Daily Living

Cardiac Device Replacement: What to Expect

All implantable cardiac devices have batteries inside that supply the energy the devices need to do their jobs. But when the energy in your device battery begins to get low, your doctor or nurse will make an appointment to replace your device.

Getting your cardiac device replaced is almost always easier — and faster — than having your first device implanted since the original leads typically remain in place.

Replacing Your Device When the Battery Is Low

Pacemakers, implantable cardioverter defibrillators, and cardiac resynchronization therapy (CRT) devices are "all-in-one" units. During manufacturing, the battery and other parts of your device are sealed inside a metal case (Figure 1). The permanent seal on the outside of the metal case prevents anything from getting in or out of the device.

Figure 1. Inside an Implantable Defibrillator

The battery and other parts of the device are sealed inside the metal case.
The seal prevents anything from getting in or out of the device.

An implantable device cannot be opened and "re-sealed." When the energy in the battery begins to run low, your doctor has to replace the entire device. In most cases, though, the leads can remain in place.

About Your Replacement Procedure

Most likely, your device replacement procedure will be done in a special operating room at a hospital or day-surgery center. Most people go home the day of the procedure. However, you should not drive immediately afterward. So plan to have a friend or family member come with you and wait — or pick you up after your procedure.

Preparing for Your Procedure

Your doctor or nurse will tell you how to prepare for your device replacement procedure. You may be told not to eat or drink anything — or not to take certain medications — for a number of hours before the procedure.

When you arrive for the procedure, you undress and put on a hospital gown. The doctor or nurse puts an intravenous (IV) line into your arm. The IV delivers fluids and medications during the procedure. The medication makes you sleepy, but not unconscious.

During the Procedure

In most cases, you will be awake and able to talk during the procedure. However, if you are getting a new defibrillator or CRT device with a defibrillator (CRT-D), you may be put to sleep for part of the procedure. That's because when the defibrillator is tested, it sends a shock to your heart.

To begin, the skin near your shoulder is numbed. The doctor then makes an incision near where your cardiac device is located. Keep in mind that the device is just underneath the skin — not deep inside your chest.

Your doctor then:

Disconnects the leads from your device
Takes out the device
Checks whether the leads will work properly with the new device
Puts the new device in place where the old one had been
Connects the new device to the leads

Before closing the incision, the doctor checks the entire system to make sure it works properly.

After Your Procedure

You will need to stay in the recovery room for a short while after your procedure. The nurse will let you know when you are ready to go home. Most people go home the same day.

Pain medication should help take care of any tenderness at the incision site. Your doctor might order medication or tell you to take a specific type of over-the-counter pain medication. You may also be told to avoid aspirin for a certain period of time. That's because aspirin can increase the risk of bleeding.

But be sure to ask what symptoms to watch for and when to call your doctor or nurse. And always call if you notice that your incision becomes reddened, swollen, or painful.

You'll most likely recover quicker from your replacement procedure than from your initial implant. And your new device will continue to do its job for years.

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