Pacemakers & Implantable Devices

A pacemaker is a small, battery-operated device that helps the heart maintain a normal heart rate. The doctor implants the pacemaker under the skin, just under the collarbone. If your heartbeat is too slow as a result of abnormalities in your heart’s electrical conduction system, your doctor may recommend a pacemaker.

How Pacemakers Work

Pacemakers contain sensitive electrodes that monitor your heart’s activity. In the case of an excessively slow heart rate, the pacemaker automatically sends electrical pulses that pace the heart and regulate the heartbeat. Most people are not aware of the pacemaker itself, or the activity of the pacemaker.

Preparing for Your Pacemaker Implant

You may need to stop taking some medications, including blood thinners, before the procedure. Don’t eat or drink anything after midnight the day before.

On the day of the procedure, a family member or friend should drive you to BIDMC. Although you'll be wearing a hospital gown during the procedure, you will want comfortable clothes to change into afterward. You also may want to bring toiletries and personal items.

We will call you one to two days before your procedure with the time you should arrive at the medical center.

What To Expect During Pacemaker Implant

We perform pacemaker implantation in the CardioVascular Institute’s Electrophysiology (EP) Lab, located on the West Campus of BIDMC on the fourth floor of the Baker Building (Farr Complex) at 185 Pilgrim Road.

During the procedure, a member of your care team delivers local anesthesia to the area beneath your collarbone, numbing just that area. They make a small incision. Most often, the incision is on the left side. Your doctor inserts the pacemaker wires through this incision and into a vein that leads to the heart.

Once the wires are in place, the doctor connects the wires to the pacemaker. The pacemaker sits below the skin near the incision. A member of your care team closes the incision with stitches and covers it with a bandage.

The procedure takes about two hours. You can expect to spend one night in the hospital after having a pacemaker implanted. Before you leave the hospital, a member of your care team will check your pacemaker. Your doctor will let you know what activities to avoid during your recovery.

Recovery from a Pacemaker Implant

After the procedure, you'll have restrictions on some arm movements on the side where the pacemaker is. You'll need to avoid strenuous activity — especially involving the upper body —for four to six weeks. You should be able to resume driving one week after the procedure once you've returned for your follow-up visit and we've checked your pacemaker function.

Once the pacemaker is in place, you'll need to avoid these activities:

• MRI scans, if your pacemaker is not specifically approved for use with an MRI
• Heat therapy (often a part of physical therapy)
• High-voltage or radar machinery such as electric arc welders, high-tension wires, radar installations or smelting furnaces
• Airport security scanners: instead of passing through the metal detector, passengers with pacemakers should request to be screened by imaging technology or pat-down

Be sure to tell your dentist and other doctors about your pacemaker as well. 

Living With a Pacemaker

After your pacemaker is in place, you can expect to have a healthy, regular heartbeat. We recommend these steps:

• Follow your doctor's advice on activities
• Take medications exactly as instructed
• Keep regular check-up appointments so your doctor can alert you if the battery is running low
• Carry a pacemaker ID card in case of emergencies (a free download is available from the American Heart Association)

A pacemaker battery should last anywhere from five to 10 years. Once the battery runs out, you’ll need another procedure to get replace the generator. The procedure to change the pacemaker’s battery is relatively simple, does not involve an overnight stay in the hospital and requires less recovery time.

An implantable cardioverter defibrillator (ICD) is a battery-powered device that the specialist places under the skin to track your heart rate. Thin wires connect the ICD to your heart. When the device detects an abnormally fast heartbeat, the device delivers an electrical shock to normalize your heartbeat.

Some newer implantable cardioverter defibrillators also include a pacemaker function that allows the device to detect abnormally slow heart rhythms.

Implantable cardioverter defibrillators emit low-energy and high-energy pulses. Low-energy pulses are painless, and you will not notice them. However, you may feel a “thump” in your chest during a high-energy pulse. High-energy pulses only last for fractions of a second.

There are two kinds of implantable cardioverter defibrillators:

• Single-chamber implantable cardioverter defibrillators have a wire that connects to either the right ventricle or the right atrium.
• Dual-chamber implantable cardioverter defibrillators have wires that connect to both an atrium and a ventricle.

