Contraindications of ICD (Implantable Cardioverter Defibrillator)

Medically Reviewed by Dr. Aman Priya Khanna
Written by Sangeeta Sharma, last updated on 15 December 2023
Contraindications of ICD (Implantable Cardioverter Defibrillator)

According to Medical Buyer, India was the world's biggest importer of defibrillators in FY23. 1 Implantable cardioverter-defibrillators (ICDs) have transformed the treatment of potentially fatal cardiac arrhythmias. Their usage, however, is not without limitations, and certain contraindications of defibrillation must be considered.

These tiny devices are implanted in the chest to monitor and treat irregular heartbeats. In this blog, we will go over the ICD complications, focusing on the situations in which they may be inappropriate.

Understanding ICDs

An implantable cardioverter-defibrillator is a device that continuously monitors the electrical activity of the heart. It can provide an electric shock (defibrillation) to restore a normal cardiac rhythm. 

This is done when it detects arrhythmia, such as ventricular fibrillation or ventricular tachycardia. ICDs can save lives in people who are at high risk of abrupt cardiac death due to arrhythmias.

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Contraindications of ICDs

As stated before, while ICDs can be life-saving for many patients, there are certain complications of defibrillation in which their use may not be appropriate. It is essential for doctors to carefully evaluate potential candidates for ICD therapy to ensure that the benefits outweigh the potential risks. Here are some common contraindications of defibrillation:

  1. Acute Myocardial Infarction (AMI): A heart attack, also known as an AMI, can cause electrical instability in the heart. ICDs are usually recommended for individuals who have a history of ventricular tachyarrhythmias.
    However, implanting one right after an AMI may not be appropriate. Before considering ICD implantation, the patient's overall heart status and recuperation should be evaluated.

  2. Drug Intoxication: Certain drugs or toxins can produce irregular cardiac rhythms. It is essential in cases of drug intoxication to first identify and manage the harmful chemical.
    An ICD may not be effective until the drug is completely cleared from the body. Thus, it should be used with caution.

  3. Drowning and Electric Shock: As a result of the trauma, survivors of near-drowning or electrical shock accidents may develop transitory ventricular tachyarrhythmias. When the underlying reason is treated, cardiac arrhythmias are frequently reversible.
    ICD installation should be considered only if these arrhythmias persist or reoccur after the primary injury has been addressed.

  4. Electrolyte Imbalance: Electrolyte imbalances, such as abnormal potassium, sodium, or calcium levels, can cause heart rhythm problems. Before considering ICD installation, the electrolyte imbalance must be corrected.
    When electrolyte levels return to normal, the arrhythmia may resolve.

  5. Hypoxia: A lack of oxygen in the body, known as hypoxia, can influence the electrical activity of the heart.
    Priority should be given to treating the underlying cause of hypoxia (e.g., respiratory failure or anaemia). Correcting the oxygen supply will often result in the resolution of arrhythmias.

  6. Sepsis: It is a severe infection that can impact several organ systems and can result in a variety of cardiovascular problems, including arrhythmias.
    Given the increased risk of infection at the implantation site, ICD placement is generally discouraged. Before considering ICD therapy, the sepsis should be controlled and resolved.

These contraindications of defibrillation serve as guidance to ensure that ICD therapy is appropriate for each patient's particular circumstances.

Complications of Defibrillation

While ICD is highly effective in restoring a normal heart rhythm, there are potential complications of defibrillation associated with it. These complications can occur during or after the procedure and may vary in severity. Below are the potential complications of ICD insertion:

  1. Infections: This can arise at the implant site, which is commonly in the chest. Infections can result in redness, swelling, pain, and, in some cases, wound discharge. In severe situations, the infection can spread throughout the body, creating a serious health danger.

  2. Swelling, Bleeding, or Bruising: These are some of the most common ICD complications. While they are normally temporary and resolve on their own, heavy or chronic bleeding may necessitate medical treatment.

  3. Blood Leakage through Heart Valve: In some situations, placing ICD lines close to a heart valve might cause blood to seep through the valve. This disorder may affect valve function and may necessitate surgical intervention.

  4. Device or Lead Movement: The ICD device or its leads may shift or move from their intended position on occasion. This movement may cause a lead to be moved into the heart chambers or other issues, which may necessitate surgical correction.

  5. Rip or Cut in the Heart Muscle: Movement of the device or leads might also cause a tear or cut in the heart muscle in rare cases. This is a serious consequence that may require urgent medical attention.

  6. ICD Wires Causing Blood Vessel Damage: The ICD leads or wires, strung through blood vessels to reach the heart, can occasionally cause blood vessel damage. It might cause bleeding, hematoma formation, or vascular injury, requiring extra medical procedures.

  7. Bleeding Around the Heart: Although uncommon, bleeding around the heart (pericardial haemorrhage) can occur during or after ICD implantation. If not discovered and addressed promptly, this can be fatal.
    Symptoms may include chest pain, trouble breathing, or evidence of cardiac tamponade (heart compression caused by fluid accumulation).

It is important to emphasise that while complications of implantable cardioverter defibrillators are possible, they are uncommon. Doctors take great care to minimise complications and closely evaluate patients during and after implantation. 


ICDs (implantable cardioverter-defibrillators) have saved countless lives by providing life-saving shocks to rectify potentially fatal heart rhythms. Certain contraindications of defibrillation must, however, be addressed while assessing possible candidates for ICD implantation.

