Device Clinic
Overview
The Peterborough Regional Cardiac Rhythm Device Clinic
The Peterborough Regional Cardiac Rhythm Device Clinic provides follow-up for patients with Cardiac Implantable Devices such as Loop Recorders, pacemakers and Implantable Defibrillators. Registered Nurses and Cardiovascular Technologists who have special training and expertise in managing the devices and patients with cardiac rhythm problems, staff the clinic under the supervision of our Cardiologists.
The clinic is open Monday to Friday from 8am to 4pm all working days of the year.
Advisories
Current advisories from the Canadian Heart Rhythm Society about certain implantable ICDs and Pacemakers.
Frequently Asked Questions
Frequently Asked Questions About Implantable Pacemakers/ICD’s
Q: What is a Pacemaker?
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A: A Pulse Generator (pacemaker) is a small metal container that houses a battery and the electrical circuitry that regulates the rate of electrical pulses sent to your heart. It is placed under the skin in your chest to help control your heartbeat. It’s used to help your heartbeat more regularly if you have an irregular heartbeat (arrhythmia), particularly a slow one. Implanting a pacemaker in your chest requires a surgical procedure. Pacemakers work only when needed. If your heartbeat is too slow (bradycardia), the pacemaker sends electrical signals to your heart to correct the beat.
Q: Are there Different Types of Pacemakers?
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A: Depending on your condition, you might have one of the following types of pacemakers.
➢ Single chamber pacemaker. This type usually carries electrical impulses to the right ventricle of your heart.
➢ Dual chamber pacemaker. This type carries electrical impulses to the right ventricle and the right atrium of your heart to help control the timing of contractions between the two chambers.
➢ Biventricular pacemaker. Biventricular pacing, also called cardiac resynchronization therapy, is for people with heart failure with abnormal electrical systems. This type of pacemaker stimulates the lower chambers of the heart (the right and left ventricles) to make the heartbeat more efficiently.
➢ Leads (electrodes). One to three flexible, insulated wires are each placed in a chamber, or chambers, of your heart and deliver the electrical pulses to adjust your heart rate. They connect to the pulse generator.
Q: What is an Implantable Cardiac Defibrillator?
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A: A Defibrillator (also known as an ICD) is also a pacemaker but has an added ability to treat fast, life-threatening heart rhythms. It does this by either pacing the heart rapidly or shocking the heart when such a rhythm is detected. It has a wide variation of “programs”, and that program will be individualized to your particular heart rhythm problem. These devices are best managed by remote monitoring and occasional clinic visits.
Q: What is an Implantable Loop Recorder
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A: A Loop Recorder is a very small implanted device that records your heart rhythm. It is used to uncover conditions that may be giving symptoms and have not yet been diagnosed. It does not treat any rhythm condition. Information can be downloaded when you visit the clinic. It is usually removed after diagnostic information has been attained.
Q: How is a Loop Recorder Implanted?
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A: During a loop recorder implantation, your doctor does a minor procedure. He or she places the small device under your skin, on your chest wall, overlying the heart. The machine works as an electrocardiogram (ECG), continuously picking up electrical signal from your heart.
Note: These devices do not pace the heart or affect heart function. They only record information. Interference with your device has no impact on your heath status. Should there be any type of interference this will only result in the device recording signals that do not originate from the heart. There are no restrictions for loop recorder patients imposed by the loop recorder.
Q: How is a Pacemaker and ICD Implanted?
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A: A pacemaker/ICD and loop recorder require surgery to be implanted. Usually, surgery is not done under general anesthesia. Instead, conscious sedation is used. You will be given medication to help you relax, but you will still be aware of your surroundings. You will be able to hear and talk with the medical team as the procedure is being conducted. Numbing medication is given where the incision is made. While the local anesthetic will block sharp pain, you may still feel some pressure while the device is being implanted.
Note: Currently, only Pacemakers and Loop recorders are implanted in Peterborough. ICDs are referred elsewhere for implant but can return to the Peterborough Device Clinic for follow-up.
Q: How do I prepare for surgery?
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A: Prior to your procedure your doctor will review your medical history. He or she will also explain the purpose of the defibrillator, pacemaker or implantable Loop recorder, its potential benefits and possible risks. The risks of implanting a defibrillator, pacemaker or loop recorder are small and relatively safe. Most patients undergoing these procedures do not experience complications.
You will need to have blood tests, ECG and chest x-ray, before the procedure and you may need to be seen by the anesthetist. Your doctor’s office or the surgeon’s office will arrange these for you.
Note:
➢ Take a shower the night before or the morning of your surgery.
➢ Please bring with you all of your current medications or an accurate pharmacy list of them.
Continued:
➢ You will not require any personal items for your surgical day. DO NOT bring large sums of money or valuables to the hospital.
➢ You will require a driver to pick you up and someone to stay with you during the night, after you have had your procedure.
➢ If you need an interpreter, bring a friend or family member on the day of the procedure. You’ll be sedated during this procedure. Your friend or family member will be instructed on how to care for you or assist with your care after the procedure on discharge and will be required to drive and/or accompany you home. They can also help you gather information, take notes and ask questions.
