Pacemaker

A pacemaker is a small device that sends electrical impulses to the heart muscle to maintain a suitable heart rate.

Types of Pacemakers

The pacemaker has two parts: the leads and a pulse generator. There are different types of pacemakers. Some have one lead, pacing only the ventricles or the atria; others have two leads, pacing both chambers.

 Single chamber pacemaker

1 lead in the upper or lower chamber of the heart.

Dual chamber pacemaker

1 lead in the upper chamber and one lead in the lower chamber of your heart

Why you need a pacemaker

Your doctor programs the pacemaker to help to control your abnormal heart rate or rhythm. Pacemakers are used most commonly for:

• Bradyarrythmias
  slow heart rhythms which may arise from disease in the heart’s conduction system (such as the SA node, AV node or HIS-Purkinje system.

The doctor programs the minimum heart rate. When your heart rate drops below the set rate, your pacemaker generates (fires) an impulse that passes through the lead to the heart muscle. This causes the heart muscle to contract, creating a heart beat.

Pacemakers are also used to treat:

• Heart failure
• Hypertrophic cardiomyopathy

What to expect:

• You will lie on a bed and the nurse will start an intravenous line (IV) into your arm or hand. This is so you may receive medications and fluids during the procedure. You will be given a medication through your IV to relax you and make you drowsy, but it will not put your to sleep.

• The nurse will connect you to several monitors. The monitors allow the doctor and nurse to check your heart rhythm, blood pressure and other measurements during the pacemaker implant.

Your left or right side of your chest will be shaved and cleansed with a special soap. Sterile drapes are used to cover you from your neck to your feet. A strap will be placed across your waist and arms to prevent your hands from coming in contact with the sterile field.

Pacemakers are implanted two ways:

Endocardial (transvenous approach) – most common
A lead is placed into a vein, then guided to your heart. The lead tip attaches to your heart muscle. The other end of the lead is attached to the pulse generator, which is placed under the skin in your upper chest. This approach is done under local anesthetic (you will not be asleep).

Epicardial approach – less common in adults, more common in children
The lead tip is attached to the outside of the heart. The other end of the lead is attached to the pulse generator, which is placed under the skin in your abdomen. This approach is done under general anesthesia (you will be asleep) by a surgeon.

• The doctor will numb your skin by injecting a local numbing medication. You will feel a pinching or burning feeling at first. Then, it will become numb. Once this occurs, an incision will be made to insert the pacemaker and leads. You may feel a pulling as the doctor makes a pocket in the tissue under your skin for the pacemaker. You should not feel pain. If you do, tell your nurse.

• After the pocket is made, the doctor will insert the leads into a vein and guide them into position using the fluoroscopy machine.

• After the leads are in place, their function is tested to make sure they can increase your heart rate. This is called “pacing” and involves delivering small amounts of energy through the leads into the heart muscle. This causes the heart to contract. When your heart rate increases, you may feel your heart is racing or beating faster. It is very important to tell your doctor or nurse any symptoms you feel. Any pain should be reported immediately.

• After the leads are tested the doctor will connect them to your pacemaker. Your doctor will determine the rate of your pacemaker and other settings. The final pacemaker settings are done after the implant using a special device called a “programmer.”

The pacemaker implant takes about two to five hours to perform.

After the procedure:

