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From the Spring 2005 Issue

You Asked. We Answered.

Preparing for Your Cardiac Device Implant

Have you been told you need an implanted cardiac device? LifeBeat Online answers questions you might have if you're about to receive a pacemaker, implantable cardioverter defibrillator (ICD), or heart failure device.

Types of Devices

Cardiac devices are needed by many people to improve heart function:

• Pacemakers speed up slow heartbeats.
• ICDs correct heartbeats that are too fast.
• Cardiac resynchronization therapy (CRT) devices treat heart failure and may help your heart pump better.

All of these implanted battery-powered devices deliver small amounts of electrical energy to the heart. Sometimes ICDs deliver higher amounts of energy to restore a normal heartbeat.

Exactly where will my device be implanted?

Your device will likely be implanted just under the skin beneath the shoulder. Sometimes in children the device is implanted in the abdomen. Coated wires called leads carry the electrical signals from the device to the heart (Figure 1).

Figure 1

Implantable Cardioverter Defibrillator (ICD)

Click to enlarge

For your comfort and the safety of the device, some doctors recommend putting the device on the left side of the chest if you're right handed, and vice versa. Think about typical daily activities, whether related to your job or hobbies. For instance, maybe your job requires you to carry things on your shoulder—mailbags, tool carriers, or other heavy items. Mention that to your doctor before the implant. Hunting is another example. A hunter who holds a rifle against the right shoulder would want the device on the left side. The kickback from the firing of the rifle could possibly damage the device.

Clearly most hobbies or activities would not harm your device or affect its ability to work properly. But talk to your doctor about your activities and your preferences before making the decision.

Talk to your doctor about important safety information.

How big is the device?

Today's devices are much smaller than they were 10 or even 5 years ago. The average device is about 2 x 2 inches (5 x 5 centimeters) and about 0.3 inches (7.6 millimeters) thick. Each weighs about 1 to 3 ounces (28 to 85 grams).

Will I be asleep or awake during the implant?

Just before the procedure your doctor will give you medication to help you relax. For example, you might receive Valium or a similar medication. Whatever medication is used, you will be conscious and aware of your surroundings. A nurse may give you other medication to keep you as comfortable as possible.

Your doctors or nurses will ask you questions during the procedure. They'll ask if you're comfortable, if you're feeling pain, or if you can take a deep breath. They might also report the doctor's progress and tell you when the procedure is nearly finished. Most people can easily answer or ask questions during the procedure. But the medication might make you feel too drowsy to want to talk much. Within an hour or so after the procedure, you should feel more alert.

Will I be able to see the doctor right after the implant?

The procedure to implant the device usually takes about an hour. In most hospitals the doctor talks to the family right after the implant—usually to answer questions and to report how the procedure went. The doctor may also see you in the recovery room, although you may be too groggy to talk very long. You might even forget talking to the doctor.

It's a good idea for a couple of family members or friends to be at the hospital. They can talk to the doctor and nurse after the procedure. They can then fill you in on the details when you are more alert and help you gather questions for the next time the doctor sees you.

I heard a microwave could affect my device. Is that true?

No. It is completely safe for you to use most household items. That ../includes hair dryers, heating pads, electric razors, remote controls, vacuums, microwaves, and many other appliances.

But people with a cardiac device do need to be aware that their devices can be affected by electromagnetic interference (EMI). EMI is caused by strong electrical or magnetic fields.

Only rarely might something in your household have a magnetic or electrical field strong enough that it may affect your device. For instance, Guidant recommends that you avoid using body-fat measuring scales. With some motorized items like drills or hedge clippers, you should keep the motor at least 12 inches away from your device. Visit Sources of Electromagnetic Interference (EMI) for guidelines on appliances or equipment you may come into contact with at home and at work.

Once I have my device, what kind of symptoms should I call my doctor about?

Your doctor may ask you to call if you:

• Have chest pain or pressure
• Feel a shock from your ICD (or CRT device with a defibrillator)
• Hear beeping from your ICD (or CRT device with a defibrillator)
• Feel lightheaded or short of breath

The doctor's advice varies from person to person. For example, shortness of breath could result from exercise and be completely normal. Or it might result from irregular heartbeats or from your heart condition. It all depends on your health and how your device is programmed to respond to your heart rhythm.

Knowing when to call your doctor is very important. Be sure to ask your doctor or nurse which symptoms you should call about. Also ask whether you should call if you receive a shock.

But always call your doctor if your incision gets more red, swollen, or painful after you leave the hospital. And if you feel dizzy or lightheaded after receiving an ICD shock, call 911.

Finally, it's important that you go to all of your doctor appointments. Other than those visits, most people don't need additional adjustment to their device. The device is meant to allow you to live your life without worrying about irregular heart rhythms.

Note: Individual symptoms, situations, and circumstances may vary. Please consult your physician or qualified health provider regarding your condition and appropriate medical treatment or before beginning an exercise program. The information provided is not intended to be used for medical diagnosis or treatment or as a substitute for professional medical advice.

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