Replacement of Implantable Cardioverter-Defibrillator (ICD)

For patients that already have an ICD and are considering replacement.

Refresher: What is an ICD?

An ICD is designed to prevent an at-risk person from dying suddenly from a dangerous heart rhythm. When it senses a dangerous heart rhythm, an ICD gives the heart an electrical shock. It does this in order to get the heart to beat normally.

Why Replace my ICD?

You may need to replace your ICD because the battery is wearing out, the device is not working properly, or you have had an infection requiring ICD removal.

Making a choice about ICD replacement

For some people, replacing the ICD is an easy decision. They want to continue to live as long as possible, even if it means their heart condition will continue to get worse. For other people, this is a more difficult decision.

Why this might not be an easy decision

While you are still at risk for sudden cardiac death, other things in your life may have changed.

  • Your risk for sudden cardiac death may not be as high as it once was.
  • Your overall health: you may be sicker or have other illnesses on top of your heart failure.
  • You may be at a place in your life where the quality of your life is much less than it once was and preventing a sudden cardiac death isn’t as important. You may be ready to accept death when it comes and are not as concerned with preventing it.
  • You may have had some bad experiences with your ICD.

Considering replacement of an ICD

What does it mean to replace an ICD?

Regardless of why you need to replace the ICD (battery wearing out, device malfunction, infection, etc.), you will need to have a surgery much like the one you had before.

If you decide not to replace the ICD, you may let the battery run out or simply turn off the device.


There is a slightly higher risk of complications when a lead needs to be replaced. Talk with your doctor about these complications. In general, risks of this replacement procedure include pain, infection, and bleeding. Serious complications, however, are unusual.

Would I survive a dangerous heart rhythm without an ICD?

You may survive a dangerous heart rhythm only if you are treated within a few minutes with an external shock. However, many patients die before emergency help can reach them.

ICD Trade-offs

Deciding whether or not to replace your ICD can be difficult but you do have options. While the future is always unpredictable, there is an important trade-off to consider when deciding whether to get an ICD. Consider two possible paths:

Path 1

You may choose to replace the ICD. You may be feeling like you usually do, then a dangerous heart rhythm could happen. The ICD may help you live longer by treating a dangerous heart rhythm. You will continue to live with a heart condition that may get worse over time.

“I’m not ready to die. I have so much to live for. Even if it means getting shocked, I’m willing to do anything that can help me live longer.”

Path 2

You may choose to NOT replace the ICD. You may be feeling like you usually do and then a dangerous heart rhythm could happen. You may die quickly from the dangerous heart rhythm.

“The idea of dying quickly sounds painless. I’ve always said I hope to die in my sleep. Going through surgery and getting shocked is not something I want.”

Making a Decision

What if I change my mind? Can I remove the ICD?

Unless you have an infection of the ICD or the battery runs out, it is usually best not to remove an ICD. However, the ICD can be turned off or you can let the battery wear out. Once the ICD is off, it would no longer be able to shock you. In patients who are close to death, the ICD is often turned off so that it will not shock them. Some patients may choose to have it turned off because they no longer want to prevent sudden death.

What else do you need to help you make your decision?

It may be time for you to talk with your doctor, family, and friends. You may want to share the information in this decision aid with them. It is important that you have all of the information you need to make a decision that is right for you. You have the right to make your own choices!

Supporting Evidence

Here is a document outlining all evidence for practice decision aids, to help you in your decision.

View Supporting Evidence