• Overnight care: you will be admitted to the hospital overnight. The nurses will monitor your heart rate and rhythm. The morning after your implant, you will have a chest x-ray to ensure the leads and pacemaker is in the proper position.
• Wound care: keep your wound clean and dry. After five days, you may take a shower. Look at your wound every day to make sure it is healing. Call your doctor if you notice:
  • Redness
  • Swelling
  • Drainage
  • Fever
  • Chills
• Pacemaker Identification: your pacemaker settings will be checked before you leave the hospital. You will be given information about:
  • the type of pacemaker and leads you have
  • the date of implant
  • the doctor who implanted them. In about three months you will receive a permanent card from the company. It is important that you carry this card at all times in case you need medical attention.
• Activity: you may move your arm normally.
  • You do not need to restrict arm motion during normal activities.
  • Avoid extreme pulling or lifting motions
  • Avoid activities such as golf, tennis and swimming for six weeks.
  • Ask your doctor when you can resume more strenuous activities
• Electrical interference: most electrical devices, such as microwave ovens, do not interfere with pacemaker function. You need to avoid strong electric or magnetic fields such as:
  • Some industrial equipment, high output ham radios, high intensity radiowaves (found near large electrical generators, power plants or radiofrequency transmission towers), and arc or resistance welders
  • Cellular phones should not be placed directly against the chest or on the same side as your pacemaker.
  • Do not undergo any tests that require magnetic resonance imaging (MRI).
  • If you have concerns about your job or activities, ask your doctor.

Follow-up: A wound check is due 7 days after your procedure.  A complete pacemaker check should be done six weeks after your pacemaker is implanted. This can be done early if needed.  Then your pacemaker should be checked every three months on the telephone to evaluate battery function. When the battery function becomes low, it will be necessary to change your pacemaker (pacemakers usually last about four to eight years). We can arrange for a phone check if you wish.

Implantable Defibrillators

One of the treatment option for people at risk for life-threatening arrhythmias is an implanted cardioverter defibrillator. FDA approved the first implantable defibrillators more than 10 years ago. Today’s device typically consists of a generator slightly smaller than the size of a wallet attached to electrode catheters. The generator is surgically placed under or over chest or abdominal muscles. The catheters are threaded through veins to their permanent positions in the heart. Complications of implanting defibrillators are rare but serious and include bleeding, infections, and perforation of the heart.

Implanted defibrillators monitor the heart rhythm and automatically treat, with electrical stimuli or shocks, rhythms recognized as abnormal. Newer devices also can record and store data of the electrical activity of the heart that doctors can later download and evaluate for arrhythmias. The data also can be used to perform electrophysiologic testing.

Implanted defibrillators can often stem ventricular arrhythmias with low-energy shocks. Sometimes, however, high-energy shocks are needed. These shocks, though short-lasting, can be painful–somewhat akin to a kick in the chest.

The generators in implanted defibrillators usually last depending upon the usage approximately five years and can be replaced with a surgical procedure that usually requires only local anesthesia. The electrode leads tend to last longer, although they can develop cracks or component failures that require their replacement.

Normal Heart Rhythms

Normally, the signal that tells your heart to beat comes from a small area in the upper right chamber, or atrium, of your heart. This area is called the “sinoatrial node,” or “SA node.” The SA node is often called heart’s “natural pacemaker.” When the SA node sign small electrical impulse runs through the heart and node,” or “SA node.” The SA node is often called the heart’s “natural pacemaker.” When the SA node signals, a small electrical impulse runs through the heart and stimulates the heart muscle to contract (shorten). This contraction-stimulates the heart muscle to contract (shorten). This traction of the heart muscle produces a heartbeat, which forces blood out of the heart to the body. The hearts most people beat 60-80 times per minute when at rest Sometimes the heart can be made to beat faster or slow with medicines or special devices, such as artificial pacemakers.

Ventricular Fibrillation (VF)

“Ventricular fibrillation” (VF) is similar to ventricular tachycardia. Instead of one abnormal impulse, many different impulses from the ventricles try to signal the heart to beat. The heartbeat is much faster-sometimes over 300 beats a minute-and very little blood is pumped from the heart to the brain and body. A person with VF becomes unconscious very quickly and may not remember anything that happened just before or during the episode. Electrical energy is used to try to “shock” the heart back to a more normal rhythm. If an episode of ventricular tachycardia or ventricular fibrillation continues without treatment, the heart cannot supply enough oxygenated blood to the brain and body tissues. Without oxygenated blood, the brain and body tissues cannot survive.

What Is an AICD? What Does It Do?

