Information before an ICD or Pacemaker

May 22, 2018

 

Thank you for trusting us with your heart!

 

 

Pacemakers are small devices that are used to speed up the heart.  They act like timers that watch for a heartbeat, and if they don’t detect about one every second, they will make the heart beat by delivering a small, undetectable amount of electricity.  

 

ICDs (“defibrillators”) work in the same way as pacemakers.  In addition, they can also deliver a larger amount of electricity when the heart goes into a dangerous rhythm.  They are an insurance policy against heart rhythm problems that often kill people with weakened hearts, or congestive heart failure.  

 

Bi-ventricular ICDs (“Bi-v ICDs”) are a special type of defibrillator with three wires.  These are used to make very weak hearts beat more efficiently.  

 

Before your procedure:

 

Think about which side of the chest you would like used for the device implantation.  The arm on that side will be limited for 2 months after the procedure.  If you shoot a rifle, make sure it is placed on the non-shooting arm.   

If you have an infection, make sure your doctor knows - your procedure may be postponed for your safety.  

If you take a blood thinner (Warfarin/coumadin, Eliquis, Xarelto, Pradaxa), this should be held briefly before the procedure.  It will be restarted shortly afterwards.  Aspirin, Plavix, or Brilinta do not need to be stopped. 

 

If you use a CPAP machine at night, make sure you bring it with you.

 

The day of the procedure:

 

Don’t eat or drink anything after midnight the night before you procedure unless otherwise instructed.  

 

We ask that you arrive to the pre-operative area a few hours before your procedure so that we can fully prepare you for the procedure.  The room where the implant takes place is also used for other heart emergencies, so there may be unforeseen delays.  We greatly apologize for any delays.  

 

Your pre-operative nurse will place an IV in your arm on the same side to where the device will be placed and wash your chest with special soap to help prevent infection.  

 

What to expect during the implantation:

 

The procedure generally takes about an hour from start to finish, but may take longer.  It is performed under light sedation - this means you will be awake but kept comfortable and may fall asleep.  There will be blue sterile drapes in front of your face, but we try to keep them a few inches away.  

 

The worst part of the procedure is numbing the skin with lidocaine.  This will feel like a bee-sting.  After this, there should be little to no pain. 

 

We always have a nurse dedicated to your needs - whether it is an itchy nose or something more serious.  Please don’t hesitate to tell us what you need.  We want you to be comfortable during the whole process.  

 

 

After the procedure:

 

You will be our guest overnight.  We do this so that we can check the device one more time the following morning to make sure everything is working perfectly before you go home.  If there are any problems, they usually occur within the first 24 hours and can be corrected the next morning. You will have pain medications available if needed, but usually the discomfort can be treated with tylenol or advil and an ice pack.   A team member from either Boston Scientific or Medtronic, the device manufacturers, will meet you the next morning to check the device wirelessly.  They will also provide you with a home monitor and tell you how to use it.  We will also check a chest X-ray before you leave the hospital.  

 

You will be given specific printed instructions about caring for the device and the incision before going home.  

 

If you have any questions, please feel free to call!

 

 

Thanks for choosing us for your care.

 

 

Kevin R. Hayes, MD

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