What is biventricular pacemaker placement?

A biventricular pacemaker (say "by-ven-TRICK-yuh-ler") is a device used to treat heart failure. Treatment that uses this type of pacemaker is called cardiac resynchronization therapy (CRT).

When you have heart failure, the lower chambers of your heart may not pump at the same time. The pacemaker sends painless electrical signals to your heart. These signals make the chambers pump at the same time. This can help your heart pump blood better and help you feel better.

Your pacemaker may be combined with an ICD, or implantable cardioverter-defibrillator. It can control abnormal heart rhythms. This can prevent sudden death.

You will get medicine to help you relax and prevent pain. The doctor will make a cut in the skin just below your collarbone. The cut may be on either side of your chest. The doctor will put the pacemaker leads through the cut. The leads go into a large blood vessel in the upper chest. Then the doctor will guide the leads through the blood vessel into different chambers of the heart. The doctor will place the pacemaker under the skin of your chest. The leads are attached to the pacemaker. Then the cut will be closed.

The procedure may take about 2 or 3 hours. You may need to spend the night in the hospital.

Pacemaker batteries may last about 10 years. Your doctor will tell you how often you will need to have your pacemaker and battery checked.

You can likely return to many of your normal activities after your procedure. You will need to be careful with certain electric devices. You will be given more information after getting your pacemaker.

If you are worried about having a pacemaker, it may help if you learn about how the pacemaker helps your heart. Talk to your doctor about your concerns.

Activity

• Rest when you feel tired.
• Be active. Walking is a good choice.
• Do not raise your arm (on the side of your body where the pacemaker is located) above shoulder level until your doctor says it's okay. This helps keep the pacemaker and leads in place while you heal. Your doctor may recommend gentle range-of-motion exercises for your shoulder.
• For at least 3 or 4 weeks, or for as long as your doctor says, avoid activities that strain your chest or upper arm muscles. This includes mopping floors or pushing a lawn mower or vacuum. It also includes swinging a golf club or tennis racquet or swimming.
• You may need to take about 1 to 2 weeks off from work. It depends on the type of work you do and how you feel.
• Ask your doctor when you can drive again.
• Ask your doctor when it is okay for you to have sex.

Diet

• You can eat your normal diet. If your stomach is upset, try bland, low-fat foods like plain rice, broiled chicken, toast, and yogurt.

Medicines

• Your doctor will tell you if and when you can restart your medicines. You will also get instructions about taking any new medicines.
• If you stopped taking aspirin or some other blood thinner, your doctor will tell you when to start taking it again.
• Be safe with medicines. Read and follow all instructions on the label.
  • If the doctor gave you a prescription medicine for pain, take it as prescribed.
  • If you are not taking a prescription pain medicine, ask your doctor if you can take an over-the-counter medicine.
  • Do not take aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve), or other nonsteroidal anti-inflammatory drugs (NSAIDs) unless your doctor says it is okay.

Incision care

• If you have strips of tape on the incision, leave the tape on for a week or until it falls off.
• You may shower 24 to 48 hours after surgery. Pat the incision dry. Don't swim or take a bath for the first 2 weeks or until your doctor tells you it is okay.
• You will have a dressing over the incision. A dressing helps the incision heal and protects it. Your doctor will tell you how to take care of this.

Other instructions

• Keep a medical ID card with you at all times that says you have a pacemaker. The card should include the manufacturer and model information.
• Wear medical alert jewelry stating that you have a pacemaker. You can buy this at most drugstores.
• Tell all of your doctors, dentists, and other health professionals that you have a pacemaker before you have any test, procedure, or surgery.
• Ask your doctor for a list of electric devices that you might need to keep a short distance from your pacemaker.
• Check your pulse as directed by your doctor.
• Have your pacemaker checked as often as your doctor recommends. In some cases, this may be done from your home. Your doctor will give you instructions about how to do this.

The procedure usually takes 2 to 3 hours.

Procedures can be stressful. This information will help you understand what you can expect. And it will help you safely prepare for your procedure.

Preparing for the procedure

• Be sure you have someone to take you home. Anesthesia and pain medicine will make it unsafe for you to drive or get home on your own.
• Understand exactly what procedure is planned, along with the risks, benefits, and other options.
• If you take a medicine that prevents blood clots, your doctor may tell you to stop taking it before your procedure. Or your doctor may tell you to keep taking it. (These medicines include aspirin and other blood thinners.) Make sure that you understand exactly what your doctor wants you to do.
• Tell your doctor ALL the medicines, vitamins, supplements, and herbal remedies you take. Some may increase the risk of problems during your procedure. Your doctor will tell you if you should stop taking any of them before the procedure and how soon to do it.
• Make sure your doctor and the hospital have a copy of your advance directive. If you don’t have one, you may want to prepare one. It lets others know your health care wishes. It’s a good thing to have before any type of surgery or procedure.

Most people spend the night in the hospital. This is just to make sure that the device is working and that there are no problems from the surgery. But sometimes the procedure is done as an outpatient procedure, which means you don't need to stay overnight in the hospital.

You might see a little bump under the skin where the pacemaker is placed.

Daily precautions

You'll need to be cautious around certain electric devices. Some devices have a strong electromagnetic field. This field can keep your pacemaker from working right for a short time. These devices include things in your home, garage, and workplace. Check with your doctor about what you need to avoid and what you need to keep a short distance away from your pacemaker. Many household and office electronics don't affect your pacemaker.

Biventricular pacemaker placement is surgery to put a biventricular pacemaker in your chest. Your doctor made a cut (incision) just below your collarbone. The doctor put the pacemaker leads through the cut, into a large blood vessel, then into the heart. The doctor put the pacemaker under the skin of your chest and attached the leads to it.

Your chest may be sore where the doctor made the cut. You also may have a bruise and mild swelling. These symptoms usually get better in 1 to 2 weeks. You may feel a hard ridge along the incision. This usually gets softer in the months after surgery. You may be able to see or feel the outline of the pacemaker under your skin.

You may be able to go back to work or your usual routine 1 to 2 weeks after surgery. But for at least a few weeks after the surgery, you will avoid vigorous physical activity that involves your upper body.

Pacemaker batteries usually last about 10 years. Your doctor will talk to you about how often you will need to have your pacemaker checked.

You'll need to take steps to safely use electric devices. Some of these devices can stop your pacemaker from working right for a short time. Check with your doctor about what to avoid and what to keep a short distance away from your pacemaker. For example, you will need to stay away from things with strong magnetic and electrical fields. An example is an MRI machine (unless your pacemaker is safe for an MRI). You can use a cell phone and other wireless devices, but keep them at least 6 inches away from your pacemaker. Many household and office electronics don't affect a pacemaker.

• Follow the instructions exactly about when to stop eating and drinking. If you don't, your procedure may be canceled. If your doctor told you to take your medicines on the day of the procedure, take them with only a sip of water.
• Take a bath or shower before you come in for your procedure. Do not apply lotions, perfumes, deodorants, or nail polish.
• Take off all jewelry and piercings. And take out contact lenses, if you wear them.

At the hospital or surgery center

• Bring a picture ID.
• You will be kept comfortable and safe by your anesthesia provider. You may get medicine that relaxes you or puts you in a light sleep. The area being worked on will be numb.
• The procedure may take about 2 or 3 hours.

You'll get medicine to relax you and help prevent pain. After making a cut in the skin on your chest, the doctor puts the pacemaker leads through the cut, into a large blood vessel, then into the heart. The doctor places the pacemaker under the skin of your chest and attaches the leads to it.