The AICD is an implantable electronic device designed to monitor your heart rhythm and determine if the rhythm is abnormal and needs correction. This monitoring of your heart rhythm is similar to the monitoring done by machines in the coronary care unit. If the AICD senses that the rhythm is ventricular tachycardia or ventricular fibrillation, it will deliver an “internal” shock to the heart to correct the abnormal rhythm. If you are awake, you may find this shock uncomfortable for a short time-similar to a hard thump on the chest. You may not feel the shock at all if you have nearly passed out. However, you may have an uncomfortable feeling in your chest as you wake up. If the first shock does not stop the abnormal rhythm, the AICD can give three to four additional shocks. After the abnormal rhythm stops, the AICD will reset itself automatically and prepare to shock again if the abnormal rhythm reappears. As long as your heart rhythm remains “normal,” the AICD wire monitor your heart rhythm and wait until a shock is needed.

What Does the AICD Look Like? How Does It Work?

The AICD includes a pulse generator and leads. The Pulse generator is about the size and shape of a deck of cards and weighs about 1/2 pound. The pulse generater is implanted in your chest just underneath the skin. It made of a special kind of metal that normally does not react to body tissue. The pulse generator is connected one or more leads that are placed in and near your heart The lead system sends electrical signals from your heart the pulse generator, which continuously monitors your heart rhythm. When the pulse generator receives signals from the lead system that your heart rhythm is ventricle tachycardia or ventricular fibrillation, it will send a shock through the lead system to your heart to stop the abnormal rhythm.

How Is the AICD Implanted?

The AICD implant involves an operation to place the Lead or leads in and near your heart. Your doctors will make the decision about what kind of surgery to use based on:

• Your size and body shape

• If you have already had chest surgery

• What kind of lead or leads will be used

• What the safest type of surgery will be for you

• If you are having open-heart surgery, the lead or leads and pulse generator may be implanted during your heart operation.

The types of operations differ in the locations of the incisions made into your chest. Below are brief descriptions of various implant operations. Your doctors will choose the operation that is best for you.

Left Subclavian:  This is the most common site.  Almost all modern geberators are small enough to fit under clavicle.  A 4-6 cm horizontal or oblique incision is made under your collar bone.

Thoracotomy: The main incision will be made between your ribs on your left side. A second small incision may be made near your collarbone. This operation is usually chosen for a person who has already had chest surgery and may have scar tissue around the heart.

Sternotomy: The main incision will be made lengthwise over your breastbone, which will be divided so the doctor may look directly at your heart. Your doctor may also decide to make a small incision near your collarbone.

Subxiphoid: The main incision will be made lengthwise below and slightly to the left of your breastbone. Another small incision may be made near the base of your neck or collar bone.

One of he following approaches are used to implant the wires.

Transvenous Insertion: A small incision will be made near your collarbone. The lead will be threaded into the heart through a vein. The tip of the lead is then positioned inside the heart.

Open-Heart: Your doctor will decide on the incision for this type of operation depending on the other kind of surgery you need. This type of operation is done for your heart problems, and the AICD will be implanted as additional help for your heart problems..

Subcutaneous or Submuscular Placement: This procedure may be done in addition to one of the above.

No matter which type of operation your doctor chooses, the pulse generator will be implanted in the same location. Usually, one or two leads are inserted through a large vein inside your chest and into the right chamber of your heart. Another lead may be placed over the lower left chamber on the outside of your heart where your heart comes to a point (the “apex” of your heart). Alternative leads may be placed on the surface of your heart if your doctor thinks that they will work better for you.  When the connections are completed, a “pocket” will be formed just underneath your skin layers. (This “pocket” is similar to the kind made for implanted pacemakers.) The pulse generator is then placed in the “pocket.”

Preparation for implant procedures

• Ask your doctor what medications you are allowed to take. Your doctor may ask you to stop certain medications several days before your procedure (such as blood thinners and aspirin). If you have diabetes, ask your doctor how you should adjust your diabetic medications.

