Implantable cardiac devices

About implantable heart devices

The heart has its own electrical system that regulates the heartbeat. In a healthy heart, regular electrical signals cause your heart to pump blood in a steady rhythm.

Problems with the heart’s electrical system can cause abnormal heart rhythms (arrhythmias). This causes the heart to beat too fast, too slowly or in an irregular way.

Treatment for an abnormal heart rhythm depends on the cause and how it is impacting your health. Your doctor may recommend an implantable heart device such as a permanent pacemaker or ICD to help the heart beat at a regular rate and rhythm.

Implantable heart devices can greatly improve your quality of life and can be lifesaving for some people.

Types of implantable heart devices

Permanent pacemaker

The heart has a natural pacemaker to make it beat normally. The natural pacemaker (also known as the sinoatrial node) sends electrical signals to the heart to make it contract and pump blood around the body.

If the natural pacemaker is not working reliably, an artificial pacemaker (permanent pacemaker) can be inserted to take over the role of the natural pacemaker. A permanent pacemaker is a small device that is inserted under the skin of your chest. It sends electrical signals to your heart to help it beat in a regular rhythm.

Permanent pacemakers usually have two parts: a small battery-powered pacemaker and leads that are connected to your heart. It sits under the skin on the left or right side of your upper chest.

There are several types of pacemakers including:

• single chamber pacemaker – the electrical signal is sent to one chamber of the heart, usually the lower chambers (ventricles)
• dual chamber pacemaker – the electrical signal can be sent to two heart chambers, usually an upper (atrium) and lower chamber (ventricle)
• bi-ventricular pacemaker – the electrical signal can be sent to three chambers. The ventricles can be sent an electrical signal to make them pump together. This type of pacemaker is suitable for some people with heart failure.It is also called cardiac resynchronisation therapy or CRT.

Some newer types of pacemakers can be implanted directly into the heart and don’t need any leads at all.

Your doctor will consider the type of abnormal heart rhythm you have, how it makes you feel, and any health problems you might have before deciding if you need a pacemaker.

Automated implantable cardioverter defibrillator

An automated implantable cardioverter defibrillator (AICD or ICD) is a device inserted under the skin on your chest.

An ICD checks your heart rhythm 24 hours a day and can correct dangerous abnormal heart rhythms if needed.

• When your heart is beating too slow, an ICD can send impulses to correct the heart rhythm – similar to how a pacemaker works.
• When your heart is beating too fast, an ICD can deliver electric ‘shocks’ to make it beat normally again.

ICDs have two parts: the ICD generator box, and the leads. The device sits under the skin on the left or right side of your chest.

If you’ve had a fast, dangerous abnormal heart rhythm before that made you collapse, or are at risk of having certain dangerous abnormal heart rhythms, your doctor might recommend an ICD.

There are different types of ICDs available. Your doctor will discuss which ICD is most suitable for you.

How are implantable heart devices fitted?

Implantable heart devices are inserted under the skin on your chest, usually in the space just below the collar bone. They are fitted under local anaesthetic where you’ll be given an injection to numb the area. Some people may have a general anaesthetic. You may also be given sedation to help you relax before surgery.

It can take one to three hours to fit an implantable heart device. Depending on the type of device, you may need to stay overnight in hospital.

Your device will be checked thoroughly before you leave hospital. You will also be given information about the things you can and can’t do while you are recovering from your surgery. This could include things like not wearing clothes that will put pressure on your wound, and not lifting anything heavy.

Visit the Heart Foundation website for more information on preparing for a pacemaker and ICD insertion.

Living with an implantable heart device

After your device has been inserted, you will feel it under your skin. It may feel uncomfortable at first, but most people will get used to it quickly.

Many people find that they can get back to their everyday activities after a few weeks. It is important to follow your doctor’s advice about medicines and any recommended lifestyle changes.

Work and leisure activities

• When travelling, tell airport security you have an implantable heart device, as it will probably make the security scanners beep – they will then use a manual wand to check you.
• If you are working and your job involves welding or electricity generators, talk to your doctor. If you are a commercial driver or operate heavy machinery, discuss the impact of an implantable heart device on your work life with your doctor.
• Most sports and activities shouldn’t be a problem for people with an implantable heart device, but it is a good idea to talk about your activities with your doctor, especially for high contact sports where you might experience pressure or blows to your chest.
• Having an implantable heart device should not interfere with your sex life. If you’re worried, speak to your doctor.

Looking after your mental health

Living with an implantable heart device can be stressful. Sometimes people worry about their device, getting shocked, and how their life has changed. It is normal to feel this way.

Talk to your doctor, another health professional, or your loved ones about how you are feeling. Ask questions that help you understand your device and things to consider when living with an implantable heart device.

Getting a device check

You will need to have regular follow-up appointments to make sure your implantable heart device is working well. It is important to check the electrical function of your heart, your device settings, and its battery life.

• Device checks are generally conducted in specialised clinics.
• Your doctor will put a wireless wand on top of your skin to do this. Some newer devices have remote monitoring capability, which lets your doctor check your device while you are at home.
• Most pacemakers and ICDs will last between five to 15 years, depending on the type of device. Your doctor will check the battery and let you know when it needs to be changed.

Carrying your ID card

You’ll be given an ID card for your implantable heart device.

• Always carry your ID card and a list of your medicines.
• It’s also a good idea to take a photo of your ID card and share a copy of it with a family member.

Security scanners

Security systems in airports and shops with anti-theft detectors rarely cause problems with implantable heart devices.

• Inform security staff that you have an implantable heart device and show them your device ID card.
• They may conduct a hand search or use a hand-held metal detector. Ask them to not place the metal detector directly over your device.

Mobile phones and other devices

Most household appliances have little or no effect on implantable heart devices and are safe to use. These include microwave ovens, electric blankets, hair dryers and TVs.

Some electrical devices with a strong magnetic field can interfere with an implantable heart device. Try to avoid them or minimise your exposure.

• As a general precaution, try not to carry your mobile phone in your shirt pocket or place it very close to your device.
• Avoid or keep a safe distance from the following devices:
  • bathroom scales that record body fat
  • chainsaws
  • electric generators
  • industrial welders
  • magnetic bracelets
  • magnetic mattresses and pillows.

If you are concerned about using certain types of equipment, contact your device clinic or the manufacturer.

Medical and dental procedures

Some medical and dental procedures may interfere with the function of your device. Make sure that all health professionals you see know that you have an implantable heart device, in case you need specific care or instructions.

• Magnetic resonance imaging (MRI) scans are not usually performed in people with an implantable heart device, unless the device is MRI-safe. If you need to have an MRI and you have an implantable heart device, be sure to discuss this with the MRI facility in advance.
• Transcutaneous electrical nerve stimulation (TENS) machines which are used for pain relief may interfere with certain types of implantable heart device. Talk to your doctor before using a TENS machine.

End of life considerations

For people approaching end of life, it may not be appropriate for ICDs to remain active and deliver ‘shocks’ to the heart. Inactivating an ICD may be suitable for some people. Speak to you doctor if you have any concerns.

Where to get help

• In an emergency, always call Triple Zero (000)
• Your GP (doctor)
• Your cardiologist
• Your implantable heart device clinic
• NURSE-ON-CALL Tel. 1300 60 60 24 – for expert health information and advice 24 hours a day, 7 days a week
• Emergency department of your nearest hospital
• Heart Foundation