What Is a BI-V Pacemaker or ICD Implant?
In a normal heart, the heart’s lower two chambers, called ventricles,
pump at the same time. When a person has heart failure, often the right
and left ventricles do not pump at the same time. When the heart is out
of sync, the left ventricle is unable to pump enough blood to the body.
This may eventually lead to an increase in heart failure symptoms such
as shortness of breath, swelling in the ankles or legs, weight gain, fatigue,
and an irregular heartbeat.
A special type of pacemaker, called a bi-ventricular (BI-V) pacemaker,
can be implanted and helps to keep the right and left ventricles pumping
together. This is known as Cardiac Resynchronization Therapy (CRT). This
BI-V pacemaker is similar to a regular pacemaker, but instead of having
leads only in the right side of the heart, the BI-V works with a lead
in the left side of the heart as well.
With leads in the right and left ventricles, the bottom chambers beat in
a more balanced way, which has shown to decrease the symptoms of heart
failure in many people. Some people with heart failure are at higher risk
of fast irregular heart rhythms—which may be life threatening—and
may benefit from both resynchronization therapy and an implantable cardiac
defibrillator (ICD). These devices combine bi-ventricular pacing with
the ability to detect and treat rapid heart rhythms.
Who is eligible to receive a BI-V pacemaker / ICD?
Bi-V pacemakers improve the symptoms of heart failure in about 70 percent
of people who have been treated with medications but still have severe
or moderately severe heart failure symptoms.
To be eligible for a Bi-V or cardiac resynchronization therapy, you must be:
- Taking medications to treat heart failure
- Have delayed electrical activation of the heart, also called a wide QRS complex
- Have a low ejection fraction less than 35 percent. This measures how much
blood is pumped out of the ventricle with each heartbeat
Most patients who are eligible for a Bi-V pacemaker or cardiac resynchronization
therapy also meet criteria for ICD implantation due to their increase
risk of sudden cardiac death from poor heart function. Your doctor will
discuss what type of device would be most beneficial to you.
Before the Procedure
Should I take my medications?
Prior to the procedure, your doctor will discuss what medications to continue
taking or what medications to stop.
Can I eat before the procedure?
You will not be able to eat or drink anything after midnight before your
procedure. If you must take medications, you will be instructed to take
them with a very small sip of water. When brushing your teeth, do not
swallow any water.
Where does the procedure take place?
ou will be instructed on what time to arrive and where to arrive the day
of your procedure. You can call the office at (408) 839-5900 if you have
What can you expect during the procedure?
The procedure typically takes 2 to 4 hours. The Bi-V device is implanted
with numbing medication injected into the surgical site. Intravenous pain
and relaxation medication is administered by an anesthesiologist. Flexible
insulated wires (leads) are inserted into a vein under or near your collarbone,
typically on the left side. The leads are guided with the help of X-ray
images to the proper chamber of your heart: the right atrium (RA), the
right ventricle (RV), and left ventricle (LV). The other end of the lead
is attached to the generator which is implanted in a pocket under the
skin in the upper chest. Your new device and new leads will be tested
after they are properly implanted. If you received a BI-V ICD, then testing
the device may require "shocking" your heart. The anesthesiologist
will heavily sedate you so that you will not be awake during the test.
What can you expect after the procedure?
After implant, you may have some discomfort around the incision area, which
can remain tender and swollen for a few days or weeks. Pain medication
will be provided by your physician so that you have adequate pain relief.
You will stay in the hospital overnight. Your device will be re-evaluated
the morning after implant and, if everything is stable, you will be discharged
home. You will receive specific instructions about how to care for yourself
after the procedure including medication guidelines, wound care, activity
guidelines, and device care and maintenance.
What happens after I go home?
You will be periodically followed in our Arrhythmia Device Clinic or by
your cardiologist. You will be given follow-up instructions prior to discharge.
Cardiac resynchronization therapy is only one part of a comprehensive treatment
program. It is important that you continue to take your medications, make
dietary changes, live a healthy lifestyle, and keep your follow up appointments.
We want you to be an active member of your treatment team.