Cardiac Device Clinic
Surgically implanted cardiac devices play an important role in the treatment of heart disease. Approximately 400,000 devices are implanted in patients each year in the United States, with more than three million patients implanted with these devices currently.
Cardiac Pacemakers
Pacemakers are small, battery-powered devices that are used to regulate the heart beat when it is beating too slowly (bradycardia). The device, which is about the size of a large wrist watch, weighs barely an ounce, and is comprised of leads and a pulse generator.
The leads are wires that are carefully threaded through the veins into the heart and touch the heart muscle. The pulse generator is implanted into the body just below the collarbone. When the pacemaker senses the heart is beating too slowly, an electrical impulse is delivered to the heart muscle, causing it to contract and beat faster.
Getting a pacemaker does not require open-heart surgery because the device is implanted in a small pocket made by the physician in the skin under the collarbone. Once implanted, routine monitoring and follow-up care are necessary to ensure the device continues to function properly. Summa Health’s Cardiac Device Clinic monitors patients who have an implantable device. Your cardiologist can learn valuable information about how your heart and the device are working – and can make adjustments if necessary.
Implantable Cardiac Defibrillators
An implantable cardiac defibrillator (ICD) is a small, battery-powered device that can detect when a patient’s heart is beating dangerously fast and deliver a life-saving electrical shock. Implanted under the skin just below the collarbone, it contains a pulse generator which is comprised of a computer, a battery and lead wires.
The leads are in contact with the heart muscle on one end, and the pulse generator on the other end. The ICD helps detect when a patient’s heart is beating dangerously fast and delivers a life-saving electrical shock, often described by patients as a “kick in the chest,” which returns the rapid heart rate back to a normal rhythm. The devices can also act as pacemakers and can prevent too slow heart rhythms by delivering pacing signals to the heart muscle.
Subcutaneous Implantable Cardiac Defibrillators
A more recent technology, called a subcutaneous implantable cardiac defibrillator (S-ICD), provides life-saving intervention to patients without touching the patient’s heart. Unlike a regular ICD, there are no wires attached to the heart and the technique used to implant the device is also less invasive. If a patient’s heart were to stop or experience a dangerous rhythm, the device would deliver an electrical signal to the heart with the goal of restoring the patient’s heart to normal rhythm and saving his/her life.
The S-ICD device has obvious benefits for patients, including increased lifestyle flexibility and a less complex surgery requiring a smaller incision to implant it. The device is ideal for patients who are young and active, have congenital heart conditions or who are at risk for dislodging the wires of a traditional implantable defibrillator. Summa Health physicians implanted the first S-ICD in Ohio used outside of a clinical trial.
Routine Monitoring and Follow-Up Care
As with pacemakers, ICDs require routine monitoring and follow-up care to ensure the device continues to function properly. Summa Health’s Cardiac Device Clinic monitors patients who have an implantable device. Your cardiologist can learn valuable information about how your heart and the device are working – and can make adjustments if necessary.
Pacemaker and Defibrillator Lead Extraction
Although implantable cardiac devices such as pacemakers and defibrillators, are designed to be permanently implanted in the body, occasionally it is necessary to remove (extract) the leads. The most common reasons for lead extraction include:
- An infection
- A broken lead or a lead which is not functioning properly
- A mechanical lead failure which could prove dangerous to the patient, such as a protruding wire
Sometimes a lead can be left inside the body, with a new lead implanted alongside it. However, veins can only contain a limited number of leads due to space constraints. As a result, sometimes non-functioning leads must be extracted in order to make space for a new lead.
How Cardiac Devices Work
One part of the device system is the pulse generator, a metal container which surrounds electrical circuits and a battery, which is usually placed under the skin on the chest wall beneath the patient’s collarbone. The device’s wires (or leads) run between the pulse generator and the heart. In a pacemaker, the leads allow the device to increase the patient’s heart rate by delivering small bursts of electrical energy to make the heart beat faster. In a defibrillator, the lead has special coils which deliver a high-energy shock to convert a dangerous heart rhythm (such as ventricular tachycardia or fibrillation) back to a normal heart rhythm.
In order to work correctly, the leads from a traditional cardiac device must be in contact with heart tissue. Most leads pass through a vein under the collarbone and into the right side of the heart (right atrium and right ventricle). To hold the lead in place inside of the heart, most leads have either a small screw or hooks at the end. Within a few months of implantation, the body forms scar tissue along the lead and at its tip, which helps keep it securely in place inside the patient’s body. Leads usually last longer than device batteries, so existing leads can often be reconnected to each new pulse generator (battery) at the time of the replacement.
How will this program help me?
Even though pacemakers and implantable defibrillators are very reliable, it is still important for patients to have their devices checked periodically by qualified technicians or monitored at home via telephone transmission.
Summa Health offers a Cardiac Device Clinic that monitors all patients who have an implantable device. Your cardiologist can learn valuable information about how your heart and the device are working – and can make adjustments if necessary.
What can I expect during visits?
During your visit, information will be gathered electronically from your device by a technician. The data will be evaluated by an electrophysiologist. Depending on the findings and any symptoms you report experiencing, your electrophysiologist may make some adjustments to the way the device functions.
Both the data gathering and adjustments are painless and usually can be completed on an outpatient basis.