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Pacemaker implantation is the insertion of a small electronic device that is placed to help regulate electrical problems in the heart. A pacemaker may be recommended to ensure that the heartbeat maintains a healthy rate and does not fall below a certain number that could be considered dangerous or life-threatening. Pacemakers treat low heart rate problems (bradycardia) but not high heart rate problems (tachycardia). There are 2 main types of pacemakers, a traditional pacemaker with leads and a smaller or “leadless” pacemaker.  The physicians at Cardiovascular ASC, LLC are well-versed in all types of pacemaker implantations.

Why Pacemaker Implantation is Performed

A traditional pacemaker with leads is a small device that’s placed under the skin of your chest or abdomen to help control abnormal heart rhythms. This device uses electrical pulses to prompt the heart to beat at a normal rate. Pacemakers are used to treat heart rhythms that are too slow. These abnormal heart rhythms are called bradycardias.

About Pacemakers

Pacemakers can relieve some symptoms related to bradycardia, such as fatigue (tiredness) and fainting. A pacemaker can help a person who has an abnormal heart rhythm resume a more active lifestyle.

A pacemaker has two parts:

• Pulse Generator: A small metal container that houses a battery and the electrical circuitry that controls the rate of electrical pulses sent to the heart.
• Leads or Electrodes: One, two, or three flexible, insulated wires are each placed in one or more chambers of the heart and deliver the electrical pulses to adjust the heart rate
  •  Some newer pacemakers don’t require leads. These devices are called Leadless Pacemakers.

Types of Pacemakers

There are different types of pacemakers used to treat different types of arrhythmias. 

• Single Chamber Pacemaker: Carries electrical impulses to the right ventricle of your heart.
• Dual-chamber pacemaker: Carries electrical impulses to the right ventricle and the right atrium of your heart to help control the timing of contractions between the two chambers.
• Biventricular Pacemaker: Stimulates both of the lower heart chambers (the right and left ventricles) to make the heart beat more efficiently.
• Leadless Pacemaker: A self-contained device that is inserted directly into the muscle of the right ventricle of the heart. Used for patients with bradycardia who only need pacing on 1 of the heart chambers, or who will only require pacing on rare, intermittent occasions.

What to Expect

Pacemaker implantation typically takes 1-2 hours although you can expect to be under observation in recovery for 3-4 hours after the procedure. 

Before the Procedure

After checking in to the Cardiovascular ASC, you will be taken to a patient room where a specialist will insert an IV to administer a sedative. The amount of sedation needed for the procedure depends on your specific health conditions. You may be being fully awake or lightly sedated (conscious sedation).

During the Procedure

If a pacemaker with leads is being implanted, the leads are inserted into a major vein under or near your collarbone and guided to your heart with the help of X-ray images. One end of each wire is attached to the appropriate position in your heart. The other end is attached to the pulse generator, which is usually implanted under the skin beneath your collarbone.

A leadless pacemaker is smaller and typically requires less invasive surgery to implant the device. The pulse generator and other pacemaker parts are contained in a single capsule. The doctor inserts a catheter into a vein in the groin and then guides the pacemaker through the catheter to the proper position in the heart.

After the Procedure

After the pacemaker implantation, the device will be programmed to fit your heart rhythm needs. You’ll need to have someone drive you home from the ASC after the procedure.

Aftercare and Recovery

Follow the aftercare and recovery instructions provided by your doctor.  You may need to avoid vigorous exercise or heavy lifting for about a month. Avoid putting pressure on the area where the pacemaker was implanted. The side that the pacemaker is implanted on should not be raised significantly for 4 weeks. You will be discharged home with written specific instructions post-procedure. If you have pain in the area of insertion, consult your doctor about what kind of medication you can take to manage the discomfort. 

If at any point after pacemaker implantation you gain weight, your legs or ankles swell, or if you faint or get dizzy, contact your doctor as soon as possible.

Pacemaker Checks

After a pacemaker insertion, regularly scheduled appointments will be made to ensure that the wound is healing well and that the pacemaker is functioning properly. A complete pacemaker check should be done six weeks after your pacemaker is implanted.  This check is very important because adjustments will be made that can prolong the life of your pacemaker. Sometimes this check is done remotely from your home using a remote transmitter that the pacemaker company will provide without the need for you to visit the office. Other times the pacemaker needs to be check in the office by a technician.  After that, your pacemaker should be checked every six to twelve months to evaluate battery function.

