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What is a Bi-Ventricular Pacemaker or ICD Implant?
In a normal heart, the heart’s lower two chambers, called ventricles, pump at the same time. When a person has heart failure, often the right and left ventricles do not pump at the same time. When the heart is out of sync, the left ventricle is unable to pump enough blood to the body. This may eventually lead to an increase in heart failure symptoms such as shortness of breath, swelling in the ankles or legs, weight gain, fatigue and an irregular heartbeat.
A special type of pacemaker, called a bi-ventricular (BI-V) pacemaker can be implanted and helps to keep the right and left ventricles pumping together. This is known as Cardiac Resynchronization Therapy or CRT. This BI-V pacemaker is similar to a regular pacemaker, but instead of having leads only in the right side of the heart, the BI-V works with a lead in the left side of the heart as well. With leads in the right and left ventricles, the bottom chambers beat in a more balanced way and this has shown to decrease the symptoms of heart failure in many people. Some people with heart failure are at higher risk of fast irregular heart rhythms — some of which may be life threatening and may benefit from both resynchronization therapy and an implantable cardiac defibrillator (ICD). These devices combine bi-ventricular pacing with the ability to detect and treat rapid heart rhythms.
Who is eligible to receive a BI-V pacemaker/ICD?
Bi-V pacemakers improve the symptoms of heart failure in about 70 percent of people who have been treated with medications but still have severe or moderately severe heart failure symptoms. To be eligible for a Bi-V or cardiac resynchronization therapy you must be:
1. Taking medications to treat heart failure
2. Have delayed electrical activation of the heart, also called a wide QRS complex
3.Have a low ejection fraction less than 35 percent. This measures how much blood is pumped out of the ventricle with each heartbeat
Most patients who are eligible for a Bi-V pacemaker or cardiac resynchronization therapy also meet criteria for ICD implantation due to their increase risk of sudden cardiac death from poor heart function. Your doctor will discuss what type of device would be most beneficial to you.
Before the procedure
Should I take my medications? Prior to the procedure, your doctor will discuss what medications to continue taking or what medications to stop.
Can I eat before the procedure? You will not be able to eat or drink anything after midnight before your procedure. If you must take medications, you will be instructed to take them with a very small sip of water. When brushing your teeth, do not swallow any water.
Where does the procedure take place? You will be instructed on what time to arrive and where to arrive the day of your procedure. You can call the office at (408) 839-5900 if you have any questions.
What can you expect during the procedure?
The procedure typically takes 2 to 4 hours. The Bi-V device is implanted with numbing medication injected into the surgical site. Intravenous pain and relaxation medication is administered by an anesthesiologist. Flexible insulated wires (leads) are inserted into a vein under or near your collarbone, typically on the left side. The leads are guided with the help of X-ray images to the proper chamber of your heart — the right atrium (RA), the right ventricle (RV) and left ventricle (LV). The other end of the lead is attached to the generator which is implanted in a pocket under the skin in the upper chest. Your new device and new leads will be tested after they are properly implanted. If you received a Bi-V ICD, then testing the device may require "shocking" your heart. The anesthesiologist will heavily sedate you so that you will not be awake during the test.
What can you expect after the procedure?
After implant, you may have some discomfort around the incision area, which can remain tender and swollen for a few days or weeks. Pain medication will be provided by your physician so that you have adequate pain relief.
You will stay in the hospital overnight. Your device will be re-evaluated the morning after implant and, if everything is stable, you will be discharged home. You will receive specific instructions about how to care for yourself after the procedure including medication guidelines, wound care, activity guidelines, and device care and maintenance.
What happens after I go home?
You will be periodically followed in our Arrhythmia Device Clinic or by your cardiologist. You will be given follow-up instructions prior to discharge.
Cardiac resynchronization therapy is only one part of a comprehensive treatment program. It is important that you continue to take your medications, make dietary changes, live a healthy lifestyle and keep your follow up appointments. We want you to be an active member of your treatment team.