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Heart Failure and the Biventricular Pacemaker

My Doctor Recommends Combination ICD and Pacemaker Therapy. Why?

People with heart failure who have poor ejection fractions (measurement that shows how well the heart pumps with each beat) are at risk for fast irregular heart rhythms -- some of which can be life-threatening -- called arrhythmias. Currently, doctors use an ICD to prevent these dangerous rhythms. The device works by detecting such a rhythm and shocking the heart back to normal.

These devices can combine biventricular pacing with anti-tachycardia (fast heart rate) pacing and internal defibrillators (ICDs) to deliver treatment as needed. Current studies are showing that resynchronization may even lessen the amount of arrhythmia that occurs, decreasing the times the ICD needs to shock the heart. These devices are helping heart failure patients live longer and improving their quality of life.


How Do I Prepare for the Biventricular Pacemaker Implant?

Ask your doctor what medications you are allowed to take before your pacemaker is implanted. Your doctor may ask you to stop certain drugs several days before your procedure. If you have diabetes, ask your doctor how you should adjust your diabetic medications.

Do not eat or drink anything after midnight the night before the procedure. If you must take medications, drink only small sips of water to help you swallow your pills.

When you come to the hospital, wear comfortable clothes. You will change into a hospital gown for the procedure. Leave all jewelry and valuables at home.


What Happens During the Pacemaker Implantation?

Pacemakers can be implanted two ways:

Inside the Heart (Endocardial, Transvenous approach): This is the most common technique used. A lead is placed into a vein (usually under your collarbone), and then guided to your heart. The tip of the lead attaches to your heart muscle. The other end of the lead is attached to the pulse generator, which is placed under the skin in your upper chest. This technique is done under local anesthesia (you will not be asleep).

Outside the Heart (Epicardial approach): Your chest will be opened and the lead tip is attached to the outside of the heart. The other end of the lead is attached to the pulse generator, which is placed under the skin in your abdomen. This technique is done under general anesthesia (you will be asleep) by a surgeon. This is typically performed in conjunction with open heart surgery being performed for another reason.

Your doctor will decide which approach is best for you, although almost all patients receive the transvenous approach.


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