Biventricular Pacemaker

1 What is a Biventricular Pacemaker?

A biventricular pacemaker is a special pacemaker used for cardiac resynchronization therapy (CRT) in heart failure patients in which the right and left chambers (ventricles) do not pump at the same time and in sync with the heart's upper chambers (atria) as in the normal heart.

Heart failure symptoms are shortness of breath, dry cough, swelling of the ankles or legs, weight gain, increased urination, fatigue, or rapid or irregular heartbeat.

A biventricular pacemaker is designed to treat the delay in heart ventricle contractions and it keeps the right and left ventricles pumping together by sending small electrical impulses through the leads unlike the traditional pacemakers which are used to treat slow heart rhythms regulating the right atrium and right ventricle, maintaining a good heart rate and keeping the atrium and ventricle working together (AV synchrony).

A good candidate for a biventricular pacemaker has severe or moderately severe heart failure symptoms which have been treated with medications but still having pain and have delayed electrical activation of the heart (determined using ECG).

In addition, the heart failure patient may or may not need this type of pacemaker to treat slow heart rhythms and may or may not need an internal defibrillator (implantable cardioverter defibrillator, or ICD), which is designed to treat people at risk for sudden cardiac death or cardiac arrests because people with heart failure who have poor ejection fractions (measurement that shows how well the heart pumps with each beat) are at risk for fast irregular heart rhythms -- some of which can be life-threatening. Currently, doctors use an ICD to prevent these arrhythmias.

Before the procedure, the patient must not eat or drink anything after midnight the night before the procedure and if he/she must take medications, he/she can drink only small sips of water to help swallow pills.

Pacemakers can be implanted two ways:

  • Inside the Heart (Endocardial, Transvenous approach): The most common technique used. A lead is placed into a vein (usually in the patient’s groin) and then guided to the patient’s heart. The tip of the lead attaches to the heart muscle and the other end of the lead is attached to the pulse generator, which is placed under the skin in upper chest of the patient. This technique is done under local anesthesia (patient 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 the patient’s abdomen. This technique is done under general anesthesia (patient will be asleep) by a surgeon.

After the leads are in place, the doctor will determine the rate of pacemaker and other settings. The final pacemaker settings are done after the implant using a special device called a "programmer." The pacemaker implant procedure lasts about 2 to 5 hours.

Usually, the patient will be able to go home the day after the pacemaker is implanted. A doctor or nurse will go over specific instructions for care at home.

Patient must avoid extreme pulling or lift motions (such as placing an arm overhead without bending at the elbow). Activities such as golf, tennis, and swimming should be avoided for 6 weeks from when the pacemaker was implanted.

A complete pacemaker check should be done 6 weeks after the pacemaker is implanted, telephone checks are done every 3-6 months starting 3 months after 6-week check and the pacemaker is analyzed every 6 months. Biventricular pacemakers that are combined with an ICD and do not tend to last as long (about 2-4 years).