Your pacemaker’s battery should last 7 to 15 years. When the battery stops working, you’ll need pacemaker exchange [link to pacemaker exchange page] surgery to replace it. The procedure to change your pacemaker’s battery is often quicker and requires less recovery time than the procedure to implant your pacemaker. Like with any type of technology there is always a very small but real chance of device or lead malfunction in the future which may lead to either device change or revision. 

Contact ASC, LLC

At Cardiovascular ASC, LLC our board-certified cardiologists and electrophysiologists utilize advanced technologies to deliver the highest quality care in a cost-effective setting. Call Cardiovascular ASC, LLC at 727-449-9891 to learn more about our facility and the services we provide.

If you’ve had a pacemaker implanted the battery in your device should last 7 to 15 years depending on how often your heart requires pacing and the different features being used to properly pace your heart(each patient is different). Your doctor will check the battery in the pulse generator regularly to monitor it. When the battery starts depleting it will trigger an Elective Replacement Indicator (ERI) which will indicate that you’ll need pacemaker generator exchange surgery to replace it. 

What to Expect

The procedure to change your pacemaker’s battery is often quicker and requires less recovery time than the procedure to implant your pacemaker.

Before the Procedure

Your physician or a member of their team will tell you how to prepare for the procedure. You may need to stop eating or drinking anything after midnight on the day of your procedure. Arrange for someone to drive you home and stay with you after the procedure.

During the Procedure

You may be given IV sedation to make you feel calm and relaxed during the pacemaker generator exchange procedure. You may also be given local anesthesia to numb the procedure area. With local anesthesia, you may still feel pressure or pushing, but you should not feel pain.

The cardiologist will make an incision in your chest, unplug the leads from the generator and inspect them for damage. Then the physician will connect the leads to the new generator. The new generator will be inserted through the incision originally made. The incision will be closed with stitches, medical glue, or medical tape and bandaged. The procedure usually takes about 30-60 minutes, but expect to be under observation in recovery for 2-3 hours after the procedure.

After the Procedure

After the pacemaker generator exchange, your heartbeat will be monitored. They will also check your pacemaker with a machine to make sure it is working correctly. Follow the recovery and aftercare instructions provided by your doctor on resting and how to care for your incision. You may have bruising or pain near your incision, but those should resolve within a few days of the procedure.

Contact ASC, LLC

At Cardiovascular ASC, LLC our board-certified cardiologists and electrophysiologists utilize advanced technologies to deliver the highest quality care in a cost-effective setting. Call Cardiovascular ASC, LLC at 727-449-9891 to learn more about our facility and the services we provide.

An implantable cardiac defibrillator (ICD) is a small battery-powered device that is placed under the skin of your chest to monitor and treat potentially lethal arrhythmias. An ICD detects abnormal heart rhythms from the lower chambers of the heart and delivers an electric shock or pulse to restore a normal heartbeat.

Why Implantable Cardiac Defibrillator Implantation is Performed

An ICD is designed to prevent an at-risk person from dying suddenly from a dangerous heart rhythm. It constantly monitors the heart for abnormal beats. When it senses a dangerous heart rhythm, an ICD gives the heart an electrical shock. It does this to get the heart to beat normally.

Implantable cardiac defibrillators may be recommended for patients who have: 

• Had a ventricular arrhythmia
• Survived a sudden cardiac arrest
• A history of coronary artery disease and heart attack that has weakened the heart
• An enlarged heart muscle
• A genetic heart condition that increases the risk of dangerously fast heart rhythms
• Other rare conditions that may affect the heartbeat

About ICDs

An implantable cardioverter-defibrillator is a small device that’s placed in your chest or abdomen. You will most commonly hear it referred to as an ICD or defibrillator. The ICD is attached to the heart by thin wires and uses electrical pulses or shocks to help control irregular heartbeats. 

Also known as ventricular arrhythmias, these irregular heartbeats can be potentially life-threatening. This is especially true of arrhythmias that could cause the heart to suddenly stop beating, leading to sudden cardiac arrest.

An ICD is made up of several parts:

• Pulse Generator: Contains a battery and electrical circuits that read the electrical activity of your heart. The pulse generator of an ICD is about the size of a stopwatch.
• Electrodes: Wires, also called leads, that go through your veins to the heart. The leads connect the device to the heart. An ICD may have 1, 2, or 3 electrodes.
• Pacemaker: All traditional ICDs (see below) have a pacemaker built into the device, however, they are not always programmed to pace the heart. They can do so in patients that also require it.

