Pacemakers & implantable cardioverter defibrillators

• Your heart has an electrical system made up of special cells. It signals your heart muscle to squeeze or contract to pump blood and oxygen to your body.
• Aging or heart disease sometimes damages this system. This can result in:
• A slower than normal heart rate (bradycardia)
• Long pauses between beats (heart block)
• Switching between slow heart beats (bradycardia) and fast heart beats (tachycardia)
• If your electrical system is not working well, it can cause you to feel tired, dizzy, faint, or short of breath. The pacemaker helps keep your heart beating properly.

• Bring your BC Services Card plus a list of the medications and supplements you are currently taking to every appointment. Bring them on the day of your procedure as well.
• You will not be allowed to drive for at least 1 week following the pacemaker implant.
• You cannot drive home after your procedure. Please arrange for someone to drive you to the hospital and home again.
• You also need to arrange for someone to stay with you at home for the first 24 hours after the procedure.
• The hospital or doctor's office will provide more specific instructions for the procedure.
• Before the procedure, someone will instruct you on how to take your medications. Certain medications (like blood thinners and diabetic pills) might need adjusting. It is important to review these instructions carefully and take medications as directed.
• A week or so before the procedure, you might be asked to go for some blood work and an electrocardiogram (E.C.G.).
• Do not eat or drink anything the morning of your procedure. Only eat or drink if the hospital or your doctor tells you to.

• You are admitted and directed to the procedure waiting area.
• If you are already a patient in hospital, your healthcare team will help you get ready for the procedure.
• A nurse starts an intravenous (I.V.) in one of your arms to give you medicines during the procedure.
• You have bloodwork drawn and an electrocardiogram (ECG).
• The doctor reviews the procedure and then asks you to sign a consent form.

• Most people are awake for the procedure. We give you medicine to help you relax and feel comfortable.
• The doctor injects numbing medicine under the skin. This freezes the area where the pacemaker is being implanted.
• The surgeon makes a small cut or incision on the right or left side of your upper chest just below your collarbone. Your doctor talks with you beforehand about which side is best for you.
• The doctor uses a special x-ray to guide the pacing lead(s) through a large vein and into your heart.
• After attaching the leads inside the heart, they are tested to make sure they work correctly.
• The pacemaker generator is then placed in a space under the skin. The stitches that dissolve on their own over time close the incision.
• The procedure takes about 1 hour.

Note: if you are receiving a leadless pacemaker, the procedure is slightly different.

• You move to a recovery area. The nurses there monitor your heart rhythm and blood pressure.
• You might feel some discomfort around the incision and you might have a sore shoulder. Let the nurses know if you are having any pain so they can give you medicine to relieve it.
• The nurses let you know when it is safe for you to eat and drink.
• You might go home from this area or you might move to another unit if you need to stay in the hospital longer.

How soon you go home depends on your medical condition and recovery from the procedure. Most people go home the same day. Some people need to stay in the hospital for a few days.

• Your heart has an electrical system made up of special cells. It signals your heart muscle to squeeze or contract to pump blood and oxygen to your body. Aging or heart disease sometimes damages this system.
• This can result in a slower than normal heart rate (bradycardia) or faster (tachycardia).
• When the heart beats dangerously fast, the lower chambers of the heart cannot pump enough blood and oxygen to the body. If this is not treated quickly, the heart can stop (called cardiac arrest) and death follows.
• If your heart beats too slow, the ICD acts like a pacemaker. It sends an electrical impulse to trigger your heart to beat at a normal rate and rhythm.
• If your heart beats dangerously fast, the ICD acts like a defibrillator. It sends a stronger electrical impulse to shock the heart back into a normal rhythm.
• An ICD is an option for people who:
  • have had at least 1 episode of life-threatening heart rhythm (ventricular tachycardia or ventricular fibrillation)
  • have survived a sudden cardiac arrest
  • have a problem with the heart's electrical system. This makes it more likely for them to have a life-threatening heart rhythm or have a cardiac arrest.

