Biventricular Pacemaker Implantation

What is Biventricular Pacemaker Implantation

Biventricular pacemaker implantation is a procedure to place (implant) a pacemaker into both of the lower chambers (ventricles) of the heart. A pacemaker is a small, battery-powered device that helps control the heartbeat.

If the heart beats irregularly or too slowly (bradycardia), the pacemaker will pace the heart so that it beats at a normal rate or a programmed rate. The parts of a biventricular pacemaker include:

  • The pulse generator. The pulse generator contains a small computer and a memory system that is programmed to keep the heart beating at a certain rate. The pulse generator also produces the electrical signal that triggers the heart to beat. This is implanted under the skin of the upper chest, near the collarbone.
  • Wires (leads). The leads are placed in the left and right ventricles of the heart. The leads are connected to the pulse generator. They transmit electrical pulses from the pulse generator to the heart.

This procedure may be done to treat:

  • Bradycardia.
  • Symptoms of severe heart failure, such as shortness of breath (dyspnea).
  • Loss of consciousness that happens repeatedly (syncope) because of an irregular heart rate.

Tell a health care provider about:

  • Any allergies you have.
  • All medicines you are taking, including vitamins, herbs, eye drops, creams, and over-the-counter medicines.
  • Any problems you or family members have had with anesthetic medicines.
  • Any blood disorders you have.
  • Any surgeries you have had.
  • Any medical conditions you have.
  • Whether you are pregnant or may be pregnant.

What are the risks?

Generally, this is a safe procedure. However, problems may occur, including:

  • Infection.
  • Bleeding.
  • Allergic reactions to medicines or dyes.
  • Damage to other structures or organs, such as your blood vessels, lungs, or heart.
  • Failure of the pacemaker to improve your condition.

What happens before the procedure?

  • Ask your health care provider about:
    • Changing or stopping your regular medicines. This is especially important if you are taking diabetes medicines or blood thinners.
    • Taking medicines such as aspirin and ibuprofen. These medicines can thin your blood. Do not take these medicines before your procedure if your health care provider instructs you not to.

Follow instructions from your health care provider about eating or drinking restrictions.

  • Do notuse any tobacco products for at least 24 hours before your procedure. This includes cigarettes, chewing tobacco, or e-cigarettes.
  • Ask your health care provider how your surgical site will be marked or identified.
  • You may be given antibiotic medicine to help prevent infection.
  • You may have tests, including:
    • Blood tests.
    • Chest X-rays.
  • Plan to have someone take you home after the procedure.
  • If you go home right after the procedure, plan to have someone with you for 24 hours.

What happens during the procedure?

  • To reduce your risk of infection:
    • Your health care team will wash or sanitize their hands.
    • Your skin will be washed with soap.
    • Hair may be removed from your surgical area.
  • An IV tube will be inserted into one of your veins.
  • You will be given one or more of the following:
    • A medicine to help you relax (sedative).
    • A medicine to make you fall asleep (general anesthetic).
    • A medicine that is injected into your spine to numb the area below and slightly above the injection site (spinal anesthetic).
    • A medicine that is injected into an area of your body to numb everything below the injection site (regional anesthetic).
  • An incision will be made in your upper chest, near your heart.
  • The leads will be guided into your incision, through your blood vessels, and into your ventricles. Your surgeon will use an X-ray machine (fluoroscope) to guide the leads into your heart.
  • The leads will be attached to your heart muscles and to the pulse generator.
  • The leads will be tested to make sure that they work correctly.
  • The pulse generator will be implanted under your skin, near your incision.
  • Your incision will be closed with stitches (sutures), skin glue, or adhesive tape.
  • A bandage (dressing) will be placed over your incision.

The procedure may vary among health care providers and hospitals.

What happens after the procedure?

  • Your blood pressure, heart rate, breathing rate, and blood oxygen level will be monitored often until the medicines you were given have worn off.
  • You may continue to receive fluids and medicines through an IV tube.
  • You will have some pain. Pain medicines will be available to help you.
  • You will have a chest X-ray done. This is to make sure that your pacemaker is in the right place.
  • You may have to wear compression stockings. These stockings help to prevent blood clots and reduce swelling in your legs.
  • You will be given a pacemaker identification card. This card lists the implant date, device model, and manufacturer of your pacemaker.
  • Do notdrive for 24 hours if you received a sedative.

Biventricular Pacemaker Implantation, Care After

What can I expect after the procedure?