• Do not eat or drink anything after midnight the night before the procedure. If you must take medications, drink only small sips of water to help you swallow your pills.

When you come to the hospital, wear comfortable clothes. You will change into a hospital gown for the procedure. Leave all jewelry and valuables at home.

I’ve Had My Operation. Now What?

After you’ve had your AICD implanted and are back in a regular hospital room, you will be asked to return to your usual activities as soon as your doctors and nurses feel that you are rested enough. It is important that you become actively involved in your own care after surgery so you may return to your normal activities more quickly.

You may be asked to wear a special kind of tape recorder that records your heart rhythm while you perform your usual activities. (You may have worn this type of recorder before your surgery.) The results of these new recordings will be compared to those taken before your surgery. You may begin taking medications for your heart rhythm if your doctor thinks you should do so.

A nurse or doctor will look at your incisions. After six or seven days, any external stitches will be removed. If you notice any of the following , ask your nurse or doctor to look at your incision again:

1. Oozing on or around your bandage,

2- Soreness around any of your incisions or around

3- Fluid leaking around the stitches of your incisions,

4- Swollen, red, or hot areas around your incisions five more days after your operation

After you regain your strength, your doctor may ask you to have another EP test to further evaluate your AICD’s function. This may be performed while you are awake, but you may be given some medication to make you feel calm during the test. Another test that may be performed after you regain your strength is an exercise treadmill test. These tests will help your doctor observe your heart rhythm and know how the AICD is functioning.

When the tests are completed and the stitches removed, you may be allowed to go home. Don’t forget any medicines you are supposed to take! Make sure you know what they are for and when to take them.

What Should I Do After I Get Home?

• Routine wound care is a must.

• Avoid taking shower for first week.  You can do sponge bath.

• Do not drive for 2 weeks.

• Do not lift your arm above shoulder for 6 weeks.

• Regular follow up visit is after 1 wk.  when u arrive for wound check let the nurse know that you are here for wound check only.  This may avoid waiting in line.

When you first get home from the hospital, you will probably tire easily. You should increase your activity slowly so you don’t become too tired. A short walk a few times a day will help you become gradually stronger. Your doctor will help you decide what activities you may begin and how soon you may go back to work.

After you’ve been home a few days, you should make an appointment to see your heart doctor. You should have your AICD tested every three months, or follow the schedule that your physician prescribes for you. The testing can be done in a doctor’s office, emergency room, or clinic and usually takes a short time. Generally, the test will be performed by the same doctor who recommended that you receive the AICD.

Having a Follow-up Test Performed

At the heartbeat clinic we follow our defibrillators ourselves.  Normally Dr. Suleman or an assistant will use another device called programmer. This device works “noninvasively”-that is, it works from outside the body and is painless, and no surgery is needed. Using information from the testing device, your doctor can tell how well the AICD is working.

If you have any signs of ventricular tachycardia or fibrillation (fainting, nausea, weakness, rapid pulse rate, blackouts or problems with your medications, inform us immediately

What Should I Do If I Get a Shock

At some time, you may experience an abnormal heart arrhythmia at home or elsewhere. If the abnormal rhythm does not stop itself the AICD will shock your heart.   If you get an AICD shock, you or the people helping you should call your doctor’s office to report the shock. If ambulance attendants or paramedics come to help you, you or someone who knows you should tell them about your AICD.

Also, they should be shown your Identification Card.

It is important to report all AICD shocks. It is possible that you could receive a shock without any symptoms of ventricular tachycardia or fibrillation. These shocks should also be reported to your doctor as soon as possible. It is important that your doctor or the doctors and nurses at your nearby hospital know about the AICD shock and your abnormal heart rhythm. They may want to examine you to make sure the symptoms of the abnormal heart rhythm have gone away and nothing else is causing difficulty. It is also possible that you may have symptoms of abnormal heart rhythm and not receive a shock from your AICD. For example, this could occur if the heart rhythm is too slow for the AICD to recognize. Symptoms of abnormal rhythm should always be reported to your doctors or nurses as soon as possible.

