE guidance first, then relevant Royal College or specialist-society guidance, then peer-reviewed evidence for procedure-specific figures where available.

Sources & standards: NHS — Pacemaker implantation (covers ICDs and devices) British Heart Foundation — Implantable cardioverter defibrillator (ICD) British Heart Foundation — ICD dos and don'ts British Heart Foundation — Driving with a heart condition NICE — ICDs and CRT for arrhythmias and heart failure (TA314) Arrhythmia Alliance — Heart rhythm information DVLA — Assessing fitness to drive (medical guidance) DVA Northern Ireland — Telling DVA about a driver medical condition

Reviews reflect patients' experience of care, not clinical outcomes. For procedure volumes and outcome data see PHIN.

Last medically reviewed 2026-09-21. Spotted something wrong or out of date? Report an error in this guide.