Biventricular Pacemaker Implantation

A biventricular pacemaker is a special pacemaker used for cardiac resynchronization therapy in heart failure patients.

In the healthy heart, the heart's lower chambers (ventricles) pump at the same time and in sync with the heart's upper chambers (atria). When a person has heart failure, often the right and left ventricles do not pump together. When the heart's contractions become out of sync, the left ventricle is not able to pump enough blood to the body. This eventually 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 heartbeat.

Cardiac resynchronization therapy (CRT), also called biventricular pacing, uses a special kind of pacemaker, called a biventricular pacemaker, designed to treat the delay in heart ventricle contractions. It keeps the right and left ventricles pumping together by sending small electrical impulses through the leads. This therapy has been shown to improve the symptoms of heart failure and the person's overall quality of life.

What Happens During the Pacemaker Implantation?

Pacemakers can be implanted in two ways:

  • Inside the Heart (Endocardial, Transvenous approach): This is the most common technique used. A lead is placed into a vein (usually in your groin) and then guided to your heart. The tip of the lead 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 technique is done under local anesthesia (you will not be asleep).
  • Outside the Heart (Epicardial approach): 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 technique is done under general anesthesia (you will be asleep) by a surgeon.

Your doctor will decide which approach is best for you.

What Happens After The Pacemaker Is Implanted?

Hospital stay

After the pacemaker implant, you will likely be admitted to the hospital overnight. The nurses will monitor your heart rate and rhythm. You will also have aa telemetry monitor attached with small electrode patches. It will record your heart rhythm for about 12 hours. This is another way to check proper pacemaker function. The morning after your implant, you will have a chest x-ray to check your lungs and the position of your pacemaker and leads.

Final pacemaker check

For your last pacemaker check, you will sit in a reclining chair, and the pacemaker will be attached to a computer monitor. A small machine known as a programmer is used to check your pacemaker. It has a wand that is placed directly over the device. This machine allows the nurse or doctor to read your pacemaker settings and make changes during testing. With these changes, the function of the pacemaker and leads can be evaluated. You may feel your heart beating faster or slower. This is normal; however, report all symptoms to the nurse. Results of the pacemaker check are discussed with your doctor, who will then determine your pacemaker settings.

After your pacemaker check, an echocardiogram may be done. The pacemaker nurse will be there during your echo and will change your pacemaker at least 3 times. The repetition will be repeated with each change to evaluate heart function. The pacemaker will keep the settings that demonstrated your best heart function.