Implantable Devices: Pacemakers, Defibrillators (ICD) and CRTs
Treatment
Pacemaker Implantation
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A pacemaker is an artificial device that is implanted in the chest to regulate an abnormal heartbeat.
What is a Pacemaker and how does the implantation work?
The pacemaker consists of a battery, which can last around 8-10 years depending on how much the device is used, a pulse generator that generates the electrical impulses to stimulate the heart and leads which carry the electrical impulses to the correct chambers of the heart.
The pacemaker continually senses the heartbeat and if it senses that your heart has missed a beat or is beating too slowly, it sends signals at a steady rate to stimulate the heart. If, however the pacemaker senses that the heart is beating normally, it does not need to stimulate the heart.
Pacemakers also have a special sensor that recognizes body movement or your breathing rate and allows the device to pace the heart faster during periods of increased demand.
The implantation of a pacemaker is a relatively low risk and straightforward procedure.
The procedure is usually performed under local anesthetic and conscious sedation.
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The pacemaker leads (flexible wires) are advanced to the heart through a large vein under the collarbone and carefully positioned into the correct chambers of the heart with the aid of X-rays and firmly secured into place. The leads are then connected to the pacemaker device which is usually smaller than the size of a small matchbox, and then placed in a small pocket just under the skin.
The wound, which is usually only 3-4cm long, is carefully sutured and patients can be discharged usually the same day or the next morning. Pacemakers are checked using little special computers called programmers which communicate with the devices like a remote control via a magnet place over the pacemaker pocket or wireless and allow the doctor to adjust the device settings to optimize the performance of the pacemaker.
Most patients can return to normal activities within 3-4 weeks of the implant and will require regular ongoing follow up and pacemaker checks to ensure correct functioning of the pacemaker.
Why would you need a pacemaker?
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The most common reason for requiring a pacemaker is a slow heartbeat usually heart block which can cause symptoms of dizzy spells, blackouts, tiredness or breathlessness. Pacemakers greatly improve the quality of life of patients that have them implanted.
A slow heartbeat can arise due to a problem with the heart being able to initiate the heartbeat in the first place, or due to a failure of the top chambers of the heart to communicate with the bottom chambers (heart block) or for the electrical impulses generated to fail to conduct and pass along the heart’s own wiring system.
In some patients who have fast and uncontrollable heart beats, a pacemaker may be required in combination with medication. The experts at CardioCare are highly trained to assess all patients who may need a pacemaker and highly experienced in implanting devices to improve the quality of life of all patients.
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Risks involved
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Although implantation is straightforward, there is a low rate of risks related to the procedure including bruising at the site of the wound, infection or movement of the leads after insertion which may require a further intervention to reposition and correct this.
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Conditions to let us know about
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As with all procedures involving X-rays and contrast media, let your doctor know if you are currently pregnant or breast feeding and inform your doctor about possible allergies.
Medical conditions requiring blood thinning, bleeding disorders and a current infection should be communicated to your doctor prior to the procedure.
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Insurance coverage
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Implantation of a pacemaker is covered by most private insurance providers. We will seek authorization from your insurance company prior to your procedure.
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Preparing for your procedure
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Discuss with your doctor if you must stop any medication you are usually taking. A preventive antibiotic treatment may be needed under certain circumstances.
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The day of the procedure you must be fasting for at least 6 hours.
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Recovering from your procedure
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You will not need general anesthesia. After a quick recovery period you may go home or stay overnight, depending on your individual risk assessment.
The small incision will need dressing changes and control. Your doctor will see you for a follow-up appointment within 2-3 days after your procedure and discuss further care. Sutures will be removed 10 days later.
You will also be asked to reduce movements of the affected shoulder and arm where the pacemaker has been implanted for 4 – 6 weeks, during this time avoid activities that strain your shoulder muscles like playing Golf or pulling a Golf caddy, swinging movements like tennis, swimming etc. Do not raise your arm on the implantation side of the pacemaker above your shoulder this might pull the implanted leads out of their position, also this helps the healing and avoids hematoma and wound complications.
Treatment
Implantation Leadless Pacemakers
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The new generation of pacemakers: no strings attached.
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Micra by Medtronic or Nanostim by St. Jude/Abbott, the world's smallest pacemakers
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What is a Leadless Pacemaker and how does it work?
The leadless pacemaker is a truly small device, the size of a multivitamin capsule, which contains all the technology needed to fulfill the job of a pacemaker.
