Cardiac Device Implant Procedure and Follow Up

Welcome to cardiology here at Leeds teaching hospitals. In this video, we aim to provide guidance on what to expect from your cardiac device implant procedure and post-procedure follow-up for your implanted device. Our cardiac admissions team will be in contact to organise a date for your implant procedure, and we’ll discuss the information regarding when and where to arrive, along with advice on any medications to withhold prior to admissions. You’ll also be given advice on fasting prior to the procedure, if required.

Hello, my name is Dr. Chris Pepper. I’m a consultant cardiologist here at Leeds teaching hospitals. When implanting a pacemaker or an implantable cardiovert as a defibrillator that’s an ICD, the fundamental steps of the procedure are very similar. The main difference is the equipment that’s implanted and the underlying reason as to why a specific type of cardiac device is recommended.

Your cardiac team will have recommended a specific device based on your clinical findings and current medical guidance, and they will have discussed the advantages and disadvantages and highlighted any risks of the implant process with you during your consultation prior to your procedure. Your implanted cardiologist will go through this with you again in addition to any risks associated with the procedure, and they will obtain your consent to go forward.

Following the consenting process, a member of our cath lab team will escort you into the lab where we will perform the pacemaker implantation. Cardiac devices are implanted for a whole host of reasons, for example a pacemaker may be implanted if your natural heartbeat is too slow or too irregular. An ICD or defibrillator is recommended if your heart rhythm has previously been dangerously fast, or is at a risk of going dangerously fast.

If your heart muscle is weakened, the device with an extra lead a three-lead device called a cardiac resynchronization device may be recommended to help your heart contract more strongly and efficiently. The pacemaker works by watching your heart rhythm and sending a small electrical impulse to produce an artificial heartbeat that stimulates your heart to contract, if your heart is going too slowly or is missing beats. Likewise, if you’re in an abnormal life-threatening fast heart rhythm, the ICD can either shock you or pace rapidly to get the heart out of the abnormal rhythm and into a more stable situation.

Cardiac device implantation is usually performed under local anaesthetic. The cardiologist makes a small cut underneath the collarbone and passes one or more pacemaker leads into a large vein in the shoulder. These leads are then advanced into the hut and positioned into a specific part of the heart chambers. We use an X-ray camera to help visualize the heart and to determine the location and the stability of the implanted leads, so you may see the camera moving around you during the procedure, but it won’t touch you and it will cause no discomfort. After the leads are attached to the device, which includes the battery the device is then placed under the skin that will induce, stitched with dissolvable sutures and sometimes surgical glue will be placed over the wound during the procedure, we can offer you sedation. 

If you would like it to make you more comfortable the procedure generally takes less than an hour to perform but can take up to two hours depending on what sort of device is being implanted most patients are well enough to return home the same day but on occasion we may recommend that you stay overnight for observation the length of time the battery lasts depends on the type of device and how much you’re using it the battery performance will be closely observed during your device.

Follow-up appointments following discharge the key points for you to remember are to limit the movements of the arm on the side of the implanted device for at least a couple of weeks, and we ask you not to perform activities such as golf or swimming for the first three months while the leads bed in if you have a valid driving licence, you do need to notify the dvla, and we will discuss these guidelines with you prior to your discharge from the ward. After you’ve gone home we will arrange for your device to be checked in about six to eight weeks within the cardiac device clinic within the hospital this appointment is to check that the wound has healed well that the leads and device are working appropriately, and you’re not having any problems foreign ER physiologist here at Leeds teaching hospitals I would like to start by welcoming you to the cardiac device’s clinic.

This section of the video focuses on providing information on what to expect from your device. Clinic appointment You and your device will be routinely checked at six to eight weeks after the implant procedure, and we will send out an appointment letter via the post. If you’re unable to attend, please do get in contact with our team so we can offer you a more suitable appointment.
If you have a new pacemaker implanted, it is likely that you will have your device follow-up appointment at St. James’s. If you have a complex device such as a defibrillator or a cardiac resynchronisation therapy device, it is likely that your follow-up will be at Leeds General Infirmary, so what should you expect when attending Clinic? You’ll be seen by one of our specialist device physiologists during your visit, and here we will carry out identity checks.

Ensure that there are no issues with the wound or the device, and obtain a brief overview on how you’ve been since your implant or the last clinic review. It is worth noting that if you have experienced any symptoms such as dizziness, loss of consciousness palpitations increased shortness of breath or fluid retention. This should be reported to the pacemaker physiologist at the clinic appointment, we can then look for potential causes of these symptoms and advise accordingly, referring to specialist clinics if required.

You may have some electrodes or stickers attached onto your wrist, ankles and chest for an electrocardiogram trace or an ECG, which helps a physiologist tailor the programming of your device for you. We will then conduct tests to ensure that the device and the leaves are working appropriately. These tests allow us to collect information on your battery and electrics off your heart, during these tests you may notice your heartbeat changing which is completely normal, we’re just getting the pacemaker to do a bit of work and to ensure that the leads have not moved position, and that they are functioning well.

We will ensure that the pacemaker settings are fully optimized and tailored to you. We will utilize this appointment to provide advice, guidance and reassurance regarding living with your cardiac device. If you have any inquiries or questions, please do not hesitate to ask. The pacemaker physiologist will determine when your next appointment is required. This will differ depending on the device type, symptoms, battery status and maybe in person or via a home monitoring device which we will discuss in the next section of the video.
Hello, my name is Annabelle. I’m a pacemaker physiologist at Lee’s teaching hospitals. As part of a follow-up for your pacemaker, we will offer you a home monitor. We’ll use this monitor to download information from your pacemaker in between face-to-face appointments. There are a range of Home monitors available that you may be offered depending on your device type or model. The home monitor can usually detect if there are any problems with your pacemaker leads or measurements during its usual screen of your implanted device and will send this information to us automatically.

You’ll be offered your monitor on the day you have your pacemaker fitted, or when you come back to the pacemaker clinic for a check. The monitor needs to be placed next to your bed so that it’s close to you overnight when it connects to your pacemaker. Instructions will be given for your monitor to help you set it up at home, we hope this video has been helpful and informative, and please do get in contact with the cardiac devices team if you have any concerns or further questions.

At the end of the pacemaker check, we’d appreciate it if you provide any patient feedback suggestions via our digital screens in our pacemaker reception area. Thank you for watching this video, and we look forward to seeing you soon. Thank you.