Q: How do I manage my medications?
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A: You can have NOTHING to eat or drink from midnight the night before your procedure. Take your morning medications as usual.
Note: The exception to this may be a blood thinner or diabetic medication. You may be given specific instructions how to handle this. Medications can be taken with a sip of water unless you are instructed otherwise.
Blood Thinners such as Coumadin® (Warfarin), Pradaxa® (Dabigatran), Eliquis® (Apixaban) and Xarelto® (Rivaroxaban) are usually stopped 1 – 3 days before the procedure. You will be given specific instructions about what to do by your doctor or the Surgeon.
If you take any medication (pills or insulin) for your diabetes, ask for instructions from the surgical office or from your doctor about medication and food the day of the surgery.
Q: How do I manage my medications?
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A: You can have NOTHING to eat or drink from midnight the night before your procedure. Take your morning medications as usual.
Note: The exception to this may be a blood thinner or diabetic medication. You may be given specific instructions how to handle this. Medications can be taken with a sip of water unless you are instructed otherwise.
Blood Thinners such as Coumadin® (Warfarin), Pradaxa® (Dabigatran), Eliquis® (Apixaban) and Xarelto® (Rivaroxaban) are usually stopped 1 – 3 days before the procedure. You will be given specific instructions about what to do by your doctor or the Surgeon.
If you take any medication (pills or insulin) for your diabetes, ask for instructions from the surgical office or from your doctor about medication and food the day of the surgery.
Q: What Happens During Surgery to Implant a Pacemaker?
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A: The surgery is done in the operating room or heart catheterization lab. The environment is kept cool to keep the machines working properly, so you may feel cool as well. During the procedure, the nurses will monitor your heart rhythm and blood pressure. Sterile sheets will be put on you to keep the insertion site clean
The doctor will make a small cut in the upper chest and locate the vein. A small puncture is made in the vein, and the leads will be guided down the vein to the heart. The surgical team monitors the placement of the leads using a fluoroscope (type of x-ray).
Note: This is often the most time-consuming part of the operation, as the leads needs to be placed in the most optimal spot.
Next a small “pocket” is made by separating the skin and underlying tissue from the muscle, as this will be the location for the pacemaker or ICD. The pacemaker/ICD is than connected to the leads and placed in the pocket. Once the device is in place, the doctor will close the incision.
Q: How long does the surgery take?
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A: Surgery usually takes 1 – 2 hours; however, you will be here all day. Most patients are discharged the same day, but an overnight stay can last 1 – 2 days.
We do everything that we can to stay on time. Unfortunately, your appointment may be delayed by unforeseen circumstances. We recommend that you come prepared for delays.
Q: What happens after the surgery?
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A: When you wake up from the anesthetic, you will be drowsy and feel some discomfort. You will be in the recovery room for approximately 1 hour before returning to your room or on the Short Stay Unit.
When you return to your room, you’ll be allowed to have something to eat and drink. You will be connected to a telemetry monitor to monitor your heart and its activity until you are discharged from the hospital.
The nursing staff will monitor your heart rhythm and respiration rate and provide medication to control pain at the site of the incision.
Q: What does recovery look like?
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A: It is difficult to be specific about your recovery because every patient is different. However, generally recovery time varies between about 4-6 weeks. You can return to daily activities gradually. Remember to rest when you are tired. Avoid strenuous activities such as lifting heavy objects, vigorous push-pull movements (i.e.: vacuuming), above-the-shoulder activities (i.e.: tennis/golf) and overhead reaching and stretching, you may otherwise have normal range of movement.
You will be given a temporary device Identification (ID) Card that should be carried with you at all times. The permanent card will be mailed to you with four to six weeks. Let your clinic staff know if you don’t receive it. The ID card provides emergency phone number and information about your device. A letter from The Device Clinic will be given to you following surgery. It describes how to contact the Clinic and the date of your follow up appointment.
If you have a newly implanted Pacemaker or ICD, you should wait until your first follow up appointment to drive. Always wear a seatbelt, even if it crosses over your site. Keep your incision drive.
Q: How do I care for my wound?
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A:
➢ You may take a bath without getting your wound wet
➢ Avoid powders, creams and ointments at the incision site
➢ Keep your bandage dry-if it falls off, leave it off
➢ You may usually remove the outer bandage after 48 hours
➢ After 7 days, gently remove any remaining bandage but leave the small strips that cross over the incision
➢ Report any signs of infection such as fever, heat at pocket, drainage of increasing pain
➢ Attend your appointment at the Clinic at day 8-10 to have any stiches removed (some are dissolvable), the wound examined and device assessment done (this appointment should be given to you in the OR- if not, call 705-775-3333)
Q: What is remote monitoring?
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A:
➢ In-Clinic
➢ Remote Monitoring (device specific)
➢ Combination of the two
No matter what type of follow up you choose, you will always have your first several appointments in-clinic. This is for the purpose of educating you, checking your incision and pocket and fine-tuning the settings of the device to best suite your heart rhythm and your lifestyle.
