Implantable Device Replacement Procedure
What is an implantable device replacement procedure?
Pacemakers and implantable cardioverter defibrillators (ICDs) are heart devices. They
are surgically implanted in people who need them. Pacemakers are used to treat slow
heart rhythms. ICDs stop dangerous, fast heart rhythms.
These devices have two main parts: a pulse generator and a set of wires (leads).
The pulse generator is a small metal box. It contains electric circuits and a battery.
During the first placement of your heart device, your doctor put this generator under
your skin or the muscles of your chest wall. Normally, these generators are powered
by lithium batteries. They generally last up to 10 years before they need to be replaced.
Time to replacement varies depending on the type of device you have, how much energy
it uses and the amount of time it paces your heart. To replace the pulse generator,
you will need an implantable device replacement procedure.
The leads are wires that run between the pulse generator and your heart. These leads
can deliver a burst of energy from the pulse generator. This energy can cause your
heart to beat more quickly (in a pacemaker) or it can stop fast heart rhythms (in
an ICD). To do this, the leads must make contact with your heart. Most leads travel
through a vein to attach to the right side of your heart. They are often attached
to the heart wall with a small screw or hook.
Replacing the pulse generator is a simple outpatient surgery similar to your initial
implant but this time only the generator will be replaced. If the original leads are
working normally, they will continue to be used with the new generator.
Your old generator will be disconnected from your leads. Then it will be taken out.
Then your surgeon will put a new generator in the same pocket and connect it to the
leads that are in place. At that point, your new ICD or pacemaker can work just as
In rare cases, you may need to have the leads removed along with or instead of the
generator if, for example, there is a malfunction with one or more of the leads. This
is a more complex procedure.
If you are completely dependent on the pacemaker to maintain a heartbeat, your doctor
may use a temporary pacing wire during the procedure to help your heart to beat while
the generator is being changed out and replaced. This temporary wire would then be
removed once the new generator is connected and working.
Why might I need an implantable device replacement procedure?
Most generators need to be replaced within 5 to 15 years after they are inserted.
This depends on how much you are using the implanted device which affects battery
life. Your healthcare provider can check the battery and functioning of your device.
Most of the time, these devices give plenty of warning that they are nearing the end
of their battery life. You often have a few months to schedule your replacement procedure
even after the device triggers the replacement interval.
Sometimes, you need to replace your generator before the battery life ends. This may
Your generator starts to malfunction or stops working.
You have an infection at the site of the generator, and you need more than antibiotics
to clear it up. In this case, the whole pacemaker/ICD system would need to be removed
It’s important for your pacemaker or ICD to work well. The pacemaker can keep your
heart from beating too slowly. ICDs can stop the kind of dangerous heart rhythms that
can lead to sudden death. You may need an ICD if you had a sudden cardiac arrest,
heart failure, or heart rhythm problems.
What are the risks of an implantable device replacement procedure?
This procedure is very safe, but it comes with some rare risks. These include:
There is also a small risk that you will also need your leads replaced at the same
time of the device replacement. This requires a more complex surgery. In most cases,
your surgeon will know ahead of time if you will need this.
Your risks may differ depending on your age, health issues, and where your generator
was originally placed. Ask your healthcare provider about your outlook before your
How do I get ready for an implantable device replacement procedure?
Your healthcare provider may tell you not to eat or drink anything before midnight
of the day of your procedure. Follow your healthcare provider’s orders about what
medicines to take. Don’t stop taking any medicine unless your healthcare provider
tells you to do so. It’s a good idea to ask someone to drive you home after the procedure.
Your healthcare provider may do some tests before your procedure. These may include
an electrocardiogram (ECG). This test is done to check your heart rhythm. Or you may
need an echocardiogram. This test evaluates heart function. Routine blood tests are
also done before the procedure.
Just before the procedure, someone may shave your skin above the area where you will
have the incision. Someone will also start an IV (intravenous) line. This is done
so you can get medicine during the surgery.
What happens during an implantable device replacement procedure?
The procedure often takes less than an hour. In general you can expect the following:
You may be given medicine through an IV line. This will make you feel sleepy and relaxed.
Antibiotics will be given as well.
Medical staff will closely watch your heart rate, blood pressure, and other vital
After cleaning the area, the healthcare provider injects medicine to numb the skin
over your generator. This will keep you from feeling pain as the device is replaced.
The surgeon makes a cut into the pocket of skin and tissue surrounding the generator
and gets access to the generator.
The surgeon disconnects your old generator from its leads. Then the surgeon takes
it out of your body.
The pocket is then cleaned with antibiotic solution.
The surgeon puts your new generator in the same pocket where the old generator was.
It's attached to your old leads.
Medical staff will check that the new device is working properly
The surgeon will close up the pocket and the small incision in your skin.
What happens after an implantable device replacement procedure?
Your healthcare provider will monitor you after the procedure. You may not remember
much of the procedure. In most cases, you can go home after a couple of hours.
Try to take it easy the rest of the day. Make sure someone is around to help you.
You can eat your normal diet as soon as you are able to. You may have some minor pain
after the procedure. Ask your healthcare provider if you can take over-the-counter
Your healthcare provider will tell you how the procedure went. