Pacemaker

A pacemaker is a device that is implanted in the body, that sends electrical signals to the heart, telling it to pump. The pacemaker comprises a battery (the generator), and an insulated wire (leads) that connect the generator to the heart muscle, where it is permanently anchored.

What is involved in a pacemaker implantation?

A pacemaker implantation generally takes about 1 hour. This is usually performed under local anaesthetic and general sedation. A small incision is made below the collar bone and the pacemaker generator is placed under the skin and fat layers. The leads enter a vein near the collar bone and are guided to the heart using an X-ray machine.

Patients routinely stay overnight following pacemaker implantation. The battery life of a pacemaker is about 5-10 years and the battery may be replaced when it runs out. Patients with a pacemaker will need routine follow-up to ensure the pacemaker is working properly.

When are pacemakers considered?

Pacemakers may be considered if the heart rate is too slow, in certain abnormal heart rhythm conditions when medications result in a slow heart rate, or in patients with heart failure who require a special pacemaker to help the heart pump better.

Implantable cardioverter defibrillator (ICD)

An implantable cardioverter defibrillator (ICD) is a device that is implanted in the body, which can detect a dangerous heart rhythm and potentially deliver an electric shock to reset the heart rhythm.

An ICD also has the functions of a pacemaker. An ICD comprises a battery (the generator), and insulated wire (leads) that connect the generator to the heart muscle.

What is involved in an ICD implantation?

An ICD implantation generally takes about 1 hour. This is usually performed under local anaesthetic and general sedation. A small incision is made below the collar bone and the ICD generator is placed under the skin and fat layers. The leads enter a vein near the collar bone and are guided to the heart using an X-ray machine. 

Patients routinely stay overnight following ICD implantation. The battery life of an ICD is about 5-8 years, depending on how often it delivers shocks, and the battery may be replaced when it runs out. Patients with an ICD will need routine follow-up to ensure the ICD is working properly.

When are ICDs considered?

ICDs may be considered in certain patients who have dangerous heart rhythms from the lower half of the heart (ventricular tachycardia or ventricular fibrillation), and in patients who have certain heart conditions that increase the risk of sudden cardiac arrest. If an abnormal heart rhythm is detected, a low- or high-energy shock is delivered to reset the heart back to normal rhythm.

Cardiac Resynchronisation Therapy

Is a special pacemaker that resynchronises a weak heart with abnormal electrical conduction (left bundle branch block). It has been proven, in the right patients, to improve heart pump function and extend life. There is a generator (battery) and lead(s) which sit under the skin on the left or right side of the chest. It continuously monitors your heartbeat.

Loop Recorder

If your symptoms occur very infrequently, a loop recorder may be implanted under the skin on the left side of the chest. It continuously records your heart electrical activity and detects abnormal heart rhythms. It has a battery life of 2 to 4 years.

Cardiac Ablations

Cardiac ablations are procedures that can correct abnormal fast heart rhythm problems (arrhythmias). They work by targeting the part of the heart that produces or sustains the fast heart rhythms. Catheters (long flexible tubes with electrode tips) are inserted through the vein or artery in the groin. These are then threaded up to the inside of your heart to take electrical measurements. These catheters can deliver heat or cold energy to modify the part of your heart causing the arrhythmia.

Supraventricular Tachycardia Ablation

A supraventricular tachycardia is a fast heart rhythm (arrhythmia) originating from the top of the heart (right atrium or left atrium) including AV Nodal Reentrant Tachycardia (AVNRT), Wolf-Parkinson White Syndrome, Atrial Tachycardia, and Atrial Flutter. Ablation targets the focus or area that sustains the particular arrhythmia.

Atrial Fibrillation (AF) Ablation

It is a procedure to stop the abnormal electrical signals from the pulmonary veins (veins of the lung) causing atrial fibrillation. The procedure creates a small area of scar tissue in the upper left-hand chamber of the heart (left atrium) to stop the abnormal electrical signals that produce or sustain atrial fibrillation. This helps reduce the signs and symptoms and improve quality of life for people suffering from atrial fibrillation.

Ventricular Tachycardia Ablation

Ventricular tachycardia occurs when arrhythmia from the lower chambers of the heart (right or left ventricle) causes the heart to beat erratically and ineffectively. Ablation targets the areas of the heart that produce or sustain the arrhythmia. In some cases, a high frequency of extra beats from the bottom of the heart (the ventricles) can weaken the heart.

Coronary Angiogram

A coronary angiogram is a procedure that uses X-ray imaging to see your heart's blood vessels. The test is generally done to see if there's a restriction in blood flow going to the heart.

Coronary angiograms are part of a general group of procedures known as heart (cardiac) catheterizations. Cardiac catheterization procedures can both diagnose and treat heart and blood vessel conditions. A coronary angiogram, which can help diagnose heart conditions, is the most common type of cardiac catheterization procedure.

During a coronary angiogram, a type of dye that's visible by an X-ray machine is injected into the blood vessels of your heart. The X-ray machine rapidly takes a series of images (angiograms), offering a look at your blood vessels. If necessary, your doctor can open clogged heart arteries (angioplasty) during your coronary angiogram.

Why it's done

Your doctor may recommend that you have a coronary angiogram if you have:

  • Symptoms of coronary artery disease, such as chest pain (angina)

  • Pain in your chest, jaw, neck or arm that can't be explained by other tests

  • New or increasing chest pain (unstable angina)

  • A heart defect you were born with (congenital heart disease)

  • Abnormal results on a non-invasive heart stress test

  • Other blood vessel problems

  • A heart valve problem that requires surgery

Because there's a small risk of complications, angiograms aren't usually done until after non-invasive heart tests have been performed, such as an electrocardiogram, an echocardiogram or a stress test