Pacemaker/ICD Battery Change
Dr. Jim Stone and Dr. Karthik Prasad Patients
When a battery needs to be replaced, the entire device is actually replaced so that you can benefit from new circuitry and any new features that have recently been added to the device. Most often, this procedure is very simple because the leads are already in place. After giving medicine to numb the skin, your health care provider makes a cut to reopen the pocket holding the device and disconnects the old device from its leads. The leads are routinely tested at this time. If they are working okay, the new pacemaker/ICD may simply be connected to the existing leads. If there is any problem with the old lead system, it may be wise to replace the lead system while inserting the new device..
There are many things that affect how long a pacemaker/ICD battery will last:
⦁ Age of the device..
⦁ Number of leads (1, 2 or 3).
⦁ Pacemaker work load. If the pacemaker is helping the heart more often, then the battery will not last as long as if the pacemaker does not need to help the heart.
⦁ Resistance of the leads. The greater the resistance, the greater the drain on the battery. This can increase as the leads get older or if one or more of the leads does not have the best contact with the heart.
⦁ Power (voltage) settings.
⦁ The health of the person's heart. If the health of the heart gets worse, then the device may have to work more often and the setting changed to accommodate these changes.
Your health care provider will be alerted to the fact that it is time to replace the battery during follow-up exams. He or she will check your device using a small table-top computer, called a programmer, and a wand. The wand is about the same size as a remote control. Your provider puts the wand on your body in the area where the device is located. Information from the device is received about how well your heart is working and the status of the battery. It is not painful, and it usually takes just a few minutes. You will have plenty of time before the battery is fully used up to plan for replacement.
INSTRUCTIONS FOR CARE:
⦁ It is normal to have some discomfort in the area of the implant for the first week or two. You may take Tylenol for this discomfort. You may experience some bruising and swelling at the insertion site. This will improve.
⦁ You should avoid repetitive activity with affected arm/shoulder while sore.
⦁ If you are told NOT to drive, you will need to discuss with your doctor on your three (3) month follow-up appointment when you should resume driving.
⦁ Your incision may be closed with stitches, if so; they cannot be seen and will dissolve on their own. Your incision may be closed with staples, if so; they will be removed when you return for your office visit in 7-10 days.
⦁ In addition, if you develop a fever or chills, you need to notify your physician. Please call our office Monday-Friday from the hours of 8 am-5 pm at (662) 620-6800 and nights and weekends call the NMMC hospital at (662) 377-3000 and ask for the cardiologist on call.
⦁ Remove dressing daily and check for signs of infection. Look for the following signs: Redness, Swelling, Drainage, Warmth
⦁ Change your dressing daily. Do NOT apply any ointments, creams, or lotions to the incision site. A small gauze dressing should be reapplied each day and secured with tape.
⦁ Do NOT get your incision wet. Do NOT take a shower. You may take a sponge or tub bath.
⦁ You should receive an appointment to see a nurse in approximately 7-10 days. After you see the Device Nurse, you will need to start washing your incision. You may shower or continue taking a tube bath, whichever you prefer. You may leave the site open to air and no longer cover it with a dressing.
⦁ Activity:
⦁ You should avoid repetitive activity with affected arm/shoulder while sore.
⦁ Incision Site:
⦁ When changing your dressing you should observe the site.
⦁ There may be some normal bruising and swelling. This should improve.
⦁ If there is an increase in swelling you should call your doctor.
⦁ If there is continuous drainage (longer than 12 hours) on the bandage you should call your doctor.
⦁ Work: You may return to work as soon as you feel able to perform your usual work duties. You will need to discuss with your doctor and confirm a time that is appropriate for you to return to work.
⦁ Follow-up: You will be scheduled to come in to see the Device Nurse for a wound check in 7-10 days at one of the CANM clinics in Columbus, Oxford, Starkville or Tupelo. You will follow up with your doctor in three (3) months after the procedure (our office will call with the appointment date and time). If your device is not checked the day of your wound check, then you should have an appointment to see your doctor in one month following the procedure.
