Pacemakers

If your heart beats too slowly, a pacemaker may help restore your rhythm. This small device sends gentle electrical signals to keep your heart beating at a steady pace. It can prevent fainting, reduce dizziness, fatigue, or shortness of breath caused by slow or missed heartbeats.

At WMCHealth, you’ll find advanced pacemaker care close to home. Our experienced electrophysiology team specializes in placing and managing the full range of pacemaker devices, including the latest leadless and MRI conditional options. We provide ongoing support through in-person visits and remote monitoring to ensure your device continues to meet your needs. Current remote monitoring technology has not only maximized patient convenience but has also improved patient care by reducing hospitalizations and increasing longevity.

For some patients, a leadless pacemaker may be more appropriate. These small “bullet-shaped” devices are placed directly into the heart via a catheter which is usually placed through a vein from the leg.

How Is a Pacemaker Different from a Defibrillator?

A pacemaker helps manage slow heartbeats by sending steady signals to keep your heart rhythm on track. An implantable cardioverter defibrillator (ICD) monitors for dangerously fast heart rhythms and can deliver a shock to stop the dangerous rhythm, thus restoring e a normal heartbeat. Most ICDs have the ability to function as a pacemaker if needed.

In some cases, if you need help with both slow and fast rhythms, your care team may recommend an ICD with an additional lead; these involve the implantation of a cardiac resynchronization therapy defibrillator (CRT-D). A more recent alternative involves placement of a pacing lead nearby or directly into the normal “wiring” (conduction system) of the heart; a method called “conduction system pacing”. These devices help coordinate your heartbeat to optimize the efficiency of the squeezing of the heart and can also deliver a life-saving shock if needed—especially if you have certain types of heart failure.

There is also another option for ICD implantation, especially for those patients with increased risk of infection or with limited venous access from the chest/arms. This involves placement of a subcutaneous ICD (SICD). This device has a generator which is implanted on the left side of your body (a few inches below the armpit) with a lead that is placed in the subcutaneous tissue in the chest wall, avoiding placement of a lead in the venous system.

For several reasons including bacterial infection in the blood, device pocket infection, lead malfunction, your doctor may recommend that your pacemaker or ICD system, including the leads, be removed. Depending on how long the leads have been in place, different tools may be required to extract them. These tools include laser sheaths as well as mechanical tools.

What to Know About Your Pacemaker Procedure

Here’s what to expect before, during, and after your pacemaker or ICD is implanted.

How to Prepare

Your care team will provide specific instructions, such as:

Do not eat or drink for eight hours before your procedure.
Tell your care team about all medications you take, especially blood thinners.
You may need to discontinue some medications for several days prior to the procedure.
Plan for someone to drive you home.
Wear comfortable, loose-fitting clothing.

What to Expect During the Procedure

One of our cardiac electrophysiologists will perform your procedure in a specialized lab:

You’ll receive local anesthesia and moderate~~light~~ sedation to help you stay comfortable.
A small cut is made near your collarbone.
Your electrophysiologist will guide one or more leads through a vein into your heart.
Your pacemaker or ICD is placed under your skin and attached to the leads.
Your electrophysiologist tests the device to make sure it’s working properly before the incision is closed.
Please note that leadless pacemakers and SICDs require different incisions and approaches.

Your procedure will likely last one to two hours.

What to Expect After

Immediately following your procedure, you’ll be monitored for a few hours. Any mild pain, swelling, or bruising you experience at the site of your incision is normal.

When you return home and to your routine, avoid lifting heavy items or raising your arm on that side for a few weeks. You can expect follow-up visits with your electrophysiologist’s team to check your device settings. Remote monitoring is used to track your device between appointments.