Pacemaker and Implantable Cardioverter-Defibrillator (ICD) FAQ

Who needs a pacemaker? A pacemaker is required when a patient has a slow heart rate (usually less than 60 beats/minute) causing symptoms that may include fatigue, light-headedness, dizziness, and loss of consiousness.
Who needs an ICD? A defibrillator is needed for very fast and potentially life-threatening heart rhythm abnormalities due to prior heart attack, heart failure, or abnormal genetic conditions. Sometimes patients with very decreased heart function, measured as an ejection fraction (EF), will need an ICD due to their high risk for these types of abnormal rhythms. ICDs can treat these rhythms with faster pacing or delivery of a shock to convert the heart to a normal rhythm All defibrillators have pacing function.
How is a pacemaker/ICD implanted? After sedation provided by the anesthesiologist, local anesthetic is used to numb the skin and an incision is made in the chest near the shoulder to locate the veins. Electrical wires (leads) are placed into the heart through these veins. The pacemaker/ICD is attached to the leads and placed under the skin. The skin is then closed with sutures.
Will I be asleep for the surgery? Yes, deep sedation is provided by an anesthesiologist during the procedure.
How long does the surgery take? Typically, surgery takes about 1 hour. Total time including preparation and recovery is usually 2.5 hours once the patient goes into the operating room.
When will I go home after surgery? Most patients go home the morning after their procedure.
Will I have pain after the procedure? Some pain is normal and usually controlled with extra strength Tylenol. Occasionally stronger medications, such as Tylenol with Codeine are needed for the first 2-3 days after surgery.
When can I return to work? Depending on the type of work done, usually within 2-3 days unless your job requires strenuous activity.
When can I drive? When your pain is contolled does not limit motion of your arm unless you have a history of passing out, in which case this will be evaluated in follow-up.
What kind of follow-up do I need? You will be seen 1 week after implantation to make sure your incision is healing well and again 1 month after surgery. After that pacemakers are checked every 6 months and ICDs every 3 months.
How long do pacemaker/ICDs last? Pacemaker longevity is usually 8-15 years and ICDs last 6-9 years. When the battery reaches replacement time this is usually done as a relatively simple outpatient procedure.
How is the pacemaker checked? A wand is placed over the device which allows it to communicate with the programmer. Battery life, device settings, and stored rhythms can be checked and adjusted in this way. Some devices are also able to communicate wirelessly.