Device Implantation

Cardiac implantable electronic devices (CIED) are gadgets that can be surgically implanted in the chest region that help to regulate heart rhythms, correct dangerously fast heart rhythms, synchronize the contraction of the heart chambers or simply serve to monitor and detect undiagnosed abnormal rhythms.

Patients with significantly slow heart rhythms may experience symptoms such as poor effort tolerance, giddiness and even fainting. Lifestyle changes and medications have not been proven to improve these conditions. In most cases, a pacemaker (PPM) implantation may be recommended.

In patients who have developed, or are at risk of, dangerously fast heart rhythms or sudden cardiac arrest, an implantable cardioverter defibrillator (ICD) may be recommended.

In patients who have an electrocardiogram (ECG) showing bundle branch block, it is suggestive of electrical delay on one side of the heart resulting in the heart chambers contracting out of sync. This is especially important in patients with poor heart function and a cardiac resynchronization therapy (CRT) device may be recommended.

In patients who have had experienced symptoms suggestive of an abnormal rhythm or suffered a stroke potentially caused from an abnormal rhythm, an implantable loop recorder (ILR) may be recommended.

Medications, such as beta-blockers, calcium-channel blockers, and other anti-arrhythmic drugs, may be prescribed to regulate the heart rhythm. In certain cases, an invasive procedure called catheter ablation may be recommended to modify or eradicate the cause of fast heart rhythms.

For slow heart rhythms that have resulted in significant symptoms, lifestyle changes and medications may not be sufficient to improve the condition. In most such cases, pacemaker (PPM) implantation may be recommended. In patients who have developed, or are at risk of, dangerously fast heart rhythms or sudden cardiac arrest, an implantable cardioverter defibrillator (ICD) may be recommended.

The Pacemaker (PPM)

What is it?

A pacemaker (PPM) is a tiny device that helps regulate the heartbeat when it is too slow. It does this by sending electrical signals to the heart to keep it beating at a normal pace. The PPM has a generator with a battery and circuitry that sends electrical signals through wires, called leads, to the heart. The leads also sense the heart’s electrical activity and tell the generator to stop pacing when the heart is beating normally.

How is it performed?

A PPM is usually placed under the skin, below the collar bone, and connected to the heart through a blood vessel. This makes it not easily noticeable except for a small bump. Some people may be recommended to get a leadless PPM, which does not need wires or a chest incision and is implanted through a blood vessel in the groin.

Your doctor may recommend it for

Patients who are experiencing symptoms from an abnormally slow heartbeat.

Implantable Cardioverter-Defibrillator (ICD)

What is it?

An implantable cardioverter-defibrillator (ICD) is a small device that helps monitor and correct life-threatening heart rhythms. It has a generator with a battery and circuitry that is connected to the heart through a wire called a lead. The ICD detects abnormally fast heart rhythms and sends electrical shocks to the heart to restore normal rhythm. It can also work as a pacemaker and send electrical pulses to keep the heart beating at a normal rate if it beats too slowly.

How is it performed?

The ICD is usually implanted at the left upper chest where a small incision is made just below the collar bone, and the lead is inserted into the heart through a blood vessel. It is not easily noticeable except for a small bump. Some people may get a subcutaneous ICD which does not need leads inserted through blood vessels inside the heart. This type of ICD is implanted at the side of the chest and may be recommended for certain patients.

Your doctor may recommend it for

Patients who have developed or are at risk of developing life-threatening abnormal heart rhythms, such as Ventricular Tachycardia (VT) or Ventricular Fibrillation (VF).

Cardiac resynchronization therapy (CRT)

What is it?

Cardiac resynchronization therapy (CRT) is a treatment that involves using an electronic device to synchronize the contraction of the heart chambers, with the aim of improving heart function.

How is it performed?

The CRT device includes a generator that has an in-built battery and circuitry, which is connected to the heart via insulated wires known as leads. An additional wire may be deployed near the left side of the heart or in the central wall that divides the lower chambers of the heart, to coordinate the electrical timing between the left and right heart chambers, thereby achieving synchronization.

The CRT device can function as a pacemaker (CRT-P) by detecting slow heart rates and delivering electrical impulses to keep the heart beating, or as a defibrillator (CRT-D) by detecting and treating life-threatening fast heart rhythms. Typically, a CRT device is implanted at the left upper chest, where a small incision is made just below the collarbone. The lead(s) are then inserted through a large blood vessel into the heart and connected to the generator, which is placed in a chest pocket. The entire device is buried under the skin and, except for a small protrusion, is not obviously noticeable.

Implantable Loop Recorder (ILR)

What is it?

An implantable loop recorder (ILR) is a small device that is surgically implanted under the skin at the chest to record the heart rhythm continuously over a period of 2 to 4 years.

During the patient’s normal daily activities, the ILR device can capture important information about the heart’s rhythm, which can help the doctor identify any arrhythmias or abnormalities that might be responsible for the symptoms. This can aid in diagnosis and guide appropriate treatment.

How is it performed?

The ILR is typically placed just under the skin beside the breastbone on the left side of the chest. The implantation procedure involves making a small incision, around 1cm in length, and slipping the ILR under the skin using a delivery tool. Once in place, the entire device is buried under the skin and, apart from a small protrusion, it is not noticeable. This procedure usually takes around 10-20 minutes to complete.

Your doctor may recommend it for

Patients who have suffered from stroke due to unclear reasons or experiencing symptoms such as unexplained fainting, dizziness, palpitations, or irregular heartbeats may suggest the presence of an abnormally slow or irregular heart rhythm that may not be detected by routine testing.