Candidates for Implantable Cardioverter Defibrillator

Your specialist may suggest an implantable cardioverter defibrillator (ICD) if you have a chronic (long-term), life-threatening arrhythmia due to these conditions:

• Brugada syndrome
• Cardiac arrest survival
• Congenital heart disease
• Heart attack(s)
• Long QT syndrome
• Ventricular arrhythmia

Preparing for an Implantable Cardioverter Defibrillator

You may need to stop taking some medications — including blood thinners — prior to your procedure. Don’t eat or drink anything after midnight the day before.

On the day of the procedure, a family member or friend should drive you to BIDMC. Although you’ll be wearing a hospital gown during the procedure, you will want to wear comfortable clothes to change into afterward. You may want to bring toiletries and personal items.

Our team will call you one to two days before your procedure with the time you should arrive at the medical center.

What To Expect

We perform implantable cardioverter defibrillator (ICD) implantation in the CardioVascular Institute’s Electrophysiology (EP) Lab, located on the West Campus of BIDMC on the fourth floor of the Baker Building (Farr Complex) at 185 Pilgrim Road.

During the procedure, you’ll receive local anesthesia to the area beneath your collarbone, and a small incision will be made. Most often, the incision is on the left side. A member of the team will insert the ICD wires through this incision and into a vein that leads to the heart.

Once the wires are in place, a member of your care team will connect them to the implantable cardioverter defibrillator (ICD). The ICD sits below the skin at the incision. After the implantable cardioverter defibrillator (ICD) is in place, a member of your care team closes the incision with stitches and covers it with a bandage.

The procedure takes about two hours. You can expect to spend one night in the hospital. Before you leave the hospital, a member of your care team will check the ICD. Your doctor will let you know what activities to avoid during the recovery period. 

Recovery from Implantable Cardioverter Defibrillator Implant

After an implantable cardioverter defibrillator (ICD) is implanted, some of your arm movements on the side of the ICD will be restricted. You should avoid strenuous activity — especially involving the upper body — for four to six weeks.

Most people can start driving again one week after the procedure, once you’ve come back to the office for our team to check your implantable cardioverter defibrillator (ICD) function.

Be sure to tell your dentist and all other doctors about your implantable cardioverter defibrillator.

Living with an Implantable Cardioverter Defibrillator

After your implantable cardioverter defibrillator (ICD) is implanted, we recommend these steps:

• Follow activity instructions that your doctor provides
• Take medications exactly as instructed
• Keep check-up appointments so your doctor can alert you if the battery is running low
• Monitor your mental health: in some cases, patients with ICD experience feelings of anxiety or depression, so be sure to talk to your doctor if you have changes in your mental health
• Carry an implantable cardioverter defibrillator identification card in case of emergencies (a free download is available from the American Heart Association)

Once you have an implantable cardioverter defibrillator, you will need to avoid these activities:

• MRI scans
• Heat therapy (this may be part of physical therapy)
• High-voltage or radar machinery such as electric arc welders, high-tension wires, radar installations or smelting furnaces
• Airport security scanners: instead of passing through the metal detector, you must ask to be screened by imaging technology or pat-down

An implantable cardioverter defibrillator (ICD) battery should last anywhere from five to ten years. During your regular ICD check-ups (every three to six months), your doctor will test the device's battery life. If the battery is running low, your doctor will replace it with a new one during a minor outpatient procedure.

The procedure to change the pacemaker's battery is simple, does not involve an overnight stay in the hospital and requires little recovery time.

To fix structural heart and valvular conditions, our specialists offer the latest treatments:

• Artificial heart valve replacement
• ECMO
• MitraClip
• Transcatheter aortic valve replacement (TAVR)

Heart Valve Repair with MitraClip

The goal of this heart valve surgery is to repair defective or diseased heart valves. This includes minimally invasive mitral valve repair to improve the flow of oxygen-rich blood throughout the body.