After the procedure, it is common to have:

  • Mild pain or soreness in your chest for several days.
  • A small amount of blood or clear fluid coming from your incision.
  • A slight bump in your chest where the pulse generator was placed. You may be able to feel the generator under your skin. This is normal.

Follow these instructions at home:

Medicines

  • Take over-the-counter and prescription medicines only as told by your health care provider.
  • Do nottake any new medicines without asking your health care provider first.
  • If you were prescribed an antibiotic medicine, take it as told by your health care provider.Do notstop taking the antibiotic even if you start to feel better.

Incision care

  • Keep your incision area clean and dry.
  • Follow instructions from your health care provider about how to take care of your incision. Make sure you:
    • Wash your hands with soap and water before you change your bandage (dressing). If soap and water are not available, use hand sanitizer.
    • Change your dressing as told by your health care provider.
    • Leave stitches (sutures), skin glue, or adhesive strips in place. These skin closures may need to stay in place for 2 weeks or longer. If adhesive strip edges start to loosen and curl up, you may trim the loose edges. Do not remove adhesive strips completely unless your health care provider tells you to do that.

Check your incision area every day for signs of infection. Check for:

  • More redness, swelling, or pain.
  • More fluid or blood.
  • Warmth.
  • Pus or a bad smell.

Activity

  • Return to your normal activities as told by your health care provider. Ask your health care provider what activities are safe for you.
  • Do notlift anything that is heavier than 10 lb (4.5 kg) until your health care provider approves.
  • Do not lift your upper arms above your shoulders for at least 6 weeks or as long as told by your health care provider.
    • If you sleep with your arms above your head, wear an arm restraint while you sleep to prevent this from happening.
    • Avoid sudden movements that pull your upper arms far away from your body for at least 6 weeks.
  • Do a mild form of exercise at least once a day. As you feel better, you may exercise more.
  • Gently stretch your shoulders at least once a day to help prevent stiffness in your chest.

Electricity and Magnetic Fields

  • Avoid places and objects that have a strong electric or magnetic field. This includes:
    • Airport security checkpoints. When you are at the airport, tell officials that you have a pacemaker and show them your pacemaker identification card. Officials will check you in safely so that your pacemaker is not damaged. Do notallow magnetic wands to be waved near your pacemaker. That can make the pacemaker stop working.
    • Metal detectors. If you must pass through a metal detector, walk through it quickly.Do notstop under the detector or stand near it.
    • Power plants.
    • Large electrical generators.
    • Radiofrequency transmission towers, such as cell phone and radio towers.
  • Do notuse amateur (“ham”) radio equipment or electric (“arc”) welding torches. If you are not sure whether something is safe to use, ask your health care provider.
    • Some devices may be safe to use if you hold them at least 1 ft (0.3 m) from your pacemaker. These devices may include power tools, lawn mowers, and speakers.
  • When you talk on your cell phone, hold it to your ear that is opposite from the side that your pacemaker is on. Do notleave your cell phone in a pocket over your pacemaker.

Long-Term Care

  • Carry your pacemaker identification card with you at all times, especially when you travel.
  • Consider wearing a medical alert bracelet or necklace that explains your pacemaker and any heart conditions you have.
  • Tell all health care providers who care for you that you have a pacemaker. This may prevent you from having an MRI because of the strong magnets used during that test.
  • Have your pacemaker checked every 3–6 months or as often as told by your health care provider.

General instructions

  • Do notuse any tobacco products, such as cigarettes, chewing tobacco, or e-cigarettes. If you need help quitting, ask your health care provider.
  • Do notdrive or operate heavy machinery while taking prescription pain medicine.
  • Do not take baths, swim, or use a hot tub until your health care provider approves.
  • Follow instructions from your health care provider about eating or drinking restrictions.
  • Weigh yourself every day and write down your weight.
  • Keep all follow-up visits as told by your health care provider. This is important.

Contact a health care provider if:

  • You suddenly gain 3 lb (1.4 kg) or more in 24 hours.
  • You have swelling in your feet or legs.
  • You have an irregular heartbeat (palpitations).
  • You have more redness, swelling, or pain around your incision.
  • You have more fluid or blood coming from your incision.
  • Your incision area feels warm to the touch.
  • You have pus or a bad smell coming from your incision.

Get help right away if:

  • You have chest pain.
  • You have difficulty breathing.
  • You suddenly feel light-headed.
  • You have a fever.
  • You faint.
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