Pacemakers and implantable cardioverter defibrillators (ICDs) are heart devices. They are surgically placed in people. Pacemakers are used to treat slow heart rhythms. ICDs stop dangerous, fast heart rhythms.
These devices have two main parts: a pulse generator and a set of wires (leads).
The pulse generator is a small metal box. It contains electric circuits and a battery. During the first placement of your heart device, your doctor put this generator under your skin or the muscles of your chest wall. In rare cases, these are placed in a pocket in your abdomen. Normally, these generators are powered by lithium batteries. They work for 5 to 10 years before they need to be replaced. To replace the pulse generator, you will need an implantable device replacement procedure.
The leads are wires that run between the pulse generator and your heart. These leads can give a burst of energy. This energy can cause your heart to beat more quickly (in a pacemaker) or it can stop fast heart rhythms (in an ICD). To do this, the leads must make contact with your heart. Most leads travel through a vein to attach to the right side of your heart. They are often attached to the heart with a small screw or hook.
Replacing the pulse generator is a simple surgery. But your surgeon won’t have to enter your chest cavity itself.
Your old generator will be disconnected from your leads. Then it will be taken out. Then your surgeon will put a new generator in the same pocket and connect it to the leads that are in place. At that point, your new ICD or pacemaker can work just as before.
In rare cases, you may need to have the leads removed along with or instead of generator replacement. This is a more complex procedure.
Most generators need to be replaced 5 to 15 years after they are inserted. This is because their batteries run out over time. Your healthcare provider can check the battery and functioning of your device. Most of the time, these devices give plenty of warning that they are nearing the end of their battery life. You often have a few months to schedule your replacement procedure.
Sometimes, you need to replace your generator before the battery life ends. This may happen if:
- Your generator starts to malfunction or stops working.
- You have an infection at the site of the generator, and you need more than antibiotics to clear it up.
It’s important for your pacemaker or ICD to work well. The pacemaker can keep your heart from beating too slowly. ICDs can stop the kind of dangerous heart rhythms that can lead to sudden death. You may need an ICD if you had a sudden cardiac arrest, heart failure, or heart rhythm problems.
This procedure if very safe, but it comes with some rare risks. These include:
- Heavy bleeding
- Allergic reaction to anesthesia
There is also a small risk that you will also need your leads replaced. This requires a more complex surgery. In most cases, your surgeon will know ahead of time if you will need this.
Your risks may differ depending on your age, health issues, and where your generator was originally placed. Ask your healthcare provider about your outlook before your surgery.
Your healthcare provider may tell you not to eat or drink anything before midnight of the day of your procedure. Follow your healthcare provider’s orders about what medicines to take. Don’t stop taking any medicine unless your healthcare provider tells you to do so. Arrange for someone to drive you home after the procedure.
Your healthcare provider may do some tests before your procedure. These may include an electrocardiogram (ECG). This test is done to check your heart rhythm. Or you may need an echocardiogram. This test checks how blood is moving through your heart.
Just before the procedure, someone may shave your skin above the area where you will have the incision. Someone will also start an IV (intravenous) line. This is done so you can get medicine during the surgery.
The procedure may take a few hours. In general you can expect the following:
- Medical staff will start a medicine through an IV line. This will make you feel sleepy and relaxed.
- Medical staff will closely watch your heart rate, blood pressure, and other vital signs.
- After cleaning the area, the healthcare provider injects medicine to numb the skin over your generator. This will keep you from feeling pain as the device is replaced.
- The surgeon makes a cut into the pocket of skin and tissue surrounding the generator. This will be just below your collarbone or somewhere in the soft tissue of your abdomen. This cut will not enter your chest or belly (abdominal) cavity.
- The surgeon disconnects your old generator from its leads. Then he or she takes it out of your body.
- The surgeon puts your new generator in the same pocket where the old generator was. He or she attaches it to your old leads.
- Medical staff will check that the new device is signaling the right way.
- The surgeon will close up the pocket and the small incision in your skin. You will need bandages.
Your healthcare provider will monitor you after the procedure. You may not remember much of the procedure. In most cases, you can go home after a couple of hours.
Try to take it easy the rest of the day. Make sure someone is around to help you. You can eat your normal diet as soon as you are able to. You may have some minor pain after the procedure. Ask your healthcare provider if you can take over-the-counter (OTC) medicines.
Your healthcare provider will tell you how the procedure went. Be sure to follow all of your healthcare provider’s instructions. You will need to care for your wound. You may also need to take antibiotics for a few days after the procedure.
Tell your healthcare provider right away if you have heavy bleeding from your incision, a fever, or other severe symptoms. You will likely have a checkup a week or so after your surgery. Your healthcare provider will monitor your ICD or pacemaker regularly, just like he or she did before the procedure.
Before you agree to the test or the procedure make sure you know:
- The name of the test or procedure
- The reason you are having the test or procedure
- What results to expect and what they mean
- The risks and benefits of the test or procedure
- What the possible side effects or complications are
- When and where you are to have the test or procedure
- Who will do the test or procedure and what that person’s qualifications are
- What would happen if you did not have the test or procedure
- Any alternative tests or procedures to think about
- When and how will you get the results
Who to call after the test or procedure if you have questions or problems
- How much will you have to pay for the test or procedure
May 23, 2018
Buch E, Boyle NG, Belott PH. Pacemaker and defibrillator lead extraction. Circulation. 2011;123(11):e378-e380., Knight BP. Patient information: implantable cardioverter-defibrillators (beyond the basics). UpToDate. http://www.uptodate.com/contents/implantable-cardioverter-defibrillators-beyond-the-basics, Olshansky B, Hayes DL. Patient information: pacemakers (beyond the basics). UpToDate. http://www.uptodate.com/contents/pacemakers-beyond-the-basics
Sudheendra, Deepak, MD,Sather, Rita, RN