Pacemaker and Defibrillator Implants

About The Procedure

Cardiovascular disease is the number one cause of mortality not just in US but around the world. According to center for disease control the chance of getting the disease is high because of lifestyle choices. A common heart disease that affects millions of Americans is Arrhythmia. An arrhythmia is a disorder that affects the heart rate and rhythm. A condition called bradiacardia occurs if the heart is beating slowly, tachycardia if the heart is beating too fast, atrial fibrillation if the atrium is beating irregularly and fast, ventricular fibrillation if the ventricles are beating fast and irregular.

When these problems arise pacemaker and Implantable cardioverter defibrillators may be indicated by your physician to treat the problem. A pacemaker/implantable cardioverter defibrillator insertion is a minor operation done under local anesthesia to correct the problems of heart rate and rhythm.

Pacemaker

It is a small sophisticated electronic device implanted below the collar bone. It has three parts: Generator, houses the electronic computer responsible in sending signals to the heart; it contain battery and inner circuitry sealed in titanium container.

Lead is an extensible insulated wire connected from the generator into the heart; it is responsible in carrying the electric signals back and forth the heart chambers to the generator.

The pacemaker is implanted under the skin; usually the device is inserted opposite your dominant hand. Ex: if your right hand is your dominant hand the pacemaker will be placed on the left side part and vice versa to avoid dislodgement.

Modern pacemaker has different variations depending on the type of problem it will be used for. In atrial arrhythmia an atrial pacemaker will be use, the lead is place on the affected atrium taking over the function of non functional sino atrial node (SA node/Sinus node). Ventricular pacemaker whose lead wire is placed on the ventricles is used to treat ventricular arrhythmia. The lead of pacemaker can be place on either atrium or ventricles depending on which area is affected. It can also be placed on both atrium and ventricle.

Cardiac resynchronization therapy on the other hand is a type of treatment used to treat congestive heart failure in which both ventricles (lower chamber of the heart) are affected. A biventricular pacemaker is the treatment choice of doctors for patients who’s suffering from CHF, the pacemaker sent signals triggering the heart to pump more blood that is needed by the body.

Implantable cardioverter defibrillator (ICD)

Also known as automatic implantable cardioverter-defibrillator,is a small device similar to pacemaker but is slightly larger (size of a pager). It also has a generator that consists of battery, capacitor, a microchip (brain of the device) and one or more leads with electrodes. It is implanted below the collar bone to prevent sudden death from uncontrolled cardiac arrest because of abnormal hearth rhythms. Usually ICD is indicated to patients who have suffered from life threatening tachycardias such as ventricular tachycardia and ventricular fibrillation. It can also be indicated to patients who are at risk of developing the above condition. Also ICD’s are best for patients who sustained muscle damage due to prior heart attack.

About 450,000 Americans suffered from sudden cardiac arrest and is the most common cause of mortality in US each year.

ICD’s are placed in patient’s chest below the collarbone; it is a minor procedure using local anesthetics and the operation last for 2 – 3 hours. Heavy sedation can be use if doctors will test the defibrillators for proper functioning as it will deliver shock into the body. Once properly placed the leads will carry signals from the defibrillator to the heart and vice versa. The leads are responsible in monitoring heart rhythms, If it sense that there are an abnormality in the heart it delivers electric shocks (mild or strong depending on the condition) to correct the tachycardias.

ICD’s are inactive if the heart is beating normally, when there is an episode of tachycardia patient feels dizzy because of rapid heart rate as blood is not fully oxygenated from the heart when delivered in the body. The ICD will send weak electrical shocks to convert the tachycardia into a normal rhythm (cardioversion). Once shocks occur patient may feel a throb in chest but should be tolerable.

Strong Shocks (defibrillation) may be delivered by the ICD’s if patient is suffering from a condition called ventricular fibrillation. Patient may lose consciousness due to lack of blood supply in the brain, once heart rhythm is successfully restored patient may regain consciousness, if still unconscious after 30 seconds a family member or anyone near the patient should call 911 or the doctor for more complicated aid.

Modern ICD’s are now programmable by the doctors and has a built in pacemaker. It has the ability to pace both atrium and ventricles at the same time, this sophisticated device is very useful especially if one suffered from Tachycardia, instead of administering a shock this device can do rapid pacing converting the abnormal rhythm to normal.

Patient who has an ICD should bring their ICD cards with them at all times; it contains information about emergency instructions etc. In case you will have to go overseas, the card should be shown to securities in the airport as strong signals in the airport can interfere with ICD.

Outside electrical sources that can interfere with ICD Outside electrical sources that are safe Possible risks of pacemaker or ICD insertion are the following:

What to Know Before the Procedure

Your physician will explain the procedure such as what to expect and will offer you the opportunity to ask for questions. Preparation for this procedure is similar to other operations. A health assessment, blood work, x-rays, adding or changing medications to avoid excess blood loss during the operation, and pre-operative instructions on food, you will be ask to fast for 8 to 12 hours. You should notify your physician if you have some allergy to a certain medicine, latex products, anesthetic agents etc. You should also advise your doctor if you are taking in blood thinning agents or if you have history of blood disorders, your doctor will advise you to stop taking them for some time before the procedure. If you are pregnant or suspect that you are notify your physician ASAP. Advanced planning for a ride at discharge and assistance for the first day is recommended because pain and tiredness are the chief complaints during recovery.

What to Know After the Procedure

You will be taken to the recovery room to assess your vital signs for a specified period of time. You can eat or drink once you are completely awake. The incision site is painful after the procedure so pain medication may be administered as needed. Once blood pressure, pulse, heart rate, and breathing are stable you can be discharge still depending on your doctors’ assessment. After the procedure you should arrange for someone to drive you home. Everyone recovers at their own pace, so it's recommended for patients to increase their activity level gradually. Without complications, a return to work is possible after two weeks. At home, you should not do any heavy lifting in a few weeks as this may dislodge the ICD or pacemaker in your chest. Your physician will give you further instructions as to when to resume driving. If you experience any palpitations, chest pain, dizziness, foul smelling on the incision site, redness and swelling notify your doctor immediately.