Name of the Procedure:

Intraventricular pacing

Summary

Intraventricular pacing involves placing a specialized pacing device inside the ventricles of the heart to help regulate abnormal heart rhythms.

Purpose

Intraventricular pacing addresses conditions such as heart failure and arrhythmias (irregular heart rhythms). The primary goal is to improve heart function and ensure a consistent heart rate, which can enhance the patient's overall quality of life and reduce symptoms associated with heart conditions.

Indications

• Heart failure
• Bradycardia (slow heart rate)
• Tachycardia (fast heart rate)
• Bundle branch block
• Certain types of arrhythmias
• Patients with weak or irregular heartbeats that are not adequately managed through medication.

Preparation

• Patients may need to fast for several hours before the procedure.
• Medication regimens might need to be adjusted under a doctor's supervision.
• Pre-procedure diagnostic tests might include an ECG, chest X-ray, blood tests, and possibly an echocardiogram.

Procedure Description

1. Initial Prep: The patient is taken to a cardiac catheterization lab.
2. Anesthesia: The procedure is typically performed under local anesthesia with sedation.
3. Insertion: A small incision is made near the collarbone to access a major vein.
4. Guidance: Using fluoroscopy, a pacing wire is guided through the vein to the right ventricle.
5. Placement: The pacemaker device is connected to the wire and placed subcutaneously near the incision site.
6. Testing: The pacing device is tested to ensure proper function.
7. Closure: The incision is closed with sutures.

Duration

The procedure typically takes 1 to 2 hours.

Setting

Intraventricular pacing is usually performed in a hospital, specifically in a cardiac catheterization lab or a specialized operating room.

Personnel

• Cardiologist or cardiac electrophysiologist (main physician performing the procedure)
• Nurses
• Anesthesiologist or nurse anesthetist
• Radiologic technologist

Risks and Complications

• Infection at the incision site
• Bleeding or bruising
• Lead displacement or malfunction
• Puncture of the lung or heart muscle
• Arrhythmias induced by the procedure (rare)
• Allergic reaction to medication or anesthesia

Benefits

• Improved cardiac function
• Regular heart rhythm
• Reduced symptoms of heart failure and arrhythmias
• Enhanced quality of life
• Potential reduction in hospitalizations related to heart failure

Recovery

• Patients may need to stay in the hospital overnight for monitoring.
• Post-procedure instructions include avoiding heavy lifting and strenuous activities for a few weeks.
• Follow-up appointments are necessary to check the pacemaker's function and adjust settings if needed.

Alternatives

• Medication management (with varying effectiveness)
• Implantable cardioverter defibrillator (ICD)
• Biventricular pacing (for more complex cases of heart failure)

• Open heart surgery (for structural problems causing arrhythmias)

  Each alternative comes with its own set of pros and cons depending on the patient's specific condition.

Patient Experience

• During the procedure: Patients may feel discomfort at the incision site but should not experience significant pain due to local anesthesia and sedation.
• After the procedure: Mild soreness around the incision area is common and can be managed with over-the-counter pain relievers.
• Ongoing: Patients may feel the pacemaker under their skin but typically adjust quickly. Regular follow-ups ensure device efficiency and address any concerns.