Pacemakers, Defibrillators & Bi-Ventriculars

####1. What are Pacemakers, Defibrillators & Bi-Ventriculars? 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.
• Defibrillators 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 local anesthesia and mild sedation. 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 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, Defibrillators & Bi-Ventricular Devices

What to Expect During the Procedure

• The procedure for implanting a pacemaker, defibrillator, or bi-ventricular device usually takes 1 to 2 hours and is performed under local anesthesia with sedation. You will be awake but relaxed, and the area where the device is to be implanted will be numbed.
• The doctor 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 shouldn't feel pain. Your heart's response to the device will be tested during the procedure to ensure it's working correctly.

Pre-op Instructions

• Fasting: You'll likely be instructed to not eat or drink anything after midnight before your procedure.
• Medications: Discuss all medications and supplements you're taking with your doctor. 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

• You may be asked to stop taking certain medications, such as blood thinners, a few days before the procedure to reduce the risk of bleeding. Do not stop any medication without first consulting your healthcare provider.

What to Bring to the Surgery Center

• Identification and Insurance Information: Bring a photo ID and your insurance card.
• List of Medications: Include all medications and supplements you are currently taking.
• Emergency Contact: Have the name and contact information of a family member or friend who can be reached if necessary.

What to Expect After the Procedure

• After the procedure, you'll be taken to a recovery area to be monitored. You might feel drowsy from the sedation.
• Most patients can go home the same day, but occasionally, an overnight stay is required for monitoring.
• You'll 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 about 4 to 6 weeks after the procedure. Your doctor will let you know when you can resume normal activities.
• Incision Care: Keep the incision clean and dry. Follow your doctor's instructions on how to care for the wound and when you can shower.
• Device Checks: You'll 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, fainting spells, or if the device gives you a shock, contact your healthcare provider immediately.

By understanding how to prepare and what to expect, you can help ensure a smoother procedure and recovery process when receiving a pacemaker, defibrillator, or bi-ventricular device.