⦁ General Information: Currently pacemakers last 7-10 years and ICD's (defibrillators) last 5-7 years (approximately), before the battery will need replacing. Replacing the device battery is generally an outpatient procedure. Your device will tell us when the battery is approaching the end of life. This can only be determined by the checks done in our office or via the phone interrogation, so it is very important you keep all of your appointments. You will receive a registration card in the mail in 4-6 weeks to your home address. You should carry this card with you at all times.
⦁ Do NOT:
⦁ Manipulate or scratch the area around the incision as this may lead to infection.
⦁ Stand in the metal detectors or door monitors in stores for a long period of time. Walking through at a normal pace is fine.
⦁ Carry a cellular phone in a shirt/jacket pocket over the device. Using the phone is fine!
⦁ Work on electric generators while the machine is running.
⦁ Do NOT weld (If necessary, talk with your physician).
⦁ Your doctor or device representative will let you know if you can have a MRI (Magnetic Resonance Imaging Study)
⦁ You may have a CT or regular X-ray.
⦁ Microwaves are fine!
⦁ Please contact our office from 8 am-5 pm Monday-Friday at 1-866-620-6800 or one of the following numbers, if you have any questions.
CARDIOLOGY ASSOCIATES OF NORTH MISSISSIPPI
Tupelo (662) 620-6800
Oxford (662) 234-7441
Columbus (662) 327-3092
Starkville (662) 324-1475
After 5pm, holidays and weekends call the NMMC hospital at (662) 377-3000 and ask for the cardiologist on call.
⦁ Sedation: If you had sedation, please pay particular attention to the following instructions.
⦁ Do not drink alcoholic beverages including beer for 24 hours. This enhances the effects of anesthesia and sedation.
⦁ Do not drive a motor vehicle; operate machinery or power tools for 24 hours.
⦁ Do not make important decisions or sign important papers for 24 hours.
⦁ You may experience lightheadedness, dizziness and sleepiness following surgery. Please do not stay alone. A responsible adult should be with you for this 24-hour period.
⦁ Rest at home with moderate activity as tolerated. It may not be necessary to go to bed, however, it is important to rest for 24 hours following anesthesia.
⦁ Progress slowly to a regular diet unless your physician has instructed you otherwise.
Pre-op Patient Shared Decision Aid Cardioverter Defibrillator Implantation
An implantable cardioverter defibrillator (ICD) is a small, lightweight, battery-powered device that is placed (implanted) under the skin in the chest or abdomen. Your caregiver may prescribe an ICD if:
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You have had an irregular heart rhythm (arrhythmia) that originated in the lower chambers of the heart (ventricles).
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Your heart has been damaged by a disease (such as coronary artery disease) or heart condition (such as a heart attack).
An ICD consists of a battery that lasts several years, a small computer called a pulse generator, and wires called leads that go into the heart. It is used to detect and correct two dangerous arrhythmias: a rapid heart rhythm (tachycardia) and an arrhythmia in which the ventricles contract in an uncoordinated way (fibrillation). When an ICD detects tachycardia, it sends an electrical signal to the heart that restores the heartbeat to normal (cardioversion). This signal is usually painless. If cardioversion does not work or if the ICD detects fibrillation, it delivers a small electrical shock to the heart (defibrillation) to restart the heart. The shock may feel like a strong jolt in the chest. ICDs may be programmed to correct other problems. Sometimes, ICDs are programmed to act as another type of implantable device called a pacemaker. Pacemakers are used to treat a slow heartbeat (bradycardia).
LET YOUR CAREGIVER KNOW ABOUT:
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Any allergies you have.
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All medicines you are taking, including vitamins, herbs, eyedrops, and over-the-counter medicines and creams.
