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  1. Pacemakers
  2. ICDs
  3. CRTs

Pacemakers

Pacemakers are small, battery-operated devices that help the heart beat at a normal rate. They are implanted in the chest, just under the skin, beneath the collarbone

Pacemakers are typically implanted in patients that have:

  • Slow heart rate called bradycardia.
  • Heart block which is a slowed or disrupted electrical signal through the heart.
  • Following a procedure called an AV (atrioventricular) node ablation to treat atrial fibrillation.

Types of Pacemakers implanted at Hilo Medical Center

  • Single chamber
  • Dual chamber
  • Biventricular (CRT-device)
  • Leadless

How Does it Work?

A pacemaker works by receiving and sending electrical signals to and from the heart to regulate the heart rate.

A transcutaneous pacemaker is typically implanted in the upper left chest with wires (or leads) that are connected to the pacemaker. The wires (leads) are threaded through the veins and implanted into the heart muscle. These wires send tiny electric charges (which cannot be felt) from the pacemaker to the heart as necessary. It can have one, two or three wires (leads), depending on the specific heart condition. All pacemakers have sensors that can detect motion and some can even detect breathing to increase the heart rate during exertion (e.g., exercise) to meet the body’s need for more blood and oxygen.

A leadless pacemaker is a self-contained generator and electrode system that is implanted directly into the right ventricle using a femoral vein transcatheter approach. It requires no chest incision or subcutaneous generator pocket.

It provides only single-chamber ventricular pacing and lack defibrillation capacity. It may be appropriate for patients with permanent atrial fibrillation with bradycardia, bradycardia-tachycardia syndrome, or those who infrequently require pacing. These pacemakers are inappropriate for patients who with certain forms of heart block or sinus node dysfunction that require dual chamber pacing.

What to expect

The implanting physician accesses a vein near the collarbone and thread the wires (leads) into the heart using the guidance of fluoroscopy. The wires (leads) are secured in the appropriate chambers of the heart. The wires (leads) are tested to ensure accurate placement.

A pocket is formed under the skin, above the muscle, for the generator. The wires (leads) are attached to the generator. The pocket is closed using dissolvable sutures, surgical skin glue, and steri strips.

After the procedure

The implant site will be covered with a simple dressing and should be kept clean and dry for one week.

Patients will typically have a follow up appointment one week after having the device implanted to assess the site and test the device to ensure it is functioning appropriately.

Extreme arm movements above the shoulder level and heavy lifting should be avoided for the first 4-6 weeks after device implantation.

Routine monitoring of the device is required through both in clinic testing and remote home monitoring. Monitoring consists of evaluating the device’s battery, wire (lead) functioning, pacing, and arrhythmia burden.

Implantable Cardiac Defibrillators (ICDs)

Implantable cardioverter defibrillators (ICDs) are small battery powered devices implanted in the chest. It continuously monitors for potentially life-threatening heartbeats that occur in the heart’s lower chambers, or ventricles.

ICDs are typically implanted in patients who have:

  • A weakened heart due to a history of heart blockages and/or heart attacks,
  • Those with heart muscle tissue that is enlarged or thickened.
  • Have an inherited heart defect that makes their heart beat abnormally.

Types of ICDs implanted at Hilo Medical Center

  • Single chamber
  • Dual chamber
  • Biventricular (CRT-device)

How Does an ICD Work?

When an ICD detects a dangerously fast heart rhythm, it will deliver ATP (anti tachycardia pacing) or an electrical shock to stop the fast rhythm. Most ICDs can also act as pacemakers and keep the heart from going to slow. An ICD does not prevent heart attacks. The device is typically implanted in the upper left chest with a wire (or lead) that are connected to the ICD. The wires (leads) are threaded through the veins and implanted into the heart muscle.

What to expect

The implanting physician accesses a vein near the collarbone and thread the wires (leads) into the heart using the guidance of fluoroscopy. The wires (leads) are secured in the appropriate chambers of the heart. The wires (leads) are tested to ensure accurate placement.

A pocket is formed under the skin, above the muscle, for the generator. The wires (leads) are attached to the generator. The pocket is closed using dissolvable sutures, surgical skin glue, and steri strips.

After the procedure

The implant site will be covered with a simple dressing and should be kept clean and dry for one week.

Patients will typically have a follow up appointment one week after having the device implanted to assess the site and test the device to ensure it is functioning appropriately.

Extreme arm movements above the shoulder level and heavy lifting should be avoided for the first 4-6 weeks after device implantation.

Routine monitoring of the device is required through both in clinic testing and remote home monitoring. Monitoring consists of evaluating the device’s battery, wire (lead) functioning, pacing, and arrhythmia burden.

What to Do if You are Shocked

If you believe you have shocked by your device and feel otherwise well, call the physician’s office for instructions on what to do.

If you have received a shock and feel unwell or receive more that one shock in a 24-hour period, call 911. This can indicate a persistent abnormal heart rhythm or device malfunction.

Cardiac Resynchronization Therapy (CRT)

Cardiac resynchronization therapy (CRT), also called biventricular pacing, is used to treat advanced heart failure. Patients who use CRT usually enjoy improved life quality, improved ability to exercise and fewer hospitalizations for heart failure.

CRT device are typically implanted to assist with:

  • Increase the pumping function of the heart
  • Improve heart failure symptoms such as shortness of breath and fatigue.
  • Reduce mortality in certain heart failure patients.

How does it work?

To “resynchronize” contractions and improve the pumping efficiency of the heart, CRT device uses three leads, one each going into the right atria, right ventricle and left ventricle. This device sends small electrical impulses to the heart to help the right and left ventricles pump together more normally.

There are two types of CRT devices: one that functions a pacemaker and one that functions a defibrillator. Biventricular devices can improve symptoms of heart failure in about two-thirds of patients who remain symptomatic while taking medication for heart failure.

What to expect

The implanting physician accesses a vein near the collarbone and thread the wires (leads) into the heart using the guidance of fluoroscopy. The wires (leads) are secured in the appropriate chambers of the heart. The wires (leads) are tested to ensure accurate placement.

A pocket is formed under the skin, above the muscle, for the generator. The wires (leads) are attached to the generator. The pocket is closed using dissolvable sutures, surgical skin glue, and steri strips.

After the procedure

The implant site will be covered with a simple dressing and should be kept clean and dry for one week.

Patients will typically have a follow up appointment one week after having the device implanted to assess the site and test the device to ensure it is functioning appropriately.

Extreme arm movements above the shoulder level and heavy lifting should be avoided for the first 4-6 weeks after device implantation.

Routine monitoring of the device is required through both in clinic testing and remote home monitoring. Monitoring consists of evaluating the device’s battery, wire (lead) functioning, pacing, and arrhythmia burden.