Why Should I Carry My ID Card?

You will receive a wallet-sized Identification Card containing information about the doctor to be called in case of an emergency. You should carry this ID card in your wallet where it can be easily seen. If you become unconscious, the people helping you will need to know about your AICD and whom they should contact, The card provides this important information. Also, if you go to a doctor or hospital for tests or problems other than your heart condition, always remember to report them about your AICD and show them your ID card!

When Will My AICD Pulse Generator Have to Be Replaced? How Will This Be Done?

The exact period for which the AICD will last depends on the number of shocks you receive. Please refer to your AICD warranty for the warranty period and for terms and conditions regarding device replacement. If you receive many AICD shocks or if you have a significant change in your heart rhythm or medication, you may need a replacement sooner.

You will need to have surgery to remove the old pulse generator and have a new one implanted. In most cases, you will not need to have your lead or leads changed at the same time.

The surgery involves making a new incision over the old scar and removing the pulse generator from its “pocket.” The old pulse generator is disconnected and a new one is connected in its place. Your doctor will probably wish to test the new pulse generator before putting in the stitches.

What Things Should I Avoid Doing?

When you are feeling stronger and have returned To your usual activities, you should avoid:

• Any activity that involves rough contact with your pulse generator or lead system.

• Strong magnetic fields close to your pulse generator. This may make the AICD act as though it is being “tested,” or may actually turn it off and prevent it from working when needed.

• If you hear beeping sounds coming from your pulse generator, move away from the area where you are standing. Call your doctor as soon as possible, explain exactly what happened, and follow his instructions.

• Do not place magnets on or near your pulse generator!

• Treatments or surgery involving the use of diathermy or electrocautery machines. Ask your doctor before using these machines in your care.

• Lifting heavy objects until your doctor says you can.

Things I Should Do

• Always follow your doctor’s instructions exactly.

• Always take medications prescribed for you as instructed by your doctor.

• Always call your doctor if you have questions, problems, or notice anything unusual.

• Always tell doctors and dentists treating you that you have an AICD.

• To Remember that rescue crews and family members may use other standard emergency measures such as cardiopulmonary resuscitation (CPR) and external defibrillation. Tell others to begin these measures if you should become unconscious.

• Keep ambulance and/or paramedic numbers close to the telephone for emergencies.

• To Consider teaching local emergency room and ambulance service staff about your device, how it works, and whom to call in an emergency.

Remember to Call Doctor If:

The area around your pulse generator becomes sore to the touch or has a bruise

• Any of your incisions from surgery become reddened, You have a fever that will not go away after a few days

• At any time you have signs of your abnormal heart

• You plan to take a trip or move to another place

• You hear beeping tones coming from the pulse

• You have questions concerning your AICD

• You notice anything unusual or unexpected, especially

• You need to have any surgery during which equipment cauterization is used.

Biventricular defibrillators and Pacemakers

What is heart failure?

Heart failure is a condition in which the heart’s pumping power is weaker than normal. With heart failure, blood moves through the heart and body at a slower rate and pressure in the heart increases. As part of the condition, problems develop in the ventricles of the heart. A delay between the contraction of the right ventricle and the left ventricle often occurs. When this happens, the walls of the left ventricle are unable to contract at the same time. This leads to an increase in heart failure symptoms, such as shortness of breath, dry cough, swelling in the ankles or legs, weight gain, increased urination, fatigue, or rapid or irregular heart beat.

A special kind of pacemaker, called a biventricular pacemaker, is designed to treat the delay in heart ventricle contractions. This new therapy has been shown to improve the symptoms of heart failure (fatigue, shortness of breath and exercise intolerance) and the person’s overall quality of life.

What is a pacemaker?

A pacemaker is a device that sends electrical impulses to the heart muscle to maintain a suitable heart rate and rhythm. The pacemaker has two parts: the leads and the pulse generator.

