Procedures
Pacemakers, defibrillators, and heart failure devices
Implantable devices that watch the heart continuously and act when something goes wrong — pacing a rhythm that runs too slow, stopping one that becomes dangerous, recording what happens so it can be diagnosed, or, in heart failure, coordinating the contraction and reporting the pressures behind it.
How an implant works
A cardiac device has two parts: a small sealed generator holding the battery and the electronics, and one or more thin insulated leads that carry signals between the generator and the heart.
The generator sits in a pocket made just under the skin below the collarbone. The leads travel from that pocket through a vein into the heart, where their tips are fixed against the chamber wall. Once in place, the device listens to every beat and responds according to the settings your physician programs for you.
Implantation is done under local anesthesia with sedation. It does not require opening the chest, and most patients go home the same day.
Choosing the right device
A pacemaker treats a heart that beats too slowly or conducts unreliably. It supplies a gentle signal whenever your own rhythm falls below a safe rate.
An implantable cardioverter-defibrillator is for patients at risk of a dangerous fast rhythm. It watches for ventricular arrhythmias and can pace or shock the heart back into rhythm within seconds.
A loop recorder treats nothing. It is a diagnostic monitor smaller than a AAA battery, placed under the skin to record continuously for up to three years — used when symptoms are too infrequent to catch on a wearable monitor.
Which device is right, and how many leads it needs, depends on your rhythm recordings, your ejection fraction, your symptoms, and guideline criteria your physician will go through with you.
Device procedures we perform
Pacemaker Implantation
Placement of a small device that keeps the heart from beating too slowly.
A pacemaker is positioned just under the skin below the collarbone and connected to the heart by one or more thin leads. It monitors every beat and delivers a gentle electrical signal whenever the rhythm falls below a safe rate. Most patients go home the same day.
- Bradycardia
- Heart block
- Sick sinus syndrome
Defibrillator (ICD) Implantation
Placement of an ICD that detects dangerous rhythms and restores a normal heartbeat.
An implantable cardioverter-defibrillator continuously watches the heart's rhythm. If it detects a life-threatening arrhythmia, it delivers pacing or a shock within seconds. ICDs are recommended for patients at elevated risk of sudden cardiac arrest.
- Ventricular tachycardia
- Ventricular fibrillation
- Reduced ejection fraction
Generator Replacement and Device Revision
Exchanging the battery unit of an existing pacemaker or defibrillator, and related lead work.
Cardiac devices are powered by a sealed battery that is replaced every several years. The existing pocket is reopened, the generator is exchanged, and the leads already in place are tested and reconnected. It is a shorter procedure than the original implant and is routinely done as an outpatient.
- Battery depletion
- Device upgrade
- Scheduled generator change
Loop Recorder Implantation
A long-term monitor placed under the skin to capture infrequent rhythm events.
Some arrhythmias appear too rarely to be caught on a short-term monitor. An insertable loop recorder is smaller than a AAA battery, sits under the skin of the chest, and records continuously for up to three years. Insertion takes only a few minutes under local anesthesia.
- Unexplained fainting
- Intermittent palpitations
- Stroke workup
Cardiac Resynchronization Therapy (CRT)
A pacing device that re-coordinates the two ventricles when a conduction delay is making heart failure worse.
In some patients with heart failure, the electrical signal reaches one ventricle later than the other, so the two chambers no longer contract together and the heart pumps less efficiently than its muscle should allow. A resynchronisation device paces both ventricles so they contract in step. It is implanted the same way as a pacemaker, through a small incision below the collarbone, and can be combined with a defibrillator where one is also indicated.
- Heart failure with a conduction delay
- Left bundle branch block with reduced ejection fraction
- Ventricular dyssynchrony
Cardiac Contractility Modulation (CCM)
An implanted device that strengthens the heart's contraction rather than changing its rhythm — for patients who are not candidates for resynchronisation.
Explore CCM: device, charger, and video →Cardiac contractility modulation delivers electrical signals to the heart muscle during the part of each beat when it cannot be triggered into contracting, which improves the force of the next contraction rather than altering the timing. The Optimizer system was FDA approved in March 2019 for chronic moderate-to-severe heart failure in patients in normal sinus rhythm with an ejection fraction between 25% and 45% who remain symptomatic on optimal medication and are not candidates for CRT — a group that previously had no device option.
- NYHA class III heart failure
- Ejection fraction 25–45%
- Symptoms despite optimal medical therapy
- Not a candidate for resynchronisation
CardioMEMS Pressure Monitor
A pressure sensor placed in the pulmonary artery that lets a heart failure team see decompensation coming before symptoms start.
A sensor smaller than a paperclip is placed in a branch of the pulmonary artery through a vein, with no battery and no leads. From home, the patient lies on a pillow that reads the sensor and transmits the pressure to the clinical team. Pressures rise days before weight gain or breathlessness appear, so medication can be adjusted before a hospital admission becomes necessary. In the CHAMPION trial, managing patients using these pressures reduced heart failure hospitalisations.
- NYHA class II or III heart failure
- Heart failure hospitalisation in the past year
- Elevated natriuretic peptides
Questions about your procedure?
Our team will confirm your date, walk you through preparation, and answer questions about insurance, sedation, and recovery.