• Bring your BC Services Card and a list of your current medications and supplements to every appointment and the day of your procedure.
• You cannot drive home after your procedure. Please arrange for someone to drive you to the hospital and home again.
• You also need to arrange for someone to stay with you at home for the first 24 hours after the procedure.
• The hospital or the doctor's office will give you more specific instructions for the procedure.
• Before the procedure, someone will instruct you on how to take your medications. Doctors might need to adjust certain medications (like blood thinners and diabetic pills). It's important to review these instructions carefully and take medications as directed.
• Talk with your doctor about future driving restrictions. The B.C. Motor Vehicle Act has strict rules on driving after having an ICD implanted.
• A week or so before the procedure, you might need to get blood work, an electrocardiogram (ECG) and an echocardiogram. Links to these tests are below.
• Do not eat or drink anything the morning of your procedure. Only eat or drink if the hospital or your doctor tells you to.

• You are admitted and directed to the procedure waiting area.
• If you are already a patient in hospital, your healthcare team will help you get ready for the procedure.
• An intravenous (IV) is started in one of your arms to give you medicines during the procedure.
• You have bloodwork drawn and an electrocardiogram (ECG).
• The doctor reviews the procedure and then asks you to sign a consent form.

• Most people are awake for the procedure. A medicine is given to you to help you relax and feel comfortable.
• The doctor injects a numbing medicine under the skin to freeze the area where the ICD is being implanted.
• The surgeon makes a small cut or incision on the right or left side of your upper chest just below your collarbone. Your doctor talks with you beforehand about which side is best for you.
• The doctor uses a special x-ray to guide the pacing lead(s) through a large vein and into your heart.
• After attaching the leads inside the heart, they are tested to make sure they work correctly.
• The ICD generator is then placed in a space under the skin. The incision is closed with stitches that will dissolve on their own over time.
• The procedure takes about 1-2 hours.

• You move to a recovery area. The nurses there monitor your heart rhythm and blood pressure.
• You might feel some discomfort around the incision and you might have a sore shoulder. Let the nurses know if you are having any pain so they give you medicine to relieve it.
• The nurses will let you know when it is safe for you to eat and drink.
• You might go home from this area or you might move to another unit if you need to stay in the hospital longer.

How soon you go home depends on your medical condition and recovery from the procedure. Some people go home the same day. Others need to stay in the hospital for a few days.

• Your heart has an electrical system made up of special cells. It signals your heart muscle to squeeze or contract to pump blood and oxygen to your body.
• Sometimes aging, heart disease, or a genetic condition can damage this system. It affects your heart's electrical system. This can result in faster than normal heart rate (tachycardia).
• When the heart beats dangerously fast, the lower chambers of the heart cannot pump enough blood and oxygen to the body. If this is not treated quickly, the heart can stop (called cardiac arrest) and death follows.
• The S-ICD sends a strong electrical impulse to shock the heart back into a normal rhythm.
• An S-ICD is an option for people who:
  • have had at least 1 episode of life-threatening heart rhythm (ventricular tachycardia or ventricular fibrillation)
  • have survived a sudden cardiac arrest,
  • have a problem with the heart's electrical system. This makes it more likely for them to have a life-threatening heart rhythm or have a cardiac arrest.

• Bring your BC Services Card plus a list of the medications you are currently taking to every appointment and the day of your procedure.
• You cannot drive home after your procedure. Please arrange for someone to drive you to the hospital and home again.
• You also need to arrange for someone to stay with you at home for the first 24 hours after the procedure.
• The hospital or the doctor's office will give you more specific instructions for the procedure.
• Before the procedure, someone will instruct you on how to take your medications. Doctors might need to adjust certain medications (like blood thinners and diabetic pills). It's important to review these instructions carefully and take medications as directed.
• Talk with your doctor about future driving restrictions. The B.C. Motor Vehicle Act has strict rules on driving after having an S-ICD implanted.
• A week or so before the procedure, you might need to get blood work, an electrocardiogram (ECG) and an echocardiogram. Links to these tests are below.
• Do not eat or drink anything the morning of your procedure. Only eat or drink if the hospital or your doctor tells you to.

• You are admitted and directed to the procedure waiting area.
• If you are already a patient in hospital, your healthcare team will help you get ready for the procedure.
• An intravenous (I.V.) is started in one of your arms to give you medicines during the procedure.
• You have bloodwork drawn and an electrocardiogram (ECG).
• The doctor reviews the procedure and then you will be asked to sign a consent form.

• Most people are asleep for the procedure.
• The doctor injects a numbing medicine under the skin to freeze the area where the S-ICD is being implanted.
• The surgeon makes one or two small cuts (incisions) near the top and bottom of your breastbone (sternum). Next to your rib cage, the surgeon makes a third small incision on the left side of your chest. Your doctor talks with you beforehand about which side is best for you.
• The surgeon tunnels the lead under your skin along the breastbone. Then, they bring it over to the incision on your left chest.
• The generator is placed in the incision on your left chest and the lead attached. The S-ICD is tested to make sure it is working correctly.
• Stitches that will dissolve on their own over time close the incisions.
• The procedure takes about 2 to 3 hours.

