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Pacemaker and Implantable Cardioverter Defibrillator Placement

Figure 1: Battery powered implantable pacemaker
Courtesy of Medtronic
More than three million people worldwide with persistent or intermittent slow or irregular heart rate have pacemakers or defibrillators. They include patients with bradycardia (slow heart rate), atrial fibrillation (irregular heart rate), syncope (fainting) and congestive heart failure.

A pacemaker is used to replace the function of the heart's natural pacemaker when the heart is beating too slowly or experiences heart block. A pacemaker is a small, battery-powered device that sends out electrical impulses that cause the heart muscle to contract, performing the function of the body's natural pacemaker. A defibrillator can perform the functions of a pacemaker, but also has the capability to deliver life-saving shocks in the event of dangerous arrhymias.

Figure 2: X-ray view of implanted pacemaker
Pacemakers and defibrillators are implanted to regulate, monitor and initiate the heart's rhythm and the speed and pattern of the heartbeat. They emit a series of pulses to regulate the heart's rhythm and can even send life-saving shocks in the event of dangerous arrhythmias. These procedures are performed under x-ray guidance with small incisions that do not require entry into the patient's chest. Pacemaker and defibrillator surgery takes place through a small incision near the left or right clavicle (collarbone) and are considered minor surgery. The procedures can usually be done with only local anesthesia, and the entire surgery usually takes less than an hour.



Laser Removal of Pacemaker and Defibrillator Leads

A pacemaker or defibrillator may be placed in patients secondary to a slow heart rate or life-threatening arrthymias. Both pacemakers and defibrillators use implanted leads that are lodged in the heart. These leads transmit energy from a pacemaker or implantable cardioverter defibrillator directly to the heart muscle. Leads may need to be removed for a number of reasons that include damage to the inside or outside of the lead, buildup of scar tissue, or infection.

The approach at Morristown Medical Center in these cases requiring lead extraction is to avoid the need for open-heart surgery to remove these devices, and instead use only a small incision over the pacemaker or defibrillator site, reducing the risks of the surgery. This can be successfully performed even when the leads have been implanted many years prior, using a specialized laser procedure to safely remove the scar tissue holding the leads in place.

Surgical extraction of leads is done through small incisions in the in the upper chest. Morristown surgeons are skilled at use of a special sheath (tube) that is placed into the vein. This sheath is then threaded over the lead up to the end of the lead, where it attaches to the heart. The laser extraction procedure uses ultraviolet rays which vaporize the scar tissue around the lead. This procedure is less likely to damage or tear the lining or heart and blood vessels, and is less time consuming and therefore less traumatic to the patient than open-heart surgery to surgically remove the leads through conventional surgery.



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