Extravascular Implantable Cardioverter Defibrillator (EV-ICD)

An EV-ICD (extravascular implantable cardioverter defibrillator) is a heart device that helps prevent sudden cardiac death by continuously monitoring heart rhythm and delivering treatment if a dangerous rhythm occurs.

The EV-ICD is the first implantable cardioverter defibrillator designed to provide ICD protection while keeping the entire system outside the heart and blood vessels. Unlike a traditional ICD, the EV-ICD uses a thin wire (called a lead) that is placed beneath the breastbone (sternum), outside the heart and veins, allowing the device to treat dangerous heart rhythms while avoiding many of the potential complications associated with leads placed inside the heart and blood vessels.

The EV-ICD continuously monitors your heart rhythm and responds if a life-threatening fast rhythm is detected.

If needed, the device can:

• Pace the heart to try to stop a dangerous rhythm before a shock is needed (called anti-tachycardia pacing, or ATP)
• Deliver a shock to restore a normal heart rhythm if a dangerous rhythm continues
• Provide pacing after a shock if the heart rate becomes too slow afterward

One of the EV-ICD's most important advantages is its ability to deliver anti-tachycardia pacing (ATP) while keeping the entire system outside the heart and blood vessels. ATP can stop some dangerous fast heart rhythms before a shock is needed, helping some patients avoid unnecessary shocks.

This multi-step approach is designed to treat abnormal rhythms as safely and effectively as possible.

The EV-ICD can also be connected to a remote monitoring system. This allows your care team to:

• Check device function and heart rhythm data remotely
• Detect abnormal rhythms or device events early
• Reduce the need for frequent in-person device checks 

The EV-ICD offers an alternative to traditional ICD systems by avoiding wires placed inside the heart.

Because the lead is positioned beneath the sternum rather than inside the heart and veins, the EV-ICD may reduce the risk of complications associated with traditional transvenous leads, including blood vessel injury, vein blockage, lead-related problems and serious bloodstream or device-related infections.

Unlike other leadless ICD systems, the EV-ICD can also deliver anti-tachycardia pacing (ATP), giving patients the potential benefit of stopping certain dangerous heart rhythms without requiring a shock.

Key differences:

• The lead is placed outside the heart and veins
• It still monitors heart rhythm continuously
• It can deliver therapy if a dangerous rhythm is detected

The EV-ICD may be considered for patients who:

• Need protection from dangerous heart rhythms
• Do not need long-term pacing or cardiac resynchronization therapy
• May benefit from avoiding leads placed inside the heart
• Have limited access to their veins or may be at higher risk for infection, including patients receiving dialysis or those with permanent venous catheter
• Are evaluated as appropriate candidates by a heart rhythm specialist

While these patients may particularly benefit from an EV-ICD, the device may also be an option for a broader range of people who need ICD protection. Your cardiac rhythm specialist will determine whether an EV-ICD is the right choice based on your individual condition and treatment goals.

Before

Before your EV-ICD procedure, your care team will review your medical history, heart condition and test results. You may have blood tests, imaging or heart rhythm monitoring to help plan your care.

Your provider will give you instructions about:

• Which medications to take or stop before the procedure
• When to stop eating or drinking
• How to prepare on the day of the procedure

You will also meet with members of your care team, which may include heart rhythm specialists, cardiac surgeons, anesthesia providers, and nursing staff.

During the Procedure

The EV-ICD is placed during a surgical procedure while you are under sedation or general anesthesia, so you are comfortable and do not feel pain.

A small incision is made in the chest area. The device is placed under the skin, and a thin wire (lead) is positioned in the chest outside the heart and blood vessels.

Once in place, your care team will:

• Test the device to make sure it is working correctly
• Program it for your specific heart rhythm needs
• Close the incision with stitches or surgical adhesive

The procedure typically takes a few hours. Most patients stay in the hospital overnight for monitoring.

Recovery

After your EV-ICD is placed, you will be monitored to ensure the device is working properly and your heart rhythm is stable.

You may experience:

• Mild soreness, swelling or bruising at the incision site
• Fatigue for a few days after the procedure

Most patients return to light daily activities within a few days to a week. Full recovery usually takes a few weeks.

During recovery, you may need to:

• Avoid heavy lifting or strenuous activity
• Limit raising your arm on the side of the device for a short time
• Keep the incision clean and dry as it heals

Your care team will give you specific instructions based on your procedure and recovery progress.

Follow-Up Care

After your EV-ICD is placed, you will have follow-up visits to:

• Check the incision site
• Make sure the device is working correctly
• Adjust settings if needed

Your device may also be connected to a remote monitoring system, which allows your care team to check your heart rhythm and device performance from home. This helps detect important changes early and reduces the need for frequent in-person visits.

UC Health offers advanced heart rhythm care with teams known for leading new ways to treat complex heart conditions. Our Cardiac Rhythm Disorders specialists work together to provide innovative options, including emerging device technologies like the EV-ICD, for patients who may benefit from alternatives to traditional ICD systems. Our electrophysiologists, cardiac surgeons, cardiologists and cardiac anesthesiologists work together as one team to deliver this advanced treatment, ensuring every patient benefits from coordinated, expert care.

Electrophysiology Excellence in Advanced Heart Care

When it comes to the latest in care, we never miss a beat. Your heart shouldn’t either. Call 513-475-8521 or schedule online for an appointment.