Name of the Procedure:

Removal of permanent pacemaker pulse generator with replacement of pacemaker pulse generator; multiple lead system. Commonly referred to as Pacemaker Generator Replacement.

Summary

Pacemaker Generator Replacement is a surgical procedure to remove an old or malfunctioning pacemaker pulse generator and replace it with a new one. This is often done when the battery life of the pacemaker is near its end or if there are issues with the device itself. The procedure involves working with a multiple lead system, meaning that multiple wires connected to the heart will be managed and reconnected to the new generator.

Purpose

This procedure addresses issues related to a failing or outdated pacemaker. The goal is to ensure the patient’s heart continues to receive the necessary electrical impulses to maintain a regular heartbeat. Successful replacement can prevent serious heart rhythm problems and improve overall heart function.

Indications

• End of battery life of the current pacemaker generator.
• Malfunction or failure of the current pacemaker.
• Upgrading to a newer model with improved functionality.
• Patient experiencing symptoms such as dizziness, fatigue, syncope, or palpitations indicating pacemaker trouble.

Preparation

• Patients may be asked to fast for 8-12 hours prior to the procedure.
• Certain medications, particularly blood thinners, may need to be adjusted.
• Pre-procedure tests could include an electrocardiogram (EKG), blood tests, and imaging studies like a chest X-ray.
• Patients should arrange for someone to drive them home post-procedure.

Procedure Description

1. The patient is prepared and an intravenous (IV) line is started.
2. Sedation or general anesthesia is administered to ensure comfort.
3. A small incision is made near the site of the current pacemaker.
4. The surgeon carefully removes the old pacemaker generator, keeping the leads (wires) connected to the heart intact.
5. The new pacemaker generator is connected to the existing leads.
6. The new device is tested to ensure it is functioning correctly.
7. The incision is closed and dressed.

Duration

The procedure typically takes 1 to 2 hours.

Setting

The procedure is generally performed in a hospital setting, specifically in a catheterization lab or an operating room equipped for cardiac procedures.

Personnel

• Cardiac surgeon or cardiologist specialized in electrophysiology.
• Surgical nurse.
• Anesthesiologist or nurse anesthetist.
• Operating room technician.

Risks and Complications

• Infection at the site of incision.
• Bleeding or bruising.
• Lead displacement or damage.
• Reaction to anesthesia.

• Rarely, damage to the heart or surrounding vessels.

  Benefits

• Restoration of normal heart rhythm.
• Prevention of symptoms related to pacemaker failure.
• Improved quality of life.
• Benefits can be realized immediately after successful implantation.

Recovery

• Monitor in the recovery room for a few hours or overnight.
• Instructions on caring for the incision site.
• Avoid strenuous activities and heavy lifting for a few weeks.
• Follow-up appointments to monitor the pacemaker function and general health.
• Medications as prescribed for pain relief and infection prevention.

Alternatives

• Drug therapy to manage heart rhythm, though less effective for certain arrhythmias.
• Redoing the entire pacemaker system, including leads, if lead malfunction is suspected.
• Ablation procedures to address arrhythmias directly, but this is more invasive.

Patient Experience

• Mild discomfort or pain at the incision site post-procedure.
• Sedation ensures the procedure itself is painless.
• Instructions on how to manage pain and what activities to avoid.
• Follow-up visits to ensure proper healing and pacemaker function.