The pulse generator houses the battery and a tiny computer

Lead wires send impulses from the pulse generator to the heart muscle, as well as sense the heart’s electrical activity. Each impulse causes the heart to contract.

What is a biventricular pacemaker?

Leads are implanted through a vein into the right atrium (RA) and right ventricle (RV) and into the coronary sinus (CS) vein to sense and pace the left ventricle (LV). This helps the heart beat in a more balanced way (also called cardiac resynchronization therapy).

Traditional pacemakers are used to treat slow heart rhythms. Pacemakers use one or two leads to sense and pace the right atrium (RA), right ventricle (RV), or both, to maintain a good heart rate and keep the atrium and ventricle working together. This is called AV Synchrony.

Biventricular pacemakers use a third lead. When the atrium senses and contracts, both ventricles are paced to contract at the same time, causing the walls of the left ventricle (the septal and free walls) to contract “in synch.” The end result is improved cardiac function.

How does biventricular pacing work?

In the normal heart, the heart’s lower chambers (ventricles) pump at the same time and in sync with the heart’s upper chambers (atria). When a patient has heart failure, often times the right and left ventricles do not pump together (dysynchrony). When the heart’s contractions become out of sync, the walls of left ventricle (LV) do not contract at the same time. The heart has less time to fill with blood and is not able to pump enough blood out to the body. This eventually leads to an increase in heart failure symptoms.

Biventricular pacing keeps the right and left ventricles pumping together by sending small electrical impulses through the leads. This allows the left ventricle (LV) and the right ventricle (RV) to pump together and also both walls of the left ventricle. The end result? The heart is able to fill and pump blood. This, along with medical therapy, helps to improve heart failure symptoms.

Who is a candidate for a biventricular pacemaker?

Biventricular pacemakers improve the symptoms of heart failure in about 50 percent of patients that have been treated maximally with medications but still have severe or moderately severe heart failure symptoms. Therefore, to be eligible for the biventricular pacemaker, heart failure patients patients:

• have severe or moderately severe heart failure symptoms

• are taking medications to treat heart failure

• have delayed electrical activation of the heart (for example: intraventricular conduction delay or bundle branch block)

In addition, the heart failure patient may or may not need this type of pacemaker to treat slow heart rhythms or may or may not need an internal cardioverter defibrillator (ICD), which is designed to treat patients at risk for sudden cardiac death or cardiac arrests.

ICD and pacemaker therapy

People with heart failure who have poor ejection fractions (measurement that shows how well the heart pumps with each beat) are at risk for fast irregular heart rhythms. Current devices are able to provide therapy to resynchronize the heart beat as well as stop or slow down fast irregular rhythms, such as atrial tachycardias (fast heart beat from the atrium), ventricular tachycardias (fast heart beat from the ventricle), and sudden cardiac arrest. These devices combine biventricular pacing with anti-tachycardia pacing and internal defibrillators (ICD) to deliver treatment as needed. Current studies are showing that resynchronization may even lessen the amount of arrhythmia that occurs, decreasing the frequency of ICD firing. These devices are improving heart failure patients’ quality of life as well as improving their safety.

What to expect during the implant?

Pacemakers and Defibrillators can be implanted two ways:

Endocardial (Transvenous) approach –

Two leads are placed into a vein, then guided to the right atrium and right ventricle of your heart. The lead tips are attached to your heart muscle. The other ends of the leads are attached to the pulse generator, which is placed under the skin in the upper chest. The third, left ventricular lead is guided through your vein to a small vein on the back of the heart called the coronary sinus to pace the left ventricle. This approach is done under local anesthetic (you will not be asleep). This technique is technically challenging and about 10 percent of the time, is unsuccessful due to the size, shape or location of the patient’s vein.

Epicardial approach – during heart surgery
Biventricular pacemaker leads are often placed at the time of heart surgery. This surgical approach may be required if the endocardial approach was not successful. The left ventricular lead is placed on the back of the outside of the left ventricle. This technique requires general anesthesia (you will be asleep). A second procedure is done several days later after surgery to connect the leads to the pacemaker.

