Cardiac Device Implantation

Basic Facts:

  • A pacemaker is a device implanted in a patient to prevent slow heart rates that may cause symptoms, such as those from advanced AV block and/or bradycardia. 

  • Under sedation, a small generator is implanted in a pocket under the skin, then metal wires called “leads” are attached to it and run into heart through a vein. The leads carry electricity to the heart when needed. 

  • A pacemaker only prevents the heart rate from becoming too slow. It senses the heart’s natural electric activity and will only pace if the natural heart beat fails to beat for a given period of time. Some pacemakers are programmed to pace continuously.  

There are 4 types of pacemakers: 

  • Single-Chamber: only one wire in the heart, typically in a bottom chamber (ventricle), sometimes in a top chamber (atrium) 

  • Dual-Chamber: two wires in the heart, one in the top chamber (atrium) and one in the bottom chamber (ventricle)

  • Biventricular: two wires, one in each of the bottom chambers (ventricles) to help them contract simultaneously. This is also known as Cardiac Resynchronization Therapy (CRT) 

  • Leadless: no wires, the pacemaker is implanted directly into the tissue of a bottom chamber (ventricle). 

This procedure is performed in a hospital by a doctor with specialty training in the electrical system of the heart, called an electrophysiologist (EP), along with a team of specialized cardiovascular nurses and technicians: 

  1. Under gentle sedation, the doctor inserts a flexible tube (catheter) into a blood vessel in the groin, arm, or wrist area.  

  1. The catheter is guided inside heart, where a specialized tip delivers energy in the form of heat or extreme cold to create controlled areas of scar, deadening the electrical activity in the areas causing the abnormal heart rhythm. 

  1. The catheter is then withdrawn from the body, and pressure is held on the access site in the wrist, arm, or groin area.  

  1. Patient will be monitored for several hours afterwards, as the anesthesia wears off. 

  1. Most patients can go home later the same day, once the access site is stable. Others will need monitoring overnight.  

The Virginia Heart Care Team will provide each patient with specific pre- and post-procedure instructions, including which medications to take or not. Other general guidelines include: 

  • Stop eating and drinking the night before the procedure.  

  • If leaving the same day as the procedure, a patient needs to have someone else drive them home, as they were under sedation. 

  • No heavy lifting / pushing / pulling (over 10 lbs) for a few days after, to protect the access site.  

  • Avoid baths for a few days (showers are usually permitted within 24 hours). 

  • Sexual activity can usually be resumed within three to five days. 

  • Soreness around an access site is common afterwards, but it should not last more than one week.  

  • Antiplatelet medications are prescribed to all patients receiving a stent, to protect clots from forming inside the new stent(s). 

  • Follow-up office visit should be about one month after the procedure.  

  • A patient who has had an ablation does NOT need antibiotics prior to dental visits.