Types of ICDs

• Traditional ICD: Implanted in the chest with wires (called leads) that travel through a vein into the heart where they are attached.
• Subcutaneous ICD (S-ICD): Implanted under the skin at the side of the chest below the armpit. It’s attached to an electrode that runs along the breastbone (outside of the veins). An S-ICD is larger than a traditional ICD but doesn’t attach to your heart. This type of ICD does not have a pacemaker function and therefore is not indicated for patients that require intermittent pacing.

What to Expect During ICD Implantation

Cardiac defibrillator implantation typically takes 1-2 hours, followed by a few hours of recovery at the ambulatory surgical center. You’ll need to have someone drive you home from the ASC after the procedure.

Before the Procedure

After checking in to the Cardiovascular ASC, you will be taken to a patient room where a specialist will insert an IV to administer a sedative. The amount of sedation needed for the procedure depends on your specific health conditions. You may be being fully awake or lightly sedated (conscious sedation). Your electrophysiologist most often will insert your ICD when you are awake but comfortable.

During the Procedure

The area of your chest wall below your collarbone will be numbed with local anesthesia, so you will not feel pain. The electrophysiologist will make an incision through your skin and create space under your skin and muscle for the ICD pulse generator. In most cases, this space is made near your left shoulder. However, it can also be done on the right shoulder area if needed.

Your electrophysiologist will place the electrode into a vein, then into your heart. This is done using a special x-ray to see inside your chest. Then the electrophysiologist will connect the electrodes to the pulse generator.

After the Procedure

You will be taken to a recovery room for observation for several hours. Your vital signs will be monitored during this time. You’ll need to have someone drive you home from the ASC after the procedure.

You may need to wear a sling for a day or so following the procedure. Follow the aftercare and recovery instructions provided by your doctor. If at any point after ICD implantation your legs or ankles swell, or if you faint or get dizzy, contact your doctor as soon as possible.

Learn More from ASC, LLC

At Cardiovascular ASC, LLC our board-certified cardiologists and electrophysiologists utilize advanced technologies to deliver the highest quality care in a cost-effective setting. Call Cardiovascular ASC, LLC at 727-449-9891 to learn more about our facility and the services we provide.

Implantable cardiac defibrillators (ICDs) are small battery-powered devices that are placed under the skin of your chest to monitor and treat potentially lethal arrhythmias. The ICD has a pulse generator containing the battery that powers the device. After the initial ICD implantation, the generator and battery will have to be replaced during an ICD generator exchange.

Why ICD Generator Exchange is Performed

The battery in the ICD will last for several years before it needs to be replaced. Your cardiologist will monitor your ICD and let you know when it is time for the battery to be changed. When that happens, you will be scheduled for an ICD generator exchange procedure.

What to Expect

Implantable cardiac defibrillator generator exchange surgery is a relatively simple procedure. The doctor won’t have to enter your chest cavity to change the battery/generator.

Before the Procedure

After checking in to the Cardiovascular ASC, you will be taken to a patient room where a specialist will insert an IV to administer a sedative. The amount of sedation needed for the procedure depends on your specific health conditions. You may be being fully awake or lightly sedated (conscious sedation).

During the Procedure

Your electrophysiologist will make a cut into the pocket of skin and tissue surrounding the generator. The old generator will be disconnected from the ICDs leads. Then it will be removed. Your electrophysiologist will then put a new generator in the same pocket and connect it to the leads that are in place. At that point, your ICD will work just as before.

In rare cases, you may need to have the leads removed or replaced along with or instead of generator replacement. This is a more complex procedure.

After the Procedure

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. You’ll need to have someone drive you home from the ASC after the procedure.

 

Be sure to follow all of your doctor’s aftercare instructions. Tell your healthcare provider right away if you have heavy bleeding from your incision, a fever, or other severe symptoms.

Contact ASC, LLC

At Cardiovascular ASC, LLC our board-certified cardiologists and electrophysiologists utilize advanced technologies to deliver the highest quality care in a cost-effective setting. Call Cardiovascular ASC, LLC at 727-449-9891 to learn more about our facility and the services we provide.

An implantable loop recorder (ILR) is a very small heart-monitoring device that monitors your heart rhythm continuously and records abnormal events. Its battery may last for up to three years. It records the electrical signals of your heart and allows remote monitoring using a small device that is inserted just beneath the skin of the chest. 

