Cardiac pacemakers and implantable cardioverter defibrillators (also called CIEDs or cardiac implantable electronic devices) are used to correct abnormal heart rhythms. These devices are safe; however, there are times when the device needs to be replaced or changed. Your implanted device may need to be changed if:
How do I know the time of my procedure?
Your health care team will tell you the date and time to arrive for your procedure.
Should I take my medication?
Do not discontinue any of your medications, including Coumadin, without first talking to your healthcare provider. Ask your doctor which medications you should stop taking and when to stop taking them.
Can I eat?
Eat a normal meal the evening before your procedure. However, DO NOT eat, drink or chew anything after midnight the night before your procedure. This includes gum, mints, water, etc. If you must take medications, take them with only small sips of water. When brushing your teeth, do not swallow any water.
What should I wear?
Remove all makeup and nail polish. Wear comfortable clothes when you come to the hospital. You will change into a hospital gown for the procedure. Please leave all jewelry (including wedding bands), watches and valuables at home. The clothing you are wearing that morning will be returned to the person who accompanies you.
What should I bring?
You will not need a robe or toiletries when you first arrive. Your family member can keep these items to give to you after the procedure.
Bring a one-day supply of your prescription medications. Do not take these medications without first talking with the doctor or nurse.
You may also bring guided imagery tapes or music of your choice along with the appropriate player.
Where is the procedure performed?
The CIED change procedure takes place in the Electrophysiology Lab.
During the Procedure
Preparation
Before the procedure begins, a nurse will help you get ready. You will lie on a bed and the nurse will start an intravenous line (IV). The IV is used to deliver medications and fluid during the procedure.
To prevent infection and to keep the device insertion site sterile:
- An antibiotic will be given through the IV at the beginning of the procedure.
- The left or right side of your chest will be shaved.
- A special soap will be used to cleanse the area.
- Sterile drapes are used to cover you from your neck to your feet.
- A soft strap will be placed across your waist and arms to prevent your hands from coming in contact with the sterile area.
Will I be awake?
A medication will be given through your IV to relax you and make you feel drowsy, but you will not be asleep during the procedure.
Will I be monitored?
The nurse will connect you to several monitors that allow the healthcare team to check your heart rhythm and blood pressure during the procedure. The nurse continually monitors you during the procedure.
Monitors used during the procedure:
- Defibrillator / pacemaker / cardioverter
- EKG
- Blood pressure monitor
- Oximeter
- Fluoroscopy
How is my new device implanted?
An incision will be made above the device. The device will be disconnected from the leads and removed. The leads will be tested. If the function is acceptable, the new device will be connected to the existing leads and placed in the same position as the old device.
How long does the procedure last?
The device change procedure will last approximately two hours.
After the Procedure
Will I have to stay in the hospital?
After the procedure you will be admitted to a short- stay unit. You will be there for approximately four hours after your procedure is completed. Your heart will be monitored using telemetry. This consists of a small box connected by wires to your chest with sticky electrode patches. The box allows your heart rate and rhythm to be displayed on several monitors in the unit.
Can I drive after the procedure?
You will be given medication during the procedure that can impair your ability to drive. For your safety, you must bring someone to drive you home.
What tests will be done before I am discharged?
You will be transported to the Device Clinic to have your new device checked. You will sit in a reclining chair. Small, sticky patches called electrodes will be placed on your chest and connected via wires to a computer. The nurse will use a wand- like device, called a programmer, to check your new device, leads and the proper settings. At this time, you will also receive discharge instructions, incision care instructions, activity guidelines and follow-up plans.
You will also receive a temporary ID card that indicates what type of device and leads you have, the date of implant, and the doctor who performed the implant. CARRY THIS CARD WITH YOU AT ALL TIMES in case medical care is needed. Within three months, you will receive a permanent card from the device company.
Who do I call if I have questions?
The nursing staff at the Device Clinic is available from 8:00 a.m. to 5:30 p.m. Monday through Friday. Your doctor will provide you with after-hour instructions.
Discharge Instructions
Care of Your Incision
- Remove your bandage (dressing) and leave your incision open to air the day after your CIED change procedure. Do not apply any ointments, creams or dressings.
- If dressing changes are needed, your doctor will teach you how to care for your incision, and you will be given supplies before you leave the hospital.
- Look at your incision every day. Call the Device Clinic or your doctor if you notice any redness, swelling or drainage.
- Wear loose clothing over the area of your incision.
- You may take a shower five days after your CIED change procedure. DO NOT rub the area with a towel. Instead, blot it dry.
Activity
- You may return to your normal activities two weeks after your CIED change procedure. Talk to your doctor about your return to work.
- Avoid swimming and hot tubs/whirlpools until your incision is completely healed (usually 6–8 weeks).
- Avoid lifting more than 10 pounds for one week after your CIED change procedure.
- You may use microwave ovens, electric blankets and heating pads. Cellular phones should be used on the side opposite your CIED.
- Carry your DEVICE IDENTIFICATION CARD with you at all times!
Follow-up Appointment
- Your follow-up appointment will be six to eight weeks after your CIED change procedure. This is a nurse visit only. The nurse will evaluate your incision and test the leads. If you need to see your doctor, please call.
- If you have not received notification of your follow- up appointment in the mail within 14 days, please call.
- Device follow-up is every three months over the phone or every six months in clinic. Your follow- up schedule will depend on the type of device you have implanted. Your follow-up schedule will be established at your post-procedure visit (6–8 weeks after the procedure).
- Routine clinic visits should be scheduled once a year after your post-procedure visit. If you have not received notification of an appointment around the anniversary date of your implant procedure, please call.
- Call your doctor or the Device Clinic if you have any questions or concerns about your procedure or are having any new symptoms.
When to Call Your Doctor
Call your doctor or the Device Clinic if you experience any of the following:
- Increased drainage, bleeding or oozing from the incision site;
- Increased opening of the incision where the device was implanted;
- Redness, swelling or warmth around the device insertion site;
- Increased body temperature (greater than 101 degrees Fahrenheit or 38.4 degrees Celsius);
- Symptoms that may be related to your CIED (such as dizziness, heart palpitations, or fast or slow heart beats);
- If you have an implantable cardioverter defibrillator (ICD) and receive a shock before your post-procedure visit.
If you need more information or would like to make an appointment with a specialist, contact us, chat online with a nurse or call the Miller Family Heart and Vascular Institute Resource & Information Nurse at 216.445.9288 or toll-free at 866.289.6911. We would be happy to help you.
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This information is provided by Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition.
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