Ultimately, implanting an ICD should be made with the patient's overall well-being. You can also contact HexaHealth to learn more about the complications of ICD insertion. We will help you make informed judgements. Get in touch!

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Frequently Asked Questions

Are there any contraindications of defibrillation?

Yes, there are contraindications of defibrillation, including reversible causes like:

  1. Acute myocardial infarction

  2. Drug intoxication

  3. Electric shock

  4. Electrolyte imbalance

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What are the immediate complications of defibrillation?

Immediate complications of defibrillation include:

  1. Infection at the implant site

  2. Swelling, bleeding, or bruising

  3. Damage to implanted devices

  4. Pain and discomfort during and after the procedure

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What is the most frequent complication of ICD therapy?

The most frequent complication of ICD (Implantable Cardioverter-Defibrillator) therapy is infection at the implant site. This can occur in the chest area where the ICD device is implanted. Infections can lead to redness, swelling, pain, and sometimes discharge from the wound. 

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What are the long-term ICD complications?

Long-term ICD complications can include:

  1. Lead malfunction or damage

  2. Device or lead displacement

  3. Battery depletion

  4. Inappropriate shocks

  5. Recurrent arrhythmias

  6. Skin irritation or allergic reactions

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What are some of the rare complications of implantable cardioverter defibrillators?

Some rare complications of implantable cardioverter defibrillators (ICDs) include:

  1. Device or lead migration

  2. Lead perforation

  3. Thrombosis (clot formation)

  4. Bleeding around the heart

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What are the side effects of a defibrillator?

Side effects of a defibrillator can include:

  1. Lead malfunction

  2. Allergic reaction to device materials

  3. Pain or discomfort at the implant site

  4. Swelling, bleeding, or bruising

  5. Infection at the implant site

  6. Blood vessel damage from device wires

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How to prevent complications of ICD insertion?

Here’s how to prevent complications of ICD insertion:

  1. Follow pre-procedure instructions

  2. Discuss allergies and sensitivities with the doctor

  3. Inform the doctor about current medications

  4. Comply with post-procedure care instructions

  5. Attend scheduled follow-up appointments

  6. Be vigilant for signs of infection or complications 

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What are the warnings of a defibrillator?

Warnings related to defibrillators include:

  1. High voltage shock

  2. Ensure proper electrode placement

  3. Check battery and electrode expiration

  4. Avoid use near flammable materials

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Are there specific medical conditions that might prevent someone from receiving an ICD?

Yes, there are specific medical conditions that might prevent someone from receiving an ICD:

  1. Absence of heart condition

  2. Prone to contraindications

  3. Allergies to device materials

  4. Irreversible bleeding disorders

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How do contraindications impact the decision to implant an ICD for certain patients?

Contraindications guide the decision by:

  1. Identifying risks

  2. Balancing benefits and risks

  3. Tailoring care

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What is the ICD complication rate?

The rate of complications linked with ICD implantation varies from patient to patient. The complication rate for ICD implantation ranges from 4% to 30% in general. However, it is important to note that advances in technology and medical practices have helped to lower these rates throughout time.

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What happens if an ICD fails?

If an ICD (Implantable Cardioverter-Defibrillator) fails, it may be unable to detect or treat potentially life-threatening arrhythmias. It can be fatal.

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What are the indications for defibrillation?

Indications for defibrillation include:

  1. Ventricular Fibrillation (VF)

  2. Pulseless Ventricular Tachycardia (VT)

  3. Sudden Cardiac Arrest 

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Are there alternative treatment options for patients with contraindications for ICDs?

Yes, alternative treatment options for patients with contraindications for ICDs include:

  1. Antiarrhythmic medications

  2. Catheter ablation

  3. Cardiac resynchronisation therapy (CRT)

  4. Lifestyle modifications

  5. Risk factor management

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All the articles on HexaHealth are supported by verified medically-recognized sources such as; peer-reviewed academic research papers, research institutions, and medical journals. Our medical reviewers also check references of the articles to prioritize accuracy and relevance. Refer to our detailed editorial policy for more information.

  1. Iqbal AM, Butt N, Jamal SF. Automatic Internal Cardiac Defibrillator [Internet]. PubMed. Treasure Island (FL): StatPearls Publishing; 2023 [cited 2023 Nov 4]. link
  2. Mayo Clinic. Implantable cardioverter-defibrillators (ICDs) - Mayo Clinic [Internet]. 2017. link
  3. Quality ID #348: Implantable Cardioverter-Defibrillator (ICD) Complications Rate -National Quality Strategy Domain: Patient Safety -Meaningful Measure Area: Preventable Healthcare Harm 2020 COLLECTION TYPE: MIPS CLINICAL QUALITY MEASURES (CQMS) MEASURE TYPE: Outcome -High Priority [Internet]. [citedlink

Updated on : 15 December 2023


Dr. Aman Priya Khanna

Dr. Aman Priya Khanna

MBBS, DNB General Surgery, Fellowship in Minimal Access Surgery, FIAGES

12 Years Experience

Dr Aman Priya Khanna is a well-known General Surgeon, Proctologist and Bariatric Surgeon currently associated with HealthFort Clinic, Health First Multispecialty Clinic in Delhi. He has 12 years of experience in General Surgery and worke...View More


Sangeeta Sharma

Sangeeta Sharma

BSc. Biochemistry I MSc. Biochemistry (Oxford College Bangalore)

6 Years Experience

She has extensive experience in content and regulatory writing with reputed organisations like Sun Pharmaceuticals and Innodata. Skilled in SEO and passionate about creating informative and engaging medical conten...View More

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