Unlike conventional pacemaker, it is not implanted under the skin, it will be introduced into the right ventricle of the heart through a venous catheter after puncture of a major vein like the groin vein.
After being detached from the catheter it will attach to the heart wall with small anchors and start pacing immediately. If ill-positioned, it can be repositioned before it grows in over time.The catheters are removed, and the venous puncture site closed with a bandage. No anesthesia or sedation needed.
The advantages are clear: No cut, no wound, no infection risk; and reduced pre-operational risks.
Once the battery runs out, we simply implant a new one. Once implanted, it will not be removed any more.
The downside is that the pacemaker remains lifelong in the heart cavity.
Although the battery life has an estimated average longevity of 12 years, it would require he implantation of multiple devices during their lifetime and therefore the implantation in younger patients may not be indicated.
Why would I need a Leadless Pacemaker?
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For the same reasons you may need a standard pacemaker. However, it is only available as mono-chamber (ventricular) chamber option. Your doctor will inform you if a leadless pacemaker is really advantageous for your individual needs.
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Risks involved
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Due to the simplicity of the procedure, the risks are less than with the implantation of conventional pacemakers. Prior to your procedure, you will discuss your individual potential risks with your doctor.
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Conditions to let us know about
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As with all procedures involving X-rays and contrast media, let your doctor know if you are currently pregnant or breast feeding and inform your doctor about possible allergies.
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Preparing for your procedure
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You must be fasting at least 6 hours prior to the procedure.
Please discuss with your doctor what medications you are taking on a regular basis. Some, like blood thinning medications and diabetes medications, may need to be paused some days prior.
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Insurance coverage
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The implantation of leadless pacemakers is covered by most private insurance providers. We will seek authorization from your insurance company prior to your procedure.
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Recovering from your procedure
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You will not receive general anesthesia or sedation. You will be transferred to the regular room until you are ready for discharge.
You will be given written post procedure discharge instructions that will advise you about return to normal physical activity.
Treatment
Defibrillator (ICD) Implantation
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An implantable cardioverter defibrillator (ICD) is a device that is implanted in the chest to discharge life-saving electric shocks when an abnormal heartbeat occurs which may bring the heart to a sudden stop, should it not be terminated.
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What is an ICD?
Catheter-directed thrombolysis and thrombectomy is a minimally invasive treatment options that use medication is used to break up the clot and aspirate it.
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The implantable defibrillator consists of a battery which can last around 8-12 years, depending on how much the device is used, a pulse generator that generates the electrical impulses to stimulate the heart, and leads which carry the electrical impulses to the correct chambers of the heart.
The ICD continually senses the heartbeat and if it detects that your heart is beating too fast or chaotically, it gives defibrillation shocks to stop the abnormal rhythm.
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Why would you need an ICD?
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The main reason for requiring an ICD is if you are at risk of a life-threatening ventricular arrhythmia, which could cause sudden cardiac death, from ventricular tachycardia (VT) or ventricular fibrillation (VF). In this case, a pacemaker alone is not sufficient as it would not provide the defibrillation shocks required when the heart beats too fast or erratically.
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How is an ICD implanted?
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The implantation of an ICD is similar to a pacemaker implantation. The procedure is usually performed under local anesthetic and conscious sedation. The ICD leads (flexible wires) are advanced to the heart through a large vein under the collarbone and carefully positioned into the correct chambers of the heart with the aid of X-rays and firmly secured into place. The leads are then connected to the pacemaker device which is usually smaller than the size of a small matchbox, and then placed in a small pocket just under the skin.
The wound, which is usually only 5cm long, is carefully sutured and patients can be discharged usually the same day. Once implanted the ICD can be checked using programmers which communicate with the devices and allow the doctor and technicians to adjust the device settings to optimize the performance of the ICD. Most patients can return to normal activities within 4 weeks of the implant and will require regular ongoing follow up and ICD checks to ensure correct functioning of the device.
Risks involved
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Although implantation of an ICD is straight forward, there is a low rate of risks related to the procedure including bruising at the site of the wound, infection or movement of the leads after insertion which may require a further intervention to reposition and correct this.
​
Conditions to let us know about
​
As with all procedures involving X-rays and contrast media, let your doctor know if you are currently pregnant or breast feeding and inform your doctor about possible allergies.
Medical conditions requiring blood thinning, bleeding disorders and a current infection should be communicated to your doctor prior to the procedure.
