Name of the Procedure:

Removal of Permanent Pacemaker Pulse Generator with Replacement of Pacemaker Pulse Generator; Dual Lead System
Common name(s): Pacemaker Replacement, Dual Chamber Pacemaker Replacement.

Summary

In this procedure, an old or malfunctioning pacemaker pulse generator is removed and replaced with a new one. It is performed on a dual lead system, meaning that two leads (wires) that connect the pulse generator to the heart are left in place while the generator is swapped out.

Purpose

This procedure is undertaken to address issues such as battery depletion, device malfunction, or outdated technology of the existing pacemaker. The goal is to ensure the pacemaker continues to function effectively, regulating the patient’s heartbeat and improving overall cardiac function.

Indications

• Battery depletion of the current pacemaker.
• Malfunction of the existing pacemaker.
• The need for upgraded technology.
• Symptoms such as dizziness, fatigue, or fainting that suggest pacemaker issues.
• Specific heart conditions requiring continuous pacing support.

Preparation

• Patients may need to fast for a few hours prior to the procedure.
• Medications may need to be adjusted as directed by the doctor.
• Diagnostic tests such as an EKG, blood tests, and imaging studies may be required.

Procedure Description

1. The patient is administered anesthesia (local or general) to ensure comfort.
2. An incision is made near the site of the current pacemaker.
3. The old pulse generator is carefully disconnected from the existing leads.
4. The new pulse generator is connected to the leads.
5. The new device is tested to ensure proper functioning.
6. The incision is closed with sutures or surgical glue.

The procedure uses tools such as surgical scalpels, forceps, and specialized pacemaker testing equipment.

Duration

The procedure typically takes 1 to 2 hours.

Setting

This procedure is usually performed in a hospital or surgical center, often in a specialized electrophysiology lab.

Personnel

• Cardiologist or cardiac surgeon
• Electrophysiologist (specialist in heart rhythms)
• Anesthesiologist or nurse anesthetist
• Surgical nurses and technicians

Risks and Complications

• Infection at the incision site
• Bleeding or bruising
• Damage to blood vessels or heart tissue
• Lead dislodgement
• Allergic reactions to anesthesia
• Rarely, complications affecting heart function

Benefits

• Restored proper heart rhythm and function.
• Symptom relief such as decreased dizziness and fatigue.
• Extended battery life and improved device technology. Benefits are typically realized immediately after recovery from the procedure.

Recovery

• Patients may need to stay in the hospital for observation, usually overnight.
• Instructions may include wound care, activity restrictions, and medication adjustments.
• Follow-up appointments to monitor the pacemaker are essential.
• Full recovery generally takes a week or two, avoiding heavy lifting or strenuous activities.

Alternatives

• Watchful waiting, with close monitoring of pacemaker performance.
• Medication adjustments to manage symptoms.
• Alternative pacing devices, if suitable. Choosing an alternative depends on the patient's specific condition and healthcare provider’s recommendations.

Patient Experience

During the procedure, patients are typically either sedated or under local anesthesia, thus should feel minimal to no pain. Post-procedure, there might be some discomfort or pain at the incision site, which can be managed with prescribed pain medication. Most patients experience significant improvement in symptoms shortly after the procedure. Regular follow-up care is crucial to ensure the pacemaker functions correctly.