Pacemaker & Defibrillator (ICD) Implantation

Implantable heart devices, such as pacemakers and implantable cardioverter defibrillators (ICDs), monitor and treat a heartbeat that is too fast, too slow, or irregular. The devices help to prevent life-threatening symptoms, such as dangerous arrhythmias and heart failure.

If you have an irregular heart rhythm, our experienced electrophysiologists (specialists who treat the heart’s electrical system) support you through diagnosis, treatment, and recovery. We help determine the right implantable device for you, so you can feel safer and more confident in your daily life.

Pacemakers

A pacemaker is a battery-powered device placed inside the chest or heart that uses electrical impulses to stimulate the heart and control heartbeat. It treats a heart rate that is too slow (bradycardia) and helps people with heart block, which happens when electrical signals don’t travel properly through the heart. Most pacemaker batteries last about 8–12 years, depending on the device and the amount you use it.

Baystate Health offers advanced pacemaker implantation. Our team has considerable experience performing routine and complex pacemaker procedures.

Pacemakers With Leads

Pacemakers with leads (wires) are helpful for people who rely on the device to keep their heartbeat regular. We implant the wire directly into the heart to help control its rhythm and prevent the heart muscle from weakening. Electrophysiologists make a small incision in the shoulder and implant the pacemaker under the skin in the upper chest (called a skin pocket), and connect the wires to the device.

We offer three types of pacemakers with leads:

• Single-lead pacemaker has one wire, typically placed in the right ventricle. It treats a slow heart rate.
• Dual-lead pacemaker has two wires, typically placed in the right atrium and right ventricle. It treats a slow heart rate.
• Biventricular pacemaker (cardiac resynchronization therapy or CRT) has three wires, typically placed in the right atrium, right ventricle, and left ventricle. It treats left bundle branch block and heart failure.

Leadless (Wireless) Pacemakers

These smaller, vitamin-sized pacemakers don’t have wires. Leadless pacemakers are implanted directly into the heart through a catheter (thin tube) placed in a vein in the groin. The pacemaker is then threaded through the catheter up to the heart.

Implantable Cardioverter Defibrillators (ICD)

An implantable cardioverter defibrillator (ICD) is a battery-powered device that monitors the heart and delivers a shock when it detects an irregular heart rhythm. Most ICD batteries last about 6–10 years, depending on device use.

Implantable cardioverter defibrillators help treat ventricular tachycardia and ventricular fibrillation (which cause a too-fast heart rhythm) and prevent cardiac arrest and sudden cardiac death in people with heart failure. In addition to delivering shocks, an ICD can also function as a pacemaker to address a too-slow heart rate.

Most ICDs are implanted through a small incision below the collarbone. Wires (leads) running through the veins connect the device to the heart.

We offer two main types of implantable cardioverter defibrillators:

• ICD with one or two wires, which provide shocks to prevent cardiac arrest and pacing to treat slower heart rate.
• Cardiac resynchronization therapy defibrillators (CRT-D), which use three wires, typically placed in the right atrium, right ventricle, and left ventricle. It combines pacing and shocks to treat conditions including heart failure.

Subcutaneous Defibrillators (S-ICD)

We surgically place this defibrillator under the skin in the armpit, with a single wire that monitors the heart and delivers a shock if a dangerous rhythm is detected.

Because this device doesn't require wires inside the heart or veins, it can reduce some infection risks related to wires in a traditional ICD. Your doctor may recommend an S-ICD if you have a higher infection risk, or if you are younger and likely to need multiple devices over your lifetime, since replacements are less invasive than with a standard ICD.

Why Choose Baystate Health for Pacemaker and ICD Implantation?

Baystate Health has the leading electrophysiology program in western Massachusetts. We offer:

• Advanced therapies: We are the only center in western Massachusetts that implants conduction system pacemakers, which protect the heart muscle from weakening during pacing. As one of the first adopters of this technique, our team has extensive experience and expertise in performing these procedures.
• Care when you need it: We have the only 24/7 cardiac catheterization laboratory in western Massachusetts. If you need an emergency procedure, you can count on us for timely care.
• Highly specialized team: Your care team will include doctors, nurses, and technicians with specialized training in electrophysiology that helps them provide timely, accurate, and personalized treatment.

Benefits and Risks of Implantable Heart Devices

Pacemakers and defibrillators are lifesaving devices that prevent dangerous and life-threatening conditions, such as irregular heart rhythms and cardiac arrest.

Risks of pacemaker and defibrillator implantation are rare but can include:

• Bleeding around the device
• Bleeding around the heart
• Device malfunction
• Infection
• Lead dislodgement or revision (a wire moves out of place or needs repair or replacement)
• Lung injury (pneumothorax), only for devices with wires
• Need for a repeat procedure

What to Expect Before Heart Device Implantation

Before your surgery, your doctor will provide education on the device and implantation procedure. They will also review how to prepare for your procedure, including:

• What you can eat and drink before the procedure
• Medications you may need to stop taking
• Bathing and skin preparations

What Happens During Heart Device Implantation

The implantation process varies based on the type of device you need.

• Catheter-based: To implant a leadless pacemaker, your doctor inserts a thin tube (catheter) into a vein in the groin and threads the device through it to the heart. This minimally invasive procedure requires only light sedation.
• Transvenous: To implant a pacemaker with wires or an ICD, your doctor makes a small incision near the shoulder, just below the collarbone, and creates a small pocket under the skin to hold the device. The wires are then threaded through blood vessels and connected to the heart. This is also minimally invasive and requires only light sedation.
• Surgical: To implant an S-ICD, your doctor makes an incision beneath the armpit to place the device, then runs the wire just under the skin along the breastbone. This procedure is performed under general anesthesia.

Catheter-based device implantation takes about an hour. Transvenous and surgical implantation may take longer. At Baystate Health, most people who have a heart device implantation go home the same day.

Recovery After Heart Device Implantation

Most people are able to resume normal activities a few days after getting a heart device, though you may have restricted range of motion in your arm for a few weeks. Your care team will give you specific instructions about lifting, driving, wound care, and arm movement.

Our team is committed to helping you feel comfortable with the device and return smoothly to everyday life. Your doctor will provide extensive education on living with the device. You will also go home with a bedside remote monitor. This monitor lets your doctor keep track of how your device and heart are working. We will continue to follow your device after implantation to make sure it is working properly.