​
Insurance coverage
​
Implantation of a pacemaker is covered by most private insurance providers. We will seek authorization from your insurance company prior to your procedure.
​
Preparing for your procedure
​
Discuss with your doctor if you must stop any medication you are usually taking. A preventive antibiotic treatment may be needed under certain circumstances.
The day of the procedure you must be fasting for at least 6 hours.
Recovering from your procedure
​
You will not need general anesthesia. After a quick recovery period you may go home or stay overnight, depending on your individual risk assessment.
The small incision will need dressing changes and control. Your doctor will see you for a follow-up appointment within 2-3 days after your procedure and discuss further care. Sutures will be removed 10 days later.
You will also be asked to reduce movements of the affected shoulder and arm where the pacemaker has been implanted, to avoid pulling the implanted leads out of their position and to avoid unnecessary additional hematomas and wound complications.
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Cardiac Resynchronization Therapy (CRT)-Device
Treatment
Sometimes referred to as biventricular pacing, Cardiac Resynchronization Therapy (CRT) is an advanced device therapy aimed to improve the function of the heart in patients with heart failure.
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What is Cardiac Resynchronization Therapy?
Up to a third of all patients with heart failure will have discoordination (dyssynchrony) in the contraction of the heart.
One part of the heart (usually the back wall of the main pumping chamber – the left ventricle) is delayed in its contraction compared to other parts of the heart. This causes the heart to not contract in an organized and harmonious way and results in reduced efficiency.
The result is worsening breathlessness, fatigue and fluid retention leading to a poor exercise capacity and often associated with a reduction in the quality of life.
In order to overcome this dyssynchrony, a special type of a pacemaker can be implanted which not only acts as a pacemaker but also a re-synchronization device.
This involves the insertion of two leads, rather than the usual one, to the ventricles (pumping chambers of the heart) at different locations in the heart to attempt to obtain better contraction and thereby improve the function of the heart resulting in better efficiency, better exercise capacity and a better quality of life.
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CRT can be combined with an implantable cardiac defibrillator (ICD) as a single device to protect against the risk of life-threatening heart rhythms.
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How is a CRT device implanted?
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The Cardiac Resynchronization Therapy device (CRT) is implanted in a similar way to all pacemakers and ICD devices. The procedure is usually performed under local anesthetic and conscious sedation.
The pacemaker leads (flexible wires) are advanced to the heart through a large vein under the collarbone and carefully positioned into the correct chambers of the heart with the aid of X-rays and firmly secured into place. The leads are then connected to the pacemaker or defibrillator device, which is usually the size of a small matchbox, and then placed in a small pocket just under the skin.
The wound, which is usually only 5cm long is carefully sutured and patients can be discharged either the same day or after an overnight stay. Devices are checked using programmers which communicate with the new CRT system and allow the doctor and technicians to adjust the device settings to optimize the performance of the pacemakers.
Most patients can return to normal activities within 4 weeks of the implant and will require regular ongoing follow up and checks to ensure correct functioning of the devices.
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Risks involved
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Although the implantation of a CRT is straight forward, there is a low rate of risks related to the procedure including bruising at the site of the wound, infection or movement of the leads after insertion which may require a further intervention to reposition and correct this.
​
Conditions to let us know about
​
As with all procedures involving X-rays and contrast media, let your doctor know if you are currently pregnant or breast feeding and inform your doctor about possible allergies.
Medical conditions requiring blood thinning, bleeding disorders and a current infection should be communicated to your doctor prior to the procedure.
​
Insurance coverage
​
Implantation of a pacemaker is covered by most private insurance providers. We will seek authorization from your insurance company prior to your procedure.
​
Preparing for your procedure
​
Discuss with your doctor if you must stop any medication you are usually taking. A preventive antibiotic treatment may be needed under certain circumstances.
​
The day of the procedure you must be fasting for at least 6 hours.
​
Recovering from your procedure
​
You will not need general anesthesia. After a quick recovery period you may go home or stay overnight, depending on your individual risk assessment.
The small incision will need dressing changes and control. Your doctor will see you for a follow-up appointment within 2-3 days after your procedure and discuss further care. Sutures will be removed 10 days later.
You will also be asked to reduce movements of the affected shoulder and arm where the pacemaker has been implanted, to avoid pulling the implanted leads out of their position and to avoid unnecessary additional hematomas and wound complications
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