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Previous problems you or members of your family have had with the use of anesthetics.
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Any blood disorders you have had.
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Other health problems you have.
RISKS AND COMPLICATIONS
Generally, the procedure to implant an ICD is safe. However, as with any surgical procedure, complications can occur. Possible complications associated with implanting an ICD include:
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Swelling, bleeding, or bruising at the site where the ICD was implanted.
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Infection at the site where the ICD was implanted.
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A reaction to medicine used during the procedure.
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Nerve, heart, or blood vessel damage.
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Blood clots.
BEFORE THE PROCEDURE
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You may need to have blood tests, heart tests, or a chest X-ray done before the day of the procedure.
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Ask your caregiver about changing or stopping your regular medicines.
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Make plans to have someone drive you home. You may need to stay in the hospital overnight after the procedure.
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Stop smoking at least 24 hours before the procedure.
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Take a bath or shower the night before the procedure. You may need to scrub your chest or abdomen with a special type of soap.
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Do not eat or drink before your procedure for as long as directed by your caregiver. Ask if it is okay to take any needed medicine with a small sip of water.
PROCEDURE
The procedure to implant an ICD in your chest or abdomen is usually done at a hospital in a room that has a large X-ray machine called a fluoroscope. The machine will be above you during the procedure. It will help your caregiver see your heart during the procedure. Implanting an ICD usually takes 1–3 hours. Before the procedure:
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Small monitors will be put on your body. They will be used to check your heart, blood pressure, and oxygen level.
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A needle will be put into a vein in your hand or arm. This is called an intravenous (IV) access tube. Fluids and medicine will flow directly into your body through the IV tube.
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Your chest or abdomen will be cleaned with a germ-killing (antiseptic) solution. The area may be shaved.
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You may be given medicine to help you relax (sedative).
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You will be given a medicine called a local anesthetic. This medicine will make the surgical site numb while the ICD is implanted. You will be sleepy but awake during the procedure.
After you are numb the procedure will begin. The caregiver will:
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Make a small cut (incision). This will make a pocket deep under your skin that will hold the pulse generator.
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Guide the leads through a large blood vessel into your heart and attach them to the heart muscles. Depending on the ICD, the leads may go into one ventricle or they may go to both ventricles and into an upper chamber of the heart (atrium).
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Test the ICD.
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Close the incision with stitches, glue, or staples.
AFTER THE PROCEDURE
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You may feel pain. Some pain is normal. It may last a few days.
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You may stay in a recovery area until the local anesthetic has worn off. Your blood pressure and pulse will be checked often. You will be taken to a room where your heart will be monitored.
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A chest X-ray will be taken. This is done to check that the cardioverter defibrillator is in the right place.
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You may stay in the hospital overnight.
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A slight bump may be seen over the skin where the ICD was placed. Sometimes, it is possible to feel the ICD under the skin. This is normal.
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In the months and years afterward, your caregiver will check the device, the leads, and the battery every few months. Eventually, when the battery is low, the ICD will be replaced.
VALUES AND WISHES
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If you have a severe infection, your doctor will discuss with you if your ICD and or lead(s) will need to be removed and/or replaced.
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If your health becomes very poor due to another cause and you are wanting to discuss turning off your ICD, your doctor will discuss some choices with you that may not involve surgery.
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Your doctor can discuss with you your long-term health goals.
SURVIVAL AND BENEFITS
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Patients WITHOUT an ICD have a greater chance of sudden death from an irregular heart rhythm. Based on a research study* over a 5 year timeframe, 36 patients out of 100 patients with heart failure will die.
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Patients WITH an ICD have a lesser chance of suddenly dying from an irregular heart rhythm. Based on a research study* over a 5 year timeframe, 29 patients out of 100 patients with heart failure will die. So, over a 5 year timeframe, 7 more lives will be saved.
*SCD-HeFT.Bardy, GH , et al. NEJM 2005;352:225-237.