Disclaimer: The brief patient information supplied here and the outside links provided are not intended to replace the advice of your physician and are only meant to help guide patients to formulate questions during their physician appointments. Each patient's situation is unique and a large number of factors are considered when arriving at a management plan for your specific condition. 

Pacemakers and Implantable Defibrillators

Pacemakers and ICDs are electronic devices which are used to treat a variety of heart conditions. A pacemaker is usually inserted to speed up a slow heart beat, but pacemakers are sometimes used to facilitate the treatment of atrial fibrillation and special pacemakers called CRT-P (cardiac resynchronization therapy pacemaker) are used to treat patients with heart failure.

ICDs (implantable cardioverter-defibrillators) are inserted to prevent sudden cardiac death due to rapid heart rhythms and can deliver high-energy shocks). ICDs can also act as pacemakers to treat a slow heart beat. 

Pacemaker/ICD insertion

Pacemaker and ICDs are inserted under the skin of the left (or right) upper chest under the clavicle (collar bone). Patients receive a sedative and freezing medication and a small incision is made in the skin and a pocket is created to insert the small device. Next, a needle is inserted a vein which runs underneath the collar bone and one (or more) wires are advanced into the heart. The wires are then connected to the pacemaker or ICD, which is then inserted into the pocket and the pocket is closed using sutures. 

Risks of pacemaker or ICD insertion include infection, bleeding/bruising, pneumothorax (air leak around the lung), and pericardial effusion/tamponade (a rare, but potentially dangerous accumulation of blood in the sac surrounding the heart). 

Patients are generally discharged home a few hours after their procedure and major complications are generally rare (0.5% risk, mostly infection for new pacemakers, 1% risk for new ICD or CRT devices based on the recently published PADIT trial of tens of thousands of patients). Rare complications can also include a pneumothorax (air leak in the lung lining, which interferes with lung function) or heart irritation/inflammation, perforation or tamponade (which impairs heart function due to excessive blood/fluid accumulation in the outer lining of the heart).