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Why is the doctor performing this procedure?
Cardiomyopathy is a condition of having damaged heart muscle that becomes so weak that it can no longer pump the blood effectively. The damage to the heart muscle can be caused by heart attacks, chronic illnesses such as high blood pressure, or coronary artery disease, inherited disorders, viral infection and toxins (such as alcohol). The heart may become enlarged, causing a delay in the normal way the electrical conduction spreads across the heart, which in turn causes improper coordination of the ventricles (also called dyssynchrony).
Special pacemakers have been developed to improve the coordination of the lower chambers, "resynchronizing" the heartbeat, and your doctor has recommended this type of pacemaker for you, to improve the pumping function of your heart.
A biventricular pacemaker is a device that is implanted in the body and has electrode wires in that are placed at the right and left ventricle of the heart. The device is programmed to allow the chambers to work together more efficiently, to improve the way the heart pumps the blood, and is designed to improve the symptoms of congestive heart failure.
The device consists of 2 parts, the generator, which is a metal case containing both the battery and the circuitry. The battery supplies the energy and the circuitry acts like a computer to sense your heart's own natural electrical activity, and stores data about the activity, and also sends the electrical signals to the heart muscle.
The leads are insulated wires that are placed in your heart and connected to the generator. A biventricular device may have 2 ventricular leads alone, or it may also have 3 leads including an atrial lead if appropriate, to also allow the device to coordinate the activity of the upper and lower chambers, as well.
What is the procedure?
Implantaion is a surgical procedure performed in the Cath Lab of our partner hospitals. It is performed using either general anesthesia or "conscious sedation", depending on the doctor's preference, and can take two to four hours.
Before the procedure you will be given an IV antibiotic to prevent infection and the operative site will be washed with antibacterial soap, and shaved if necessary. The usual location of BVP is upper left chest, although the right side can be used. The doctor makes a small incision below the collar bone and creates a pocket in teh upper chest, where the device will be held. The leads are inserted into a large vein (subclavian) that runs down into your heart using fluoroscopy (X-ray).
Placing the leads in the righ side chambers of the heart is fairly straightforward, as the leads follow the natural flow of blood from the sublavian vein, to the heart. To approach the left side of the heart, the doctor initially places the lead the same way, through the subclavian vein, into the right atrium, but from there the wire is threaded to the outside of the heart through a large vein that opens into the right atrium (coronary sinus). Using fluoroscopy and contract (dye), the lead is threaded through a vein on the outside of the heart, until a location is found that will allow the lead to electrically stimulate the left ventricle. Successfully placing the lead on the left side may be the most time consuming of the procedure. Once the leads are successfully placed, they are tested to make sure they sense and pace the heart correctly. The wires are connected to the generator, and the device is protrammed to provide biventricular pacing. The pocket is then closed.
What are the risks of the procedure?
The procedure is usually low risk, but does carry possibility of bleeding and infection, like most surgical procedures. There is also risk of dislodgement of an electrode, and in rare instances, damage to the heart, lung, abnormal heart rhythm, or very rarely, death.
Most patients are discharged the next day, after receiving additional IV antibiotics, and providing no complications have occurred. You will be given specific instructions before you go home regarding the care of your incision, return to work/driving, and follow-up appointments. We will make an appointment for you to be seen in our device clinic at West Michigan Heart, and you will be seen 2 to 3 times a year after that.
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