During this procedure, the doctor implants a device called a MitraClip through a catheter. This device functions in place of the damaged mitral valve. The procedure helps alleviate the feeling of fatigue or breathlessness that frequently results from a damaged mitral valve. The MitraClip procedure usually takes two to three hours and requires an overnight stay in the hospital.

MitraClip therapy makes it possible for people with mitral valve disease to benefit from reduced symptoms without surgery. While surgery is the typical option for patients who are strong enough, we don't use this treatment for those who are frail and have severe mitral valve regurgitation.

Extracorporeal Membrane Oxygenation (ECMO) 

Specialists use the ECMO support device to treat advanced left ventricular heart failure. ECMO works by bringing in oxygen and removing carbon dioxide from your blood. 

ECMO is a special device that is located outside your body. 

Our cardiac surgery team has particular expertise in high-risk surgeries with ventricular assist backup. VADs are mechanical devices that take over the pumping function of the heart’s ventricles to help the failing heart pump blood throughout the body. VADs help on a short-term or long-term basis.  

We implant VADs next to the heart and maintain blood flow consistent with a healthy heart. If you have advanced heart failure that hasn’t responded to medications, this may be a good treatment option for you.  

Percutaneous Ventricular Assist Devices

These are temporary assist devices that your surgeon places under your skin (percutaneous) in the catheterization lab. You’ll be admitted to the hospital if you receive one of these devices. 

Percutaneous VADs include Impella CP, Impella RP and Impella 5.0 devices. These are important treatment options for those with advanced heart failure and cardiogenic shock who are waiting for a long-term solution. 

Cardiac Resynchronization

Cardiac resynchronization therapy (CRT) involves implanting a biventricular pacemaker to send timed electrical impulses to the heart’s lower chambers (the ventricles). This helps them pump in a synchronized manner.

BIDMC VAD Program 

The BIDMC ventricular assist device (VAD) program uses a multidisciplinary team. We provide world-class care for people with end-stage heart failure who require advanced treatment. Depending on your needs, your care team may include these and other specialists:

A left atrial appendage (LAA) occlusion is a procedure that seals off the left atrial appendage with a self-expanding device. This prevents blood from pooling and preventing blood clots from forming. As a result, it lowers your risk of stroke. One device approved by the U.S. Food and Drug Administration (FDA) to close the LAA is the Watchman device.

If advanced heart failure has severely weakened your heart, our cardiac surgeons provide temporary and durable support to restore the heart’s pumping capabilities. Our Advanced Heart Failure Program provides you with a complete range of medical and surgical treatments.

Specialized devices inside your body can manage advanced heart failure by doing several key things:

• Regulating your heartbeat
• Pumping blood throughout your body
• Tracking your vital signs to improve your treatment

BIDMC's Advanced Heart Failure Program can treat various heart failure symptoms with a range of devices and procedures.

If you have a pacemaker or ICD, you can count on our team for ongoing care and support. Active management by our experienced team can help ensure the effectiveness and safety of your device. 

Cardiac devices can become infected or stop working, which requires removal or replacement. In certain situations, your specialist may need to upgrade your device. 

The BIDMC Arrhythmia Service is one of New England’s busiest device management centers. Our team performs lead removals and replacements using the full range of tools available, including the latest laser technology. 

Device Changes 

Progression of heart disease may require you to switch from one kind of device to another. Our team is experienced in successfully upgrading an existing pacemaker or ICD to a cardiac resynchronization therapy (CRT) device. 

Lead Management 

Most pacemakers have electrical leads — or wires — that carry electrical signals between the pulse generator and your heart. Sometimes, your doctor may need to take out and replace the wires. Our doctors are pioneers in lead extraction procedures. We’ve studied the impact of devices on the heart's structure to ensure a safe procedure. Our team works with expert cardiac surgeons and infectious disease specialists, as needed.

Some pacemakers — called leadless devices — don’t have wires or leads. These devices are for those who only need the pacemaker to stimulate one chamber of the heart. They aren’t for people who have cardioverter defibrillators or certain types of heart malformations. Progression of heart disease may require you to switch from one kind of device to another.