Your doctor will decide which approach is best for you.

 A closer look at the endocardial approach

• Your procedure will take place in the EP (Electrophysiology) lab. You will lie on a bed and the nurse will start an IV (intravenous) line to deliver medications and fluids during the procedure. An antibiotic will be given through your IV at the beginning of the procedure to help prevent infection.

• You will receive a medication through your IV to make you drowsy. The medication will not put you to sleep. If you are uncomfortable or need anything during the procedure, please let the nurse know.

• The nurse will connect you to several monitors. The monitors allow the doctor and nurse to monitor your condition at all times during the procedure.

• It is very important to keep the area of insertion sterile to prevent infection. The right or left side of your chest will be shaved and cleansed with a special soap. Sterile drapes will be used to cover you from your neck to your feet. A soft strap will be placed

  across

  your waist and arms to prevent your hands from coming in contact with the sterile field.

• The doctor will numb your skin by injecting a local numbing medication. You will feel a pinching or burning feeling at first. Then the area will become numb. Once this occurs, an incision will be made to insert the pacemaker and leads. You may feel a pulling as the doctor makes a pocket in the tissue under your skin for the pacemaker. You should not feel pain. If you do, tell your nurse.

• After the pocket is made, the doctor will insert the leads into a vein and guide them into position using the fluoroscopy machine (a special x-ray machine that allows the doctor to see your blood vessels).

• After the leads are in place, the physician tests the leads to make sure lead placement is correct, the leads are sensing and pacing appropriately and the right and left ventricle are synchronized. This is called “pacing” and involves delivering small amounts of energy through the leads into the heart muscle.

• After the leads are tested, the doctor will connect them to your pacemaker. The rate of your pacemaker and other settings will be determined by your doctor. The final pacemaker settings are done after the implant using a special device called a “programmer.”

• The pacemaker implant procedure lasts about two to five hours.

Preparation for implant procedures 

• Ask your doctor what medications you are allowed to take. Your doctor may ask you to stop certain medications several days before your procedure (such as blood thinners and aspirin). If you have diabetes, ask your doctor how you should adjust your diabetic medications.

• Do not eat or drink anything after midnight the night before the procedure. If you must take medications, drink only small sips of water to help you swallow your pills.

When you come to the hospital, wear comfortable clothes. You will change into a hospital gown for the procedure. Leave all jewelry and valuables at home.

Implantable Loop Recorder

If your cardiologist has recommended an implantable looprecorder it is usually to help determine if there is an abnormal heart rhythm causing you to feel symptoms of , Palpitations, lightheadedness, dizziness, or episodes of passing out (syncope). The implantable looprecorder is a small device with internal electrodes that is implanted under the skin, usually in the left shoulder area below the collar bone. The recorder continuously monitors your heartrhythm 24 hours a day. You will be given a hand held activator to record and store your heart rhythm when you have symptoms.

During the procedure

• You will be assisted onto a narrow table in the Cath Lab.

• The insertion area will be shaved and cleansed to help prevent infection.

• Your shoulder will be draped with a sterile cover that has an opening large enough to expose the area of skin where the looprecorder will be inserted.

• A local anesthetic will be given to numb the insertion area.

• The cardiologist will make a small incision approximately 1-2 inches long. The loop recorder, which is approximately the size of a pack of gum, is inserted through the incision just under the skin.

• The incision is then closed with stitches.

• A bandage will be placed over the incision site.

After the procedure

• You will be monitored by a nurse for approximately 2-3 hours depending on amount of sedation used.

• You may remove the bandage from the incision  the day after the recorder is implanted.

• Avoid any activity that could cause direct contact with the incision until it is well healed. After the incision has healed, you may resumenormal activities.

• You and your family or friend will be given a hand held  activator and be shown how to use it. The hand held

  activator should be used when an episode of dizziness or syncope occurs.