Pacemaker & Defibrillator Implementation

Pacemaker & Defibrillator Implementation

When the heart’s natural pacemaker (the network of heart tissues that conduct the electrical impulse downward from the atria to the ventricles) malfunctions, the signals sent out may become erratic — too slow, too fast or too irregular to stimulate adequate contractions of the heart chambers.

When the heartbeat becomes erratic, it's called  arrhythmia, an abnormal rhythm of the heart. Arrhythmia can cause the heart to pump less effectively. Pacemakers and defibrillators can be implanted to help with this condition.

At Phoenix Children's Hospital, our teams have extensive experience using both of these tools to bring healing and care to our patients.

Pacemaker

This is a small device that we implant under the skin. It sends electrical signals to start or regulate a slow heartbeat. Implanted pacemakers are used to stimulate a patient’s heartbeat if the heart's natural pacemaker (the sinoatrial, or SA, node) isn’t functioning properly. An implanted pacemaker can also assist children who have an abnormally slow heart rate or rhythm, or if the electrical pathways are blocked.

Implantable Cardioverter Defibrillator (ICD)

This is a small device that we implant in the skin. An ICD senses the rate and regularity of the heartbeat. When the heart rate goes too high, the ICD delivers a small, electrical shock to the heart to slow the heart rate.

Many newer ICDs can also function as a pacemaker by pacing the heart out of a rapid rhythm and taking over when the heart rate is dangerously low. When the heartbeat becomes so erratic and disorganized that the heart muscle cannot pump blood from the ventricles, an ICD can deliver a stronger electrical pulse, often referred to as a "shock," that can restore organized electrical activity, and therefore an effective heartbeat, to the ventricles.

What happens during the procedure?

These procedures are performed in the hospital, either as a short-stay surgical procedure, or in the cardiac catheterization or electrophysiology laboratory.

Before the implantation, a child receives local anesthesia over the incision site and usually sedation to help them relax.

For older children and teenagers who receive a transvenous pacemaker, a small incision is made just under the collarbone. The pacemaker/ICD lead(s) are inserted into the heart through a blood vessel that runs under the collarbone. This procedure is usually performed in the catheterization laboratory.

In younger children, the pacemaker may be placed into the abdomen through a small incision. A second incision is made in the chest to visualize the heart. The lead(s) are gently guided to the heart, then placed on the heart's surface. This procedure is usually performed in the operating room.

What happens after the procedure?

• Once the procedure is over, the child goes through a recovery period of several hours, and is usually allowed to go home the day after the procedure.
• After a child receives a pacemaker or ICD, parents or care-givers receive an identification card from the manufacturer that includes information about the child’s specific model of pacemaker, serial number and details on how the device works. Families and loved ones should carry this card with them at all times so the information is readily available whenever a healthcare professional examines or treats the child.
• In addition, the child can wear a medical identification bracelet or necklace to alert others about the pacemaker or ICD in case of emergency.