What You Need to Know Before the Procedure
- Do not eat or drink anything after midnight the day of the procedure.
- Surgery to implant the cardiac implantable electronic device (CEID) typically takes 1-3 hours.
- If you are taking certain types of blood thinners we will likely ask you to stop them for 24-48 hours. Do not stop any medications if not instructed to do so.
What to Expect the Day of the Procedure
- The implants are performed at The Valley Hospital and take place in an operating room with specialized X-ray equipment.
- Before the procedure, a nurse will start an intravenous (IV) line on the same side of the device.
- You will receive an antibiotic through the vein for infection prevention.
- One side of your chest will be shaved and the area will be cleansed.
- CIED implantations are done using local anesthesia to numb the area of the incisions and you will receive additional IV medication to help you relax and sleep.
- During the procedure, for transvenous systems we’ll make a small incision below the collar bone, then access the vein underneath the collar bone and one or more flexible, insulated wires (leads) are threaded through that vein into the heart with the help of fluoroscopy (X-ray images).
- One end of each wire is secured to the appropriate position in your heart, while the other end is attached to the pulse generator, which is usually implanted under the skin beneath your collarbone.
- For the subcutaneous ICD, one incision is made on the side of the chest a second one close to breast bone, underneath your left breast and both the device and the wire will be placed under the skin outside the chest cavity.
- The leadless pacemaker will be implanted through the vein in the groin.
What to Expect After the Procedure
- You'll usually stay in the hospital for one day after having the CIED implanted. Before you leave, your CIED is programmed to fit your particular pacing needs.
- An office visit will be scheduled for you in 7-10 days after the implant to check the CIED site and to assure normal function of the device.
- After that, most CIEDs can be checked remotely using wireless technology. Using radiofrequency signals, your CIED transmits information to our office, where we can access the data — including your heart rate and rhythm, how your CIED is functioning, and remaining battery life.
- These remote transmissions can be made at scheduled intervals or at unscheduled times if your CIED sends an alert, or you can send a transmission if you have a concern. Remote technology means fewer trips to our office, but we’ll still need to see you in person from time to time for scheduled checkups.
- After the implantation procedure, we may recommend that you do not apply any wetness to the area for one week, avoid driving for one week and avoid lifting the arm more above your shoulder, vigorous exercise or heavy lifting for about a month.
- You may have some aches and pains near the area where your CIED was implanted. These pains can be relieved with over-the-counter medicines, such as acetaminophen (Tylenol, others) and applications of ice. We do not encourage aspirin or non-steroidal anti-inflammatory medication such as ibuprofen or diclofenac due to possibility of increased bleeding.
- We would like to be informed about any bleeding, discharge or swelling at the device site, significant chest pain or shortness of breath, dizziness, syncope or near syncope, fever or chills.
CIED Precautions
It's unlikely that your CIED would stop working properly because of electrical interference.
Even so, you'll need to take a few precautions:
- Cellphones. It's safe to talk on a cellphone, but avoid placing your cellphone directly over your CIED implantation site when the phone is turned on. Although unlikely, your CIED could misinterpret the cellphone signal as a heartbeat and withhold pacing, or provide inappropriate therapy.
- Security systems. Passing quickly through an in-store or airport metal detector won't interfere with your CIED, although the metal in it may sound the alarm. But avoid lingering near or leaning against a metal-detection system. If security personnel insist on using a hand-held metal detector, ask them not to hold the device near your pacemaker any longer than necessary or ask for an alternative form of personal search. To avoid potential problems, always carry an ID card stating that you have a CIED.
- Medical equipment. If a doctor is considering any medical procedure that involves intensive exposure to electromagnetic or radiofrequency energy, tell him or her that you have a CIED. Such procedures include magnetic resonance imaging, therapeutic radiation for cancer treatment and shock wave lithotripsy, which uses shock waves to break up large kidney stones or gallstones. If you're having surgery, a procedure to control bleeding (electrocautery) also can interfere with CIED function.
- Power-generating equipment. Stand at least 3 feet (1 meter) from welding equipment, high-voltage transformers or motor-generator systems. If you work around such equipment, your doctor can arrange a test in your workplace to determine whether it affects your CIED.
- Devices that are unlikely to interfere with your CIED include microwave ovens, televisions and remote controls, radios, toasters, electric blankets, electric shavers, and electric drills.
As with every procedure we perform, our goal is to achieve the best possible result for you, our patient. You will be an active member of the team, making decisions about treatment options.