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Heart & Vascular Center

Pacemakers and ICD Implants

Washington University physicians at Barnes-Jewish Hospital implant more than 500 pacemakers and implantable cardioverter defibrillators (ICDs) each year to treat arrhythmias. Due to our high volume of experience and advances in technology, pacemakers and ICDs generally last several years and allow patients to lead normal lives.

Pacemakers

A pacemaker is a small device implanted under the skin that is connected to the heart by one or more insulated wires, called leads, that pass through a vein from the pacemaker site to the heart. When the heart’s natural ability to generate a regular heartbeat is no longer functioning, or if the electrical pathways are blocked, a permanent pacemaker may be used to restore this normal function.

Pacemakers can be inserted during an outpatient procedure, in the cardiac catheterization lab or the electrophysiology lab. The procedure often is done with light sedation, but general anesthesia also is available for more complex patients with serious medical conditions.
 

Implantable Cardioverter Defibrillators (ICDs)

ICDs are implanted like a pacemaker through an incision under the collar bone. They are about the size of a stopwatch. Like pacemakers, one or more wire leads connect the device to the heart. If a patient has a life-threatening ventricular arrhythmia, the ICD detects it in seconds and delivers appropriate electrical therapy to stop the dangerous heart rhythm abnormality and restore a normal heart rhythm. ICDs all include a pacemaker function that is commonly necessary to treat slow heart rhythms before or immediately after treatment of rapid ventricular rhythms.

Following an ICD implantation, patients usually have a rapid recovery after an overnight hospital stay and are up and around the next day. The defibrillator doesn't do anything unless it detects an arrhythmia. The most current generation of ICDs last seven or more years before they have to be replaced.

Patients who might benefit from an ICD include those with:
  • ischemic cardiomyopathy (ICM), documented myocardial infarction, and a measured left ventricular ejection fraction that is less than 35 percent
  • nonischemic dilated cardiomyopathy (NICM) that has been present for more than three months in spite of medical treatment, and a measured left ventricular ejection fraction less than 35 percent.
  • patients who have survived a cardiac arrest or ventricular tachycardia with syncope, which is a sudden loss of consciousness, and a known cardiomyopathy 
At the Heart & Vascular Center, pacemakers and ICDs are implanted by physicians who are board certified in cardiology and electrophysiology. Physicians at the hospital have been implanting ICDs since 1985 and implant about 300 per year along with 250 pacemakers.

In addition, the incidence of ICD infections at the Heart & Vascular Center is well below the national average of 1 in 1,000. Many patients are referred to our physicians to treat infected ICDs.

To make an appointment with a Washington University heart or vascular specialist at Barnes-Jewish Hospital, call .

Ralph Damiano, MD

Cardiac Surgeon, Barnes-Jewish & Washington University Heart & Vascular Center

 

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