Pacing leads (1,2 or 3) are positioned through the collarbone vein into the heart chambers and affixed to the heart muscle. These leads are then connected to the pacemaker or ICD generator, which is placed under the skin in the front chest region just below the collarbone.
Implant success > 95%
These are rare and occur in less than 1-2% of patients: bleeding, infection, lead dislodgement, damage to lungs (pneumothorax) or heart (cardiac tamponade). There may be other potential complications related to the specific procedure.
These procedures are done in the EP laboratory and typically require an overnight stay. The procedure takes about 1 – 2 hours, more complex cases up to 3 hrs.
The patient arrives (no food that morning) to the cardiac pre-op area. Intake paperwork is being completed. ECG electrodes are attached and an i.v. line is placed. The blood pressure, heart rate and blood oxygen values are monitored. The patient is taken to the EP laboratory.
The planned implant site is prepped with disinfectant and the patient‘s whole body is draped with a sterile drape lifted up at the head area for patient comfort. A dose of an intravenous antibiotic is given.
Conscious sedation is administered. These medications make the patient very sleepy but it is not the same as anesthesia.
The electrophysiologist, assisted by a specially trained RN or technician, begins the implant procedure. A local anesthetic is injected at the implant site (this may sting and burn a bit similar to injections at the dentist). A small skin incision is made and a pocket is fashioned under the skin for later placement of the pacemaker or ICD generator. Next the leads are inserted into the collarbone vein and, using x-ray, these are advanced and placed inside the heart chambers. These leads have very tiny corkscrews at their tips, which allows them to be fixed in the heart muscle to keep a stable position. The leads are tested with regard to their ability to pace the heart. The leads are then connected to the pacemaker or ICD generator and delivered into the skin pocket. In the case of an ICD implantation, we then proceed to test the device by inducing ventricular fibrillation and allowing the device to shock the heart back to a normal heart rhythm. The wound is sutured (absorbable material) taped and dressed and the arm will be placed in a sling. The patient will then be transferred to recovery area and eventually to a hospital bed. The patient rest for 4 – 6 hrs, it typically able to be up the same evening.
The next morning we will see the patient, assess the device implant site and review overnight ECG strips. The pacemaker nurse or technician will once again test the leads to assure proper functioning. A chest X ray is taken and the patient can be discharged after review of the discharge instructions.
The arm stays in a sling for 5 days at which time we see the patient back in the pacemaker clinic to review wound healing and once again test evaluate device/lead function – no sutures have to be removed since they are self absorbing.
Future follow- up is coordinated with the referring physician. All patients with devices need to be seen on a regular basis in a device clinic.