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Pacemaker and ICD Implants

At the Washington University and Barnes-Jewish Heart & Vascular Center, we treat patients with complex arrhythmias and other heart conditions. Our board-certified cardiologists and electrophysiologists place more than 800 pacemakers and implantable cardioverter defibrillators (ICDs) each year.

Such a high number of implants leads to unparalleled expertise in placing and managing these devices. If you need a pacemaker or ICD or have a complication with your device, we can expertly manage your care.

Learn more about our care for arrhythmia and heart rhythm disorders.

Pacemaker and ICD Implants: Why Choose Us?

Our electrophysiologists offer expert care for patients who need a pacemaker or ICD. We perform these procedures percutaneously (through the skin), without an open chest incision. Our team provides:

  • High level of expertise: We have the skills and experience needed to work with these complex devices. Patients from across the country come to our center for pacemaker and ICD implantation. We also have the expertise to manage complications related to the devices, including removing or repairing the systems. For example, if your device becomes infected, we can provide the expert care you need to fix the problem.
  • Advanced technology: We are continually advancing technology for pacemakers and ICDs, including completely leadless systems. Implanting a leadless pacemaker does not require surgery, meaning a shorter, easier recovery.
  • Excellent outcomes: Thanks to advances in technology and our experience, we achieve excellent success rates, with our devices able to regulate the heartbeat and patients able to live without symptoms. Pacemakers and ICDs can last for 7-10 years, allowing you to lead a normal life.
  • Collaboration: Our electrophysiologists work closely with our cardiac surgeons to treat complex arrhythmias. For example, if an infection occurs, we perform surgery to safely remove and re-implant the system. If we cannot place the leads through a vein, our surgeons use an advanced technique to place them outside the heart.

Pacemaker Implantation: What to Expect

A pacemaker is a small device that we insert under your skin, near your heart. Its job is to maintain a normal heart rhythm, often in patients with bradycardia. An electrophysiologist often implants the device, usually in our cardiac catheterization or electrophysiology labs. It is an outpatient procedure.

There are several steps:

  1. We give you light sedation, so you are awake but do not feel any pain. If you have a more serious medical condition, we may use general anesthesia.
  2. We implant the pacemaker device under the skin.
  3. We then connect it to the heart using one or more insulated wires, called leads. These leads pass through a vein from the pacemaker to the heart.
  4. If your heartbeat is too slow, the pacemaker sends a signal to your heart to speed up the heart rate.

Implantable Cardioverter Defibrillators (ICDs): What to Expect

Similar to a pacemaker implantation, we insert an ICD through an incision under the collarbone. ICDs are about the size of a stopwatch. The current generation of ICDs lasts 7 years or more before we need to replace them.

How an ICD works:

  1. One or more wire leads connect the device to the heart.
  2. If you have a life-threatening ventricular arrhythmia, the ICD detects it in seconds. (Learn more about ventricular tachycardia.)
  3. The ICD delivers an electrical impulse to stop the dangerous heart rhythm and restore a normal heart rhythm. (The defibrillator does not do anything unless it detects an arrhythmia.)
  4. ICDs all include a pacemaker function that is often necessary to treat slow heart rhythms before or immediately after treatment of rapid ventricular rhythms.
  5. You will most likely recover quickly after your ICD implantation. After an overnight hospital stay, you can expect to be up and around the next day.

Who Needs an ICD or Pacemaker?

Patients who might benefit from an ICD include those with:

  • Ischemic cardiomyopathy (ICM), a weakened heart muscle
  • Documented myocardial infarction (heart attack)
  • Measured left ventricular ejection fraction that is less than 35 percent (a measurement of how well your heart is pumping)
  • History of cardiac arrest or ventricular tachycardia with syncope (fainting)
  • Combination of:
    • Nonischemic dilated cardiomyopathy (NICM), a type of heart disease, that you have had for more than three months in spite of medical treatment
    • Measured left ventricular ejection fraction of less than 35 percent

Patients who might benefit from a pacemaker include those who have:

Contact Us

To make an appointment with a Washington University arrhythmia specialist at Barnes-Jewish Hospital, call 855.925.0631.