Why Implantable Loop Recorders are Used

This device may be used for patients who suffered from a stroke with an unknown cause. The blockage of an artery in the brain by a clot (thrombosis) is the most common cause of a stroke. Heart arrhythmias are the leading cause of thrombosis leading to stroke.

Unfortunately, some patients may have silent, or asymptomatic arrhythmias that occur infrequently and are otherwise extremely difficult to diagnose using other diagnostic procedures. Infrequent and asymptomatic arrhythmias can still lead to a stroke, so detection is important to treat and prevent future strokes.

Some patients may experience occasional fainting spells that are secondary to bradycardias or tachycardias. These abnormal heart rhythms may also be infrequent short-lasting but they may be enough to lead to loss of consciousness. These patients may also benefit from prolonged monitoring using an ILR.

About ILRs

The ILR is placed just under the skin of your chest during minor surgery and can capture information that a standard electrocardiogram (ECG) or Holter monitor may miss, particularly arrhythmias that are infrequent.

What to Expect

Getting an implantable loop recorder inserted is a minimally invasive procedure. The implantation generally takes less than 10 minutes to perform, but you can expect the process to last several hours because it takes time to prepare for the implantation and you will be monitored afterward.

Before the Procedure

After checking in to the Cardiovascular ASC, you will be taken to a patient room where you will be prepped for the procedure. The left upper chest area will be cleaned and draped in a sterile fashion.

During the Procedure

During the procedure, your doctor numbs the skin over your chest and makes a tiny incision, inserts the implantable loop recorder, and closes the incision with sterile pieces of medical tape. No sutures are required. 

After the Procedure

Your healthcare provider will monitor you after the procedure, but you will go home the same day. In most cases, patients are discharged within 60 minutes after implant. You’ll need to have someone drive you home from the ASC after the procedure.

 

Be sure to follow all of your doctor’s aftercare instructions. Tell your healthcare provider right away if you have heavy bleeding from your incision, a fever, or other severe symptoms. The implantable loop recorder stays in place for up to three years.

Contact ASC, LLC

At Cardiovascular ASC, LLC our board-certified cardiologists and electrophysiologists utilize advanced technologies to deliver the highest quality care in a cost-effective setting. Call Cardiovascular ASC, LLC at 727-449-9891 to learn more about our facility and the services we provide.

 

ILR explant procedures are performed to remove an implantable loop recorder (ILR) that was previously implanted. The ILR may need to be removed for several reasons.

Why ILR Explant is Performed

An ILR explant is necessary when the ILR is no longer needed or when the battery in the device is depleted. A patient may no longer need an ILR if the cause of their symptoms has been diagnosed. If there is a cardiac cause of the patient’s symptoms, then the ILR can be removed while the cardiologist prescribes the proper treatment. If the cause is a non-cardiac condition, then treatment can be given by the appropriate healthcare provider (or team of providers). Some patients opt not to have the ILR removed. The decision to remove it is made between the patient and their primary cardiologist.

What to Expect

Having an ILR explant is a minimally invasive procedure. The implantation generally takes less than an hour to perform, but you can expect the process to last several hours because it takes time to prepare for the implantation and you will be monitored afterward.

Before the Procedure

After checking in to the Cardiovascular ASC, you will be taken to a patient room where a specialist will insert an IV. Sedation is usually not required for this procedure. Local anesthesia is used similar to implant. You will be fully awake.

During the Procedure

During the procedure, your doctor numbs the skin over your chest and makes a tiny incision in the skin and tissue of the pocket containing the implantable loop recorder. The doctor removes the ILR and closes the incision with sterile pieces of medical tape. Occasionally a single self-absorbable suture  (stitch) is required. 

After the Procedure

Your healthcare provider will monitor you after the procedure. In most cases, you can go home within an hour. You’ll need to have someone drive you home from the ASC after the procedure.

Be sure to follow all of your doctor’s aftercare instructions. Tell your healthcare provider right away if you have heavy bleeding from your incision, a fever, or other severe symptoms.

Learn More from ASC, LLC

At Cardiovascular ASC, LLC our board-certified cardiologists and electrophysiologists utilize advanced technologies to deliver the highest quality care in a cost-effective setting. Call Cardiovascular ASC, LLC at 727-449-9891 to learn more about our facility and the services we provide.