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Pacemaker / Defibrillator

What is a(n):

  • AICD: (automatic implantable cardioverter defibrillator) A small electronic device that works as a pacemaker but is also designed to treat life-threatening rapid heart rhythms. If it senses a dangerously fast heart rhythm it will deliver an electrical impulse or “shock” to restore a normal heart rhythm.

  • BiVent: (Biventricular pacemaker or Biventricular implantable cardioverter defibrillator) A small device that delivers electrical impulses to help the heart pump more forcefully and at the proper speed. It works as a pacemaker and/or defibrillator, and also synchronizes the pumping function of the heart.

  • Generator Change: When the battery of your device (pacemaker, AICD, Bi-vent) indicates replacement is needed, your doctor will schedule a generator replacement. This procedure is similar to the implant procedure, except that usually the “leads” do not need to be replaced, only the battery portion, sitting just under your skin on your chest wall.

  • Pacemaker: (a small, lightweight electronic device): Keeps track of the heart’s electrical activity. If it senses that the heart is beating too slowly, or is pausing too long between beats, the pacemaker delivers electrical impulses that pace, or stimulate the heart and keep it beating at the proper speed.

Special considerations before your procedure:

  • If your procedure is scheduled in the morning, do not eat or drink anything after 12 midnight the night before If your procedure is scheduled in the afternoon, you may have a light breakfast.
  • Take your routine medications with a sip of water.
  • If you have diabetes and take insulin in the morning, take ½ of your normal dose.
  • If you are taking a diabetic medication called Glucovance/Glucophage®, please stop taking this 
    medication________days before your procedure unless otherwise directed by your physician.
  • If you are on a blood thinner called Coumadin®, stop taking this medication ______days before your procedure unless otherwise directed by your physician.
  • If you are taking aspirin and/or Plavix® or Effient®, please continue unless otherwise directed by your physician.
  • If you are taking a diuretic (water pill), do not
    take it the day of your procedure, unless otherwise directed by your physician.
  • Bring all of your medicines with you in their
    original container. This includes over-the-counter and herbal medicines.
  • Bring your Bipap/Cpap machine if you have one.
  • Wear comfortable clothes.

What should I expect when I arrive?

  • At Lakeland Hospital Niles, you will check in at the Surgery Department.
  • At Lakeland Medical Center in St. Joseph, you will check in with the receptionist at the Hanson Heart Center.
  • The nurse will take you to the prep area to review your health information and answer your questions. 
  • In the prep area you will sign consents, change into a gown, and have two IVs started. The IVs will allow us to give you fluids and medications as needed. You will also be given an IV antibiotic to prevent infection. 
  • You may need lab tests done before the procedure. It will be necessary to remove hair on your chest with electric clippers.
  • If you are scheduled for a Biventricular device, a Foley catheter will be inserted before your procedure.

What happens during the procedure?

  • You will be taken into one of our procedure rooms where you will be placed on the X-ray table.
  • You will be attached to equipment that will monitor your blood pressure, heart rate, and oxygen level.
  • A nurse is present to give you medications to help you relax and to reduce any pain or discomfort you may experience.
  • Your doctor will numb the area where the device will be inserted. An incision is made under the collar bone and a “pocket” is made under the skin for the device to fit into.
  • Special wires called “leads” are positioned in the appropriate area of your heart and connected to the device. Your doctor will close the incision and that area will be covered with a sterile dressing. 
  • A clinical representative from the device company will be present to check that it is working properly during your procedure.

What happens after the procedure?

  • Immediately after the procedure you will be taken to the recovery area and have an EKG and/or chest X-ray performed.
  • An arm sling may be applied to the arm on the same side as the device to limit movement and allow the site to heal.
  • You will be given clear liquids to drink at first.  Your diet will slowly return to normal as you are able to tolerate it.
  • If you are going to be discharged after your procedure, (usually for a generator change), you will spend a minimum of two hours in the recovery area.
  • If the doctor has placed a new device or new connection wires know as “leads,” you will be admitted for an overnight stay. You will be taken to your room when it is available.
  • The nurse will give you discharge instructions before you go home.

When you go home:

  • Someone will need to drive you home.
  • Limit the use of the arm on the same side as your device until your follow-up appointment.
  • Avoid lifting more than five pounds, lifting your arm overhead, pulling, pushing or stretching with the arm for four to six weeks.
  • Do not drive until you have had your follow up appointment.
  • Use the arm sling for the amount of time you were instructed.
  • Perform dressing changes to the site as instructed. Watch for any signs of infection such as fever over 100°, increased redness, swelling, warmth or drainage. If homecare is ordered, a nurse will come to your home to assist with dressing changes.
  • Instructions concerning your medications, activity, and follow-up care will be discussed in greater detail when you are discharged home.