Biventricular Pacemaker Implantation

What is a biventricular pacemaker?

A biventricular pacemaker (BVP) is a type of permanent pacemaker placed in your chest. It improves the function of the heart.

The heart has 4 compartments, or chambers. The upper chambers are called atria. The lower chambers are called ventricles. For biventricular pacing (BVP), one wire goes from the pacemaker to the right ventricle. Another wire goes from the pacemaker to the left ventricle. BVP helps these 2 pumping chambers of the heart work together properly. Use of this type of pacemaker is called cardiac resynchronization therapy.

When is it used?

BVP is used to treat people with heart failure. Your healthcare provider may recommend BVP if:

• You keep having shortness of breath even though you are taking medicine for the problem and
• Your heart's electrical signal is slower than it should be. (This is detected with an electrocardiogram, or ECG.)

BVP is different from pacemakers that treat slow heart rates. Pacemakers that treat slow heart rates have a wire that leads just to the lower right side of the heart (right ventricle). These pacemakers also sometimes have a wire that leads to the right atrium. (The right atrium is the upper chamber on the right side of the heart.)

How do I prepare for the procedure?

Plan for your care and recovery after the operation, especially if you are to have general anesthesia. Allow for time to rest and try to find people to help you with your day-to-day duties.

If you need a minor pain reliever in the week before surgery, choose acetaminophen rather than aspirin, ibuprofen, or naproxen. This helps avoid extra bleeding during surgery. If you are taking daily aspirin for a medical condition, ask your provider if you need to stop taking it before your surgery.

Follow your provider's instructions about not smoking before and after the procedure. Smokers heal more slowly after surgery. They are also more likely to have breathing problems during surgery. For this reason, if you are a smoker, you should quit at least 2 weeks before the procedure. It is best to quit 6 to 8 weeks before surgery.

Follow any instructions your healthcare provider gives you. If you are to have general anesthesia, eat a light meal, such as soup or salad the night before the procedure. Do not eat or drink anything after midnight and the morning before the procedure. Do not even drink coffee, tea, or water.

No special preparation is needed for local anesthesia.

What happens during the procedure?

The procedure is usually done with a local anesthetic. You may also be given other medicines to relax you and keep you from feeling pain during the procedure. If you feel discomfort during the procedure, tell your healthcare provider right away.

Your upper chest will be washed and possibly shaved. Your healthcare provider will make a cut in the skin of your chest and separate the tissues to make a place for the pacemaker. The pacemaker system consists of 1 or 2 electrodes and a battery unit. The electrodes (wires that are insulated nearly to their tips) are inserted into a vein under your collarbone. With the help of X-rays, your provider places wires in your left and right ventricles. The tips of the electrodes will make contact with your heart muscle. They will transmit the electrical impulse that stimulates the heartbeat. The other ends of the electrodes are connected to the battery unit, which also contains electronic circuits. Your provider will place the battery unit under the skin of your upper chest. He or she will then sew the pocket closed.

What happens after the procedure?

You may stay in the hospital for 1 to 3 days, depending on your condition. At first you will stay in bed and your heart will be monitored. The day after the procedure you will be encouraged to walk.

Before you leave the hospital, your healthcare provider will check your pacemaker using a small table-top computer, called a programmer, and a wand. Your provider will put the wand on your body in the area where the pacemaker was placed. The wand will give information from the pacemaker about what the heart is doing and how well the pacemaker is working. You may also have an echocardiogram. If needed, your provider can adjust the pacemaker with the programmer and the wand.

You may learn how to check the function of the pacemaker with a telephone. The pacemaker can also be checked at follow-up visits with your healthcare provider.

Your provider may explain how having a pacemaker might affect your lifestyle and when the battery in the pacemaker may need to be replaced.

You will need to have regular checkups to make sure the pacemaker is working properly. Ask your healthcare provider what other steps you should take.

What are the benefits of this procedure?

You will probably have less shortness of breath than you did before the procedure. Your heart may beat in a healthy rhythm, and you may be able to go back to a more normal lifestyle. The benefits may be greater several months after the pacemaker is placed in your chest.

What are the risks associated with this procedure?

• A local anesthesia may not numb the area quite enough and you may feel some minor discomfort during the implantation. Also, in rare cases, you may have an allergic reaction to the drug used in this type of anesthesia. Local anesthesia is considered safer than general anesthesia.
• The wire could puncture one of the lungs, the vein, or the heart cavity.
• Like any electrical/mechanical device, the pacemaker may need a replacement if it stops working properly.
• The pacemaker wire may become dislodged or break.
• You may have infection or bleeding.

The risks associated with BVP are slightly higher than with some other pacemakers because it is more difficult to place the wires properly on both sides of the heart. Ask your healthcare provider how these risks apply to you.

How can I take care of myself when I have a pacemaker?

Be aware that some devices may interfere with pacemakers:

• Cell phones. Keep your cell phone at least 6 inches away from your pacemaker. When you are talking on your cell phone, hold it on the opposite side of the body from your pacemaker. When your phone is turned on but not in use, do not carry it in your breast pocket.
• Power equipment. Pacemakers may not work properly near power-generating equipment and arc welding equipment.
• Magnetic resonance imaging (MRI). MRI uses a powerful magnet to produce images of internal organs. The magnet can interrupt the pacing of pacemakers.
• Radiation. X-rays generally do not affect pacemakers, but radiation therapy for cancer may damage pacemaker circuits.
• Short-wave or microwave diathermy (deep heat treatment) signals may interfere with or damage the pacemaker.

Devices that generally do not damage pacemakers or change pacing rates include:

• CB radios and ham radios
• electric drills
• electric blankets and heating pads
• electric shavers
• metal detectors (Passing through the metal detector at airports will not damage a pacemaker, but the metal in it may sound the alarm.)
• microwave ovens
• televisions and remote controls.

Lithotripsy to dissolve kidney stones may be done safely with some reprogramming of the pacing. Electroconvulsive (shock) therapy appears to be safe for people who have pacemakers.

Tell all your healthcare providers and dentists that you have a pacemaker. Be sure to carry an ID card with you that says you have a pacemaker.

When should I call my healthcare provider?

Call your provider right away if:

• Your pulse is too slow, too fast, or irregular.
• Your symptoms return.
• The site where the pacemaker was put in becomes red or swollen or begins leaking fluid, pus, or blood.

Call during office hours if:

• You have questions about the procedure or its result.
• You want to make another appointment.