Biventricular Pacemaker

What is a Biventricular Pacemaker?

A biventricular pacemaker a small device used for cardiac resynchronization therapy for patients with heart failure. This delivers small electrical impulses to both the left and right ventricles to help them contract at the same time. This helps the heart to pump blood more efficiently with each beat.

Who needs it?

A biventricular pacemaker is used to treat patients with:
 
  • Moderate to severe heart failure
  • Ejection fraction <35% (the amount of blood pumped out of the heart with each beat)
  • Ventricular dysynchrony
  • Interventricular conduction delay or bundle branch block
  • Symptoms of heart failure not corrected with medication at maximum dosage

How a normal heart beats:

In a normal heart, the muscles and chambers of the heart contract and relax in a synchronized regulated type of harmony together. This timed synchronization or rhythm allows the ventricles to relax and fill with sufficient amount of blood then contract, pumping out a sufficient amount of blood throughout the body.

How does it work?

In a patient with heart failure, the chambers of the heart are not in sync with each other. This leads to an inadequate blood supply throughout the body and can lead to symptoms of heart failure. These symptoms include shortness of breath, dry cough, swelling of the legs, irregular heart beats, or fatigue.

A biventricular pacemaker sends a steady pattern of electrical impulses first to the right atrium then to both the right and left ventricles of the heart.

These small impulses help by keeping the contractions in sync and in a regular rhythm to provide adequate blood flow throughout the body.

This treatment resets the ventricular pumping system and is referred to as Cardiac Resynchronization Therapy (CRT).

What are the parts of a biventricular pacemaker?

A biventricular pacemaker consists of:
 
  • Battery: the pacemaker battery supplies the power to the pacemaker. This is a small, sealed, lithium battery that can lasts for years. Battery life usually lasts 5-10 years depending on how active your pacemaker is.
  • Computerized generator: this is a miniature computer inside the pacemaker. The battery transmits electrical impulses that go through this generator to stimulate the heart to beat.
  • Case: the battery and computer generator are sealed inside a metal casing.
  • Leads: 3 flexible wires connect the generator to the walls of the heart.
Biventricular Pacemakers not only monitor your heart beat, but also your body motion and breathing pattern. This can signal the pacemaker to increase during times of exercise.

What are the risks?

Although risks are very rare, as with any surgical procedure it does carry a small risk of complication.
 
These complications include:
 
  • Allergy: may produce an allergic reaction to the dye.
  • Swelling, bruising, or bleeding at or around the implantation site.
  • Formation of a clot (hematoma).
  • Infection: can occur where there pacemaker was implanted.
  • Damage to blood vessels or nerves around pacemaker site
  • Collapse lung
  • Device may move out of place from the heart.
  • Device might not detect or appropriately treat your heart rhythm.

How is this diagnosed?

Dr. Jamnadas will discuss with you about your history and symptoms.
 
Following this a physical examination will be performed to get a better idea of your condition.
 
A number of different tests can be done including:
 
  • Electrocardiogram (EKG) – a simple,non-invasive test that records the electrical activity of the heart and its beating pattern.
  • Holter monitor– records the electrical events of the heart during your normal daily activities. It is important to accurately record your activities and symptoms so Dr. Jamnadas can compare them to the Holter monitor findings. If symptoms do not occur within 24 hours, an event recorder may be ordered for you for up to 30 days. 
  • Echocardiogram (ECHO) – shows images of the heart determining the size and shape of the heart, and shows whether the heart walls and pumping activity are normal or performing weakly.
  • Stress test– helps access the blood flow to the heart at rest and during stress. Will detect if any areas receiving less blood flow.

Before the procedure:

Today pacemaker devices are amazingly small and average about 5 x 5cms, weighing only 1 to 3 ounces.

A biventricular pacemaker is usually implanted just beneath the skin of your chest, below the collarbone.

Biventricular pacemakers are typically placed on the left side of the chest, but this may not be suitable for everyone.

The procedure will take place within a hospital and does not require general anesthesia.

You may or may not stay over night in the hospital. Pack an overnight bag just in case.

You will need to arrange for someone to pick you up and drop you off.

During the procedure:

The entire procedure usually takes about one to two hours.

A sedative will be given to help you relax through an I.V. in your hand or arm that may make you sleepy.

Under sterile precautions, Dr. Jamnadas will inject a local anesthetic until you are fully numb in the area where the pacemaker will be inserted.

A needle will be inserted into a large vein to get access to the heart.

A dye will be given to view the heart under x-ray guidance.

To enter the heart, the pacemaker leads will be threaded through the vein and fixed to the wall of the right atrium and both right and left ventricles. The other end of the leads will be secured to the generator box.

The pacemaker settings are programmed to help your heart beat at a rate that is right for you.

Once the leads are fixed, Dr. Jamnadas will place a single incision just below the collar bone to insert the pacemaker underneath the skin of the chest.

After the pacemaker is placed within the chest, it will be tested to make sure it is working properly.

The incision will then be closed and a dressing will be applied.

After the procedure:

After the procedure you may feel some mild pain, tenderness, or swelling in the area of implantation. Full recovery from surgery can take several days to weeks.
 
On the side of incision, DO NOT raise your arm above your shoulder for a week. This will give the lead time to attach to the heart wall properly. Raising your arm can make the lead separate from the site of attachment.
 
Do not drive until you know how your pacemaker affects you.
 
Do not be afraid to exercise. Ask Dr. Jamnadas which exercise plan is best for you and when it is best to start.
 
Make sure to:
 
  • Change your dressing as often as instructed and avoid getting the area wet for about a week.
  • Take your temperature and check the incision everyday for signs of infection like redness, discharge, or a local rise in temperature.
  • Learn how to take your own pulse and keep record of it.
  • Avoid putting direct pressure on your pacemaker. For example, do not lie on your chest while sleeping at night.
  • Let your primary health care provider or any other healthcare providers as well as dentist know about your pacemaker before receiving any treatment.
  • Carry an ID card that contains information about your pacemaker. Your pacemaker may set off a metal detector while going through security. You may need to show this card to security personnel.
  • Keep your cellular phone away from your pacemaker. Do not carry your phone in your shirt pocket, even when it is turned off.
  • Avoid strong magnets including MRI scans and hand held security wands.
  • Avoid strong electrical fields such as those made by radio transmitting towers, ham radios, and heavy duty electrical equipment.
  • Avoid leaning over the open hood of a running car. A running engine creates am electrical field.
Keep all follow up appointments to check your pacemaker and leads. Following the surgery, an x-ray will be required to make sure the position of the lead is still intact.

What can I use?

The following items are all ok to use:
 
  • Microwave ovens
  • Computers
  • Hair dryers
  • Power tools
  • Radios
  • Televisions
  • Stereos
  • Electric blankets
  • Vacuum cleaners
  • Heating pads
  • Cars
 
Call Dr. Jamnadas if you experience any symptoms of:
 
  • Dizziness
  • Palpitations
  • Shortness of breath
  • Fatigue
  • Fainting spells
  • Twitching chest muscles
  • Chest pain or pain at pacemaker site
  • Fever
  • Hiccups that won’t stop