Pacemaker and Defibrillator Insertion

Pacemakers (including biventricular pacemakers) and most AICDs involve a pulse generator (or computer) that sits under the skin in the upper chest. 

The pulse generator is connected to between one and three ‘leads’ (insulated wires) that travel from the generator through the veins of the upper chest into the heart. 

The wires allow for the generator to monitor your heart rhythm as well as pacing the heart if the generator detects a loss of native heart rhythm. Biventricular pacemakers are designed to take over the rhythm of your heart to improve its function.

In addition, AICDs can deliver a shock to recalibrate the heart if it is beating dangerously fast. 

Why do I need a pacemaker or AICD?

• Pacemakers are used to treat problems relating to a slow heartbeat. 
• Biventricular pacemakers are used to treat heart failure. 
• AICDs are used to treat dangerously fast heartbeats in patients who have experienced them before, or in patients who are high risk for them occurring. 

What are the risks of pacemaker or AICD insertion?

The procedure is safe and usually very well tolerated. 

The most common risk for this procedure is bruising or swelling where the device is placed in the upper chest. This usually resolves within a week.

There are some very uncommon yet serious risks that can occur at the time of implant and in the future as the device is permanent. Your doctor will discuss these with you in depth prior to the procedure. 

You’re encouraged to ask any questions you have prior to the procedure. Your doctor will get you to sign a consent form. 

How do I prepare?

• Asking your doctor about taking your usual medications – especially if you take blood thinning medications. 
• You will be asked to fast (not eat) for a few hours before your procedure begins. Ask your doctor. 
• Removing any jewellery – and putting on a hospital gown

What happens during a pacemaker or AICD insertion?

Your procedure will take place in a hospital room that looks like an operating theatre. Your doctor will prescribe sedation for the procedure to assist in relaxation and pain relief. In some cases, your doctor may involve an anaesthetist to administer a deeper level of anaesthesia, however general anaesthetic is generally not required. 

You will receive antibiotics prior to the procedure to reduce the risk of infection.

During the procedure your doctor will:

• Give you a local anaesthetic – to numb the area on your chest where the pacemaker or AICD will be inserted. 
• Make an incision to allow the device to be inserted. 
• Access the vein in the upper chest to allow placement of the leads into the internal aspect of the heart. 
• Manipulate the leads into the correct position.
• The leads will then be connected to the generator, which will then be placed into the pocket under the skin.
• Overall, the procedure takes between 30 minutes and up to 3 hours for more complicated biventricular pacemaker procedures. 

What happens after the pacemaker or AICD is inserted?

• You will be transferred to the ward to recover.
• You may require additional pain relief 
• You will undergo a chest x-ray and a check of the device to ensure it is working adequately. 
• Your doctor may request you to stay overnight or organise for discharge later the same day. Discuss this with them.
• There will be restrictions on physical activity, bathing and driving following the implantation. Discuss this with your doctor.