Our Device Clinic, at Kawartha Cardiology is specialized. Nurses and technicians, who have received extra training and education in the field, staff this Clinic.
They are experts. They work under the direction of a Cardiologist. There is always a Cardiologist in the Clinic and available to see you in the event of any complications or concerns.
Many pacemakers and ICDs can now be followed remotely from your home or wherever you are. The ability to do this is dependent on the type of device that you have been given.
Q: What are my options for follow-up?
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A: Remote monitoring involves having a transmitter from the manufacturer of your device. It sits at your bedside and, through wireless technology, transmits the parameters and rhythms of your heart and your device, while you sleep. If any values are found to be abnormal, a transmission is sent to a monitoring station. In turn, that transmission is forwarded to our Clinic to let us know that you need attention. You may then get a phone call from us. This could all be done without your awareness.
There is also the ability for you to initiate a transmission if you are having symptoms of concern. This is the ideal follow up method for those of you with ICD and can also be convenient and helpful in patients with pacemakers.
Q: How often should my pacemaker/ICD be checked?
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A: A pacemaker/ICD should be checked 1-2 weeks after implant. This initial visit is a longer appointment as all aspects of life with your pacemaker/ICD will be discussed. The stitch (if not dissolvable) will be removed. Wound care will be addressed. Consent forms will be signed.
Subsequent to this visit, we will arrange to see you at 6 weeks and then again at 6 months. After that, routine follow up will take place every 6 months/yearly. At times visits are warranted in between.
As the pacemaker approaches replacement time, you may be checked more frequently.
Q: What happens during a follow-up appointment?
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A: During your visit, the nurse or technician will use a programmer to check your device. The programmer is a special external computer that can communicate with your device in two ways:
➢ By using radio frequency (RF) telemetry communication, if you have an RF-enabled device
➢ By using wanded telemetry communication. In this case the nurse or clinician will place a wand over your skin near your device.
A typical follow-up visit takes 20 minutes. During your visit, your nurse or technician will use the programmer to interrogate or check your device. They will review the devices memory to evaluate its performance since your last visit. Battery and lead status are assessed, along with evaluating whether there have been changes in your heart rhythm.
Note: It is important to attend these visits, even if you are feeling well. There are many programmable features inside the device. Safety needs to be maintained.
Q: What should I know about my pacemaker/ICD battery?
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A: A battery, safely sealed within your device, provides the energy to monitor your heart rhythm. Specifically, it provides the energy needed to pace the heart for slow rhythms or treat life threatening arrhythmias. Just like any other type of battery, the battery in your device will be used up over time. Since the battery is permanently sealed within your device, it cannot be replaced when the energy is depleted. Your entire device will need to be replaced. Life expectancy is anywhere between 5-15 years depending on the type of device you have and its individual settings.
Q: How will I know if my battery is running low?
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A: Device batteries have very predictable behaviour over time. Your device will regularly check its own battery. At every follow-up, your nurse or technician will check to see how much energy is remaining in the battery.
Q: How is my battery replaced?
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A: Eventually the energy in your device’s battery will decrease to a point where your device will need to be replaced. To replace your device, your doctor will surgically open the pocket of skin where your device is located. Your leads will be disconnected from your old device and a new one will be placed. Leads are than connected.
Note: should a lead need to be replaced due to poor function, your doctor will insert a new lead into a vein, similar to how the original lead was implanted.
Q: Are there any safety concerns with my ICD/Pacemaker?
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A: Magnets:
➢ Do not put anything with a magnet within 6 inches or 15 cm of your pacemaker/ICD.
Note: If you mistakenly place a magnet too close to your heart device, simply move the item away. Removing the magnet returns the pacemaker or implantable defibrillator back to its previous, normal programming
Cellphones:
➢ It’s safe to talk on a cellphone, but keep your cellphone at least 6 inches (15 centimeters) away from your pacemaker/ICD. Don’t keep your phone in a shirt pocket. When talking on your phone, hold it to the ear opposite the side where your pacemaker/ICD was implanted.
Antitheft gates:
➢ Walk directly through them. Do not linger.
Power-generating equipment:
➢ Stand at least 2 feet (61 centimeters) from high-voltage transformers or motor-generator systems.
➢ Unlike most other household power tools, welding with currents above 160 amps may have a higher tendency to temporarily affect the normal function of your pacemaker or implantable defibrillator.
Note: If you work around such equipment, ask your clinic staff to help determine whether the equipment affects your device.
Medical equipment:
➢ Make sure all your doctors and dentists know you have a pacemaker/ICD. Certain medical procedures, such as magnetic resonance imaging, CT scans, cancer radiation treatment, electrocautery to control bleeding during surgery, and shock wave lithotripsy to break up large kidney stones or gallstones could interfere with your pacemaker/ICD.
Note: there are MRI “safe” pacemakers- enquire if your is such a model)
Security systems:
➢ Passing through an airport metal detector won’t interfere with your pacemaker/ICD, although the metal in it could sound the alarm. But avoid lingering near or leaning against a metal-detection system.