Pacemakers, Implantable Cardioverter Defibrillators (ICDs) & Bi-Ventricular Devices

What are Pacemakers, Implantable Cardioverter Defibrillators (ICDs), and Bi-Ventriculars Devices?

Pacemakers, Implantable Cardioverter Defibrillators (ICDs), and Bi-Ventricular devices are types of cardiac devices used to regulate heart rhythm.

• Pacemakers are devices that send small electrical impulses to the heart muscle to maintain a normal heart rate and rhythm. They are typically used in patients with bradycardia (a slower than normal heart rate).
• Implantable Cardioverter Defibrillators (ICDs) monitor heart rhythms and can deliver electric shocks to restore a normal heartbeat if dangerous arrhythmias are detected.
• Bi-Ventricular devices, also known as Cardiac Resynchronization Therapy (CRT) devices, are used for patients with heart failure. They send electrical impulses to both the left and right ventricles to make them beat more in sync and improve the heart's efficiency.

Why is the Procedure Performed?

These devices are implanted to manage various cardiac conditions:

• Pacemakers are used to treat arrhythmias that cause the heart to beat too slowly, leading to symptoms like fatigue, fainting, or dizziness.
• Implantable Cardioverter Defibrillators (ICDs) are used in patients at risk of sudden cardiac death due to ventricular tachycardia or fibrillation.
• Bi-Ventricular Devices are used to treat patients with heart failure whose hearts' chambers do not beat in sync.

How is the Procedure Performed?

The implantation of these devices is a surgical procedure usually performed under sedation determined by your physician. A small incision is made near the collarbone to insert the device under the skin and lead(s) are threaded through a vein to the heart, guided by X-ray images. Once in place, the device's settings are tested and adjusted to ensure proper function before the incision is closed.

What are the Risks and Benefits of the Procedure?

• Benefits:
  • Improved quality of life and decreased symptoms of arrhythmia or heart failure.
  • Reduced risk of sudden cardiac death in the case of Implantable Cardioverter Defibrillators (ICDs).
  • Enhanced ability of the heart to pump blood efficiently (in the case of Bi-Ventricular devices).
• Risks:
  • Infection at the implantation site.
  • Bleeding or bruising.
  • Damage to the heart or blood vessels from the leads.
  • Rarely, pneumothorax (collapsed lung) or device malfunction.

Preparing for Pacemakers, Implantable Cardioverter Defibrillators (ICDs) & Bi-Ventricular Devices

What to Expect During the Procedure

• The procedure for implanting a Pacemaker, Implantable Cardioverter Defibrillators (ICDs), or Bi-Ventricular device usually takes 1 to 2 hours and is performed under sedation determined by your physician.
• The physician makes a small incision near your collarbone to insert the device just under the skin and threads the leads (thin wires) through a vein to your heart, using X-ray images as a guide.
• You may feel pressure at the incision site, but you should not feel pain. Your heart's response to the device will be tested during the procedure to ensure it is working correctly.

Pre-op Instructions

• Fasting: You will likely be instructed to not eat or drink anything 8 hours prior to your procedure.
• Medications: Discuss all medications and supplements you are taking with your physician. Some may need to be adjusted or stopped before the procedure.
• Health Information: Provide your medical team with a complete list of any allergies and your medical history.

Medications to Avoid Before the Procedure

• Blood Thinner Medications: You may be asked to stop taking medications, such as blood-thinning medications a few days before the procedure to reduce the risk of bleeding. Do not stop any medications without first consulting your healthcare provider.
• Diabetic Medications: Instructions will be provided on how to adjust or stop insulin or oral hypoglycemics due to fasting.
• Other Medications: Inform your physician about all over-the-counter medications, supplements, and herbal treatments you are taking, as some may need to be paused.

What to Bring to the Surgery Center

• Identification and Medical Insurance Information: Bring a photo ID and your medical insurance card.
• List of Medications: Include all medications and supplements you are currently taking.
• Emergency Contact Information: Have the name and contact information of a family member or friend who can be reached if necessary. Please note: Someone will need to drive you home and stay with you for 24 hours after the procedure.

What to Expect After the Procedure

• After the procedure, you will be taken to a recovery area to be monitored. You might feel drowsy from the sedation.
• All patients will go home the same day unless otherwise determined by the physician.
• you will receive instructions on caring for the incision site and any restrictions on physical activity.

Post-op Instructions

• Activity Restrictions: Avoid strenuous activities and lifting heavy objects for 3 weeks after the procedure. Your physician will let you know when you can resume normal activities.
• Incision Care: Keep the incision clean and dry. Follow your physician's instructions on how to care for the wound and when you can shower.
• Device Checks: You will have follow-up appointments to check the device's function and to adjust settings if necessary.

Recovery Tips

• Rest: Ensure you get plenty of rest to help your body heal.
• Monitor for Symptoms: Pay attention to any signs of infection at the incision site, such as redness, swelling, or discharge.
• Follow-Up Care: Keep all appointments for device checks and be aware of how to use any remote monitoring equipment if provided.

When to Seek Medical Attention

• Seek immediate medical attention if you experience symptoms of infection, such as fever, increased pain, or drainage from the incision site.
• If you notice any changes in your heart rhythm or experience fainting spells, contact your healthcare provider immediately.
• If there is any change in your condition, please contact your healthcare provider immediately. In case of an emergency, call 911.

By understanding how to prepare and what to expect, you can help ensure a smoother procedure and recovery process when receiving a Pacemaker, Implantable Cardioverter Defibrillator (ICD), or Bi-Ventricular Device.