This film will show you what to expect
if you are having an ICD or a pacemaker fitted.
I'm Hilda Henry. I'm 73.
I'm having a pacemaker today.
I can wake up in the night and think somebody's knocking on the door,
but it's my heart going out of its rhythm.
It can last anything from four hours.
The longest was eighteen.
My name is Dr Brown. Pleased to meet you.
I think I'll feel a lot more confident when I'm booking things.
I've not wanted to book a holiday.
A pacemaker will prevent the heart from going too slow in the future
and allows us to better control your symptoms and your palpitations.
I'd like to climb Rivington Pike because I used to live near there.
I'd like to get to the top of the Pike dead easy.
I'm Ben Brown, I’m a consultant cardiologist in South Manchester
and I have a special interest in management of heart rhythm problems.
To implant an implantable cardioverter defibrillator
or to implant a pacemaker,
the fundamentals of the procedure are pretty much the same.
The main difference is to do with the equipment that's implanted.
The pacemaker for Mrs Henry was a way of balancing things out.
It would allow us to give medication to control her palpitations
and then it would prevent her from having symptoms
from the heart going too slow,
as a result of the problem that's underlying.
Sometimes your heart beats in abnormal rhythms called arrhythmias.
If these rhythms are life-threatening, you may be fitted with an ICD,
implantable cardioverter defibrillator.
An ICD constantly monitors your heart rhythms
and will deliver electric shocks or pulses
to correct a life-threatening rhythm.
A pacemaker is fitted if your heart's natural pacemaker,
called the sinus node, is not working effectively.
A pacemaker sends electrical impulses to stimulate your heart
to contract and produce a heartbeat.
Although ICDs and pacemakers are used to treat different heart problems,
they are fitted in a similar way.
They are usually fitted under your collarbone
and are connected to your heart by one or more electrode leads,
which are placed into your heart through a vein.
Defibrillators have quite major lifestyle implications,
so it's important patients understand why they're having it put in
and the consequences of having it implanted before it's put in.
For a pacemaker it's generally more straightforward.
Patients will often have been seen in clinic
and having a pacemaker put in
would have been explained by the specialist seeing them.
On the day, patients will routinely receive antibiotics
and this reduces the chance of infection beforehand.
If not done recently, Patients will have blood tests performed.
- Is that OK? - Yes.
I'll need to do your checks.
A pacemaker or an implantable cardioverter defibrillator ICD
will be implanted in a cardiac catheter lab.
The simplest type of pacemaker will involve one pacemaker lead.
That would be the quickest. It takes about half an hour to do.
More complex types of pacemaker
or an implantable cardioverter defibrillator with additional leads
can take up to an hour and a half sometimes.
The majority of patients are well enough to go home later the same day.
For a defibrillator,
because usually patients have a more severe underlying heart condition,
we'll keep them in overnight to monitor them.
99% of the devices that we'll implant
are done under what we call sedation and local anaesthetic.
We'll combine the sedative with a morphine-like painkiller
and so most patients are given a comfortable feeling,
like Christmas dinner with sherry, leaving you with a warm glow inside.
To implant a defibrillator, or to implant a pacemaker,
it's local anaesthetic,
it's using the veins to pass the leads down around towards the heart.
We use an X-ray camera, giving us an outline of where the heart is.
It lets us put the leads into the right place and to see it's stable,
so it's not going to displace or move afterwards.
That's me shaking the lead and seeing that it's caught and staying put.
There's a special wrench that goes into the pacemaker.
We turn that.
Three clicks. The pacemaker is connected up.
We see on the ECG, the heart tracing, that the pacemaker’s started working.
With the pacemaker connected to the leads,
it's implanted into a pocket underneath the skin
and then the wound is closed with a dissolvable suture.
This is a stitch that will dissolve
and the patient won't be left with anything external or visible.
The pacemaker battery will run out over time.
How often the pacemaker is being used dictates how quickly that happens.
For most patients that's in the region of eight to ten years.
We ask patients not to make big shoulder movements
on whichever side of the body it's been implanted.
But in the fullness of time, within reason, we'd expect patients
to have a full range of movement
and wouldn’t expect the device to be uncomfortable.
The DVLA produces guidelines that are updated frequently.
We go through this with patients before the device is implanted,
and certainly pre-discharge, so they're aware of the guidelines.
After Mrs Henry's discharged,
we will arrange an appointment for two to three weeks' time
to check the pacemaker leads are working well, the wound is healing
and there are no infection concerns or problems of that sort.
I found it OK, yes.
I was nice and relaxed.
I could feel the pressure of the pacemaker going in,
but it was nothing alarming.
I'm hoping to do lots of things -
go on holiday, have lots of fun,
and still go out with all my friends, walking.
Yes, and not worrying.
One of the most rewarding things is when patients come back
and their life's improved.
They're able to do things that they weren't able to do before
and it's an amazing thing to be able to do.
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