Pacemaker and Implantable Cardioverter Defibrillator (ICD) Insertion, Children
What is a pacemaker and ICD insertion?
An artificial pacemaker is a small device placed in the body and connected to the
heart with wires (leads). It sends electrical signals to the heart to take control
of the heartbeat in the event it slows significantly. Sometimes a pacemaker may be
used to control a fast heartbeat. The insertion of a pacemaker requires minor surgery.
Implantable cardioverter defibrillator (ICD) insertion
An implantable cardioverter defibrillator (ICD) is a small device similar to a pacemaker.
It is placed in the body and connected to the heart with leads. If the heartbeat is
irregular, the ICD sends one or more brief shocks to correct it. If the heartbeat
is too slow, the ICD keeps the heart beating at a more normal rate. The insertion
of an ICD requires minor surgery.
Why might my child need a pacemaker or an ICD?
The heart has a natural pacemaker. When the natural pacemaker doesn't work as it should,
the heartbeat may be too fast, too slow, or irregular (arrhythmia). Your child may
need a pacemaker or ICD for some types of arrhythmias. This is especially true for
arrhythmias that cause severe symptoms.
An artificial pacemaker keeps the heartbeat regular. An ICD corrects sudden irregular
heart rhythms that may be life threatening. It also keeps the heartbeat regular.
What are the risks of a pacemaker/ICD insertion?
The complications of having either device put in the body may occur with any surgery.
- Bleeding, swelling, or bruising at the site of the insertion
- Reactions to medicines
And with an ICD, unnecessary shocks may actually cause arrhythmias or heart damage.
The wires attaching the devices to the heart are permanent. But in some cases, the
leads may need to be removed. This might be for infection or if the tissue is penetrated.
This can be very high risk.
How do I get my child ready for a pacemaker/ICD insertion?
What you do depends on your child's age. If your child is old enough, explain what
will happen in a way that he or she can understand. You might ask the cardiologist
or nurse to help explain the procedure to your child, too.
Make sure your child follows all instructions about eating, drinking, and taking medicines
before the device insertion. If your child becomes sick before the procedure, call
the provider's office.
What happens during a pacemaker/ICD insertion?
Pacemaker/ICD insertion is done in the hospital. This is either in a heart lab or
an operating room.
Before the procedure, your child will get medicine (sedative) to relax him or her.
And he or she will likely be given medicine to sleep (general anesthesia) once in
the lab or operating room.
The devices have 2 main parts. They are the wires (leads) and the generator.
- In older children, the healthcare provider makes a cut (incision) and stitches the
generator under the skin just below the collarbone. The leads are passed through a
vein and into the heart.
- In younger children, the provider makes an incision and may put the generator in the
abdomen. The leads may be placed on the surface of the heart.
While still in the lab or operating room, the provider will check it to make sure
the device is working correctly.
What happens after a pacemaker/ICD insertion?
After the pacemaker or ICD is inserted, your child will be watched closely for a few
hours. He or she may be sleepy for several hours. Some children go home the same day.
Some stay in the hospital overnight. Before you take your child home you will get
- The pacemaker or ICD, including the model and any special instructions
- Caring for the wound, including making sure it stays clean and dry
- Watching for infection, including such as watching for redness, swelling, drainage,
- Follow-up appointments
- Limits on activities
Before you agree to the test or the procedure for your child make sure you know:
- The name of the test or procedure
- The reason your child is having the test or procedure
- What results to expect and what they mean
- The risks and benefits of the test or procedure
- When and where your child is to have the test or procedure
- Who will do the procedure and what that person’s qualifications are
- What would happen if your child did not have the test or procedure
- Any alternative tests or procedures to think about
- When and how will you get the results
- Who to call after the test or procedure if you have questions or your child has problems
- How much will you have to pay for the test or procedure