Biventricular Pacemaker (ICD Implantation)

What is a Biventricular Pacemaker/ICD?

A biventricular pacemaker is a more sophisticated implantable device that has a third lead that goes to the lower left chamber (left ventricle). This is done so that the right and left ventricles receive signals from the pacemaker. The lead is placed into the main vein of the heart called the coronary sinus which enables pacing signals to be delivered to the left ventricle. A biventricular ICD performs two purposes: it is an ICD that monitors for dangerous abnormal heart rhythms; and it provides pacing to the left and right ventricles with the third lead.

Who should receive a Biventricular Pacemaker/ICD?

Biventricular pacing is recommended for patients whose hearts have uncoordinated electrical conduction, a condition called left bundle branch block (LBBB) as well as congestive heart failure. LBBB can be seen on an EKG.

What can I expect at the time of Biventricular Pacemaker/ICD implantation?

A biventricular pacemaker/ICD is implanted by making a small incision usually near the left shoulder. A needle is inserted into a vein, wires are placed through the needles, and leads are placed through that entry down to the heart. The third lead is placed by entering one of the veins of the heart called the coronary sinus. The generator is attached to the leads and placed in a small “pocket” under the skin. The procedure takes 1-3 hours. Patients usually remain overnight in the hospital for observation and go home the next morning. The main risk of the procedure is bleeding or infection which can occur about 1% of the time. Other complications which may be more serious are rare.

After implantation, we recommend that patients keep the dressing on for 5 days. Patients should avoid taking a shower for 3 days. After 3 days, the dressing may get wet. Patients are also instructed to avoid lifting their arm over their shoulder for 6 weeks to avoid dislodging the lead.