• You move to a recovery area. The nurses there monitor your heart rhythm and blood pressure.
• You might feel some discomfort around the incisions. Let the nurses know if you are having any pain so they give you medicine to relieve it.
• The nurses will let you know when it is safe for you to eat and drink.
• You might go home from this area or you might move to another unit if you need to stay in the hospital longer.

How soon you go home depends on your medical condition and recovery from the procedure. Some people go home the same day. Others need to stay in the hospital for a few days.

Your heart has special cells that make up an electrical system. Electrical impulses trigger your heart muscle to squeeze, and pump blood and oxygen to your body. Normally, the lower chambers of the heart (ventricles) pump at the same time.

• Aging or heart disease sometimes damages this electrical system. The damage can result in:
  • Weakened heart muscle
  • A heart rate that is either too slow (bradycardia) or too fast (tachycardia)
• When the heart muscle is weakened, it pumps less blood with each heartbeat. The lower chambers do not pump at the same time. This affects your body’s need for blood and oxygen. A CRT pacemaker (CRT-P) can send electrical impulses to trigger your heart to beat. It can also help both lower chambers to pump at the same time (called resynchronization).
• When the heart beats too fast, the heart cannot pump enough blood and oxygen to the body. If this is not treated quickly, the heart can stop (called cardiac arrest) and death follows. Here, the CRT defibrillator (CRT-D) can help in three ways. It can send an electrical impulse to trigger your heart to beat. It can help both lower chambers to pump at the same time. It can also send an electrical shock to the heart to stop the dangerously fast heartbeat.
• A CRT device is an option for people who have:
  • Moderate to severe heart failure
  • An existing heart rate problem (or a greater chance of having a heart rate problem) such as a heart rate that is too slow or dangerously fast

• Bring your BC Services Card plus a list of the medications you are currently taking to every appointment and the day of your procedure.
• You cannot drive home after your procedure. Please arrange for someone to drive you to the hospital and home again.
• You also need to arrange for someone to stay with you at home for the first 24 hours after the procedure.
• The hospital or the doctor's office will give you more specific instructions for the procedure.
• Before the procedure, someone will instruct you on how to take your medications. Doctors might need to adjust certain medications (like blood thinners and diabetic pills). It's important to review these instructions carefully and take medications as directed.
• Talk with your doctor about future driving restrictions. The B.C. Motor Vehicle Act has strict rules on driving after having a CRT implanted.
• A week or so before the procedure, you might need to get blood work, an electrocardiogram (ECG) and an echocardiogram. Links to these tests are below.
• Do not eat or drink anything the morning of your procedure. Only eat or drink if the hospital or your doctor tells you to.

• You are admitted and directed to the procedure waiting area.
• If you are already a patient in hospital, your healthcare team will help you get ready for the procedure.
• An intravenous (I.V.) is started in one of your arms to give you medicines during the procedure.
• You have bloodwork drawn and an electrocardiogram (ECG).
• The doctor reviews the procedure and then you will be asked to sign a consent form.

• Most people are awake for the procedure. You are given medicine to help you relax and feel comfortable.
• The doctor injects a numbing medicine under the skin to freeze the area where the CRT is being implanted.
• The surgeon makes a small cut or incision on the right or left side of your upper chest just below your collarbone. Your doctor talks with you beforehand about which side is best for you.
• The doctor uses a special x-ray to guide the pacing lead(s) through a large vein and into your heart.
• After attaching the leads inside the heart, they're tested to make sure they work correctly.
• The CRT generator is then placed in a space under the skin. The incision is stitched close with stitches that will dissolve on their own over time.
• The procedure takes about 1 to 2 hours.

• You move to a recovery area. The nurses there monitor your heart rhythm and blood pressure.
• You might feel some discomfort around the incision and you might have a sore shoulder. Let the nurses know if you are having any pain so they give you medicine to relieve it.
• The nurses will let you know when it is safe for you to eat and drink.
• You might go home from this area or you might move to another unit if you need to stay in the hospital longer.

How soon you go home depends on your medical condition and recovery from the procedure. Some people go home the same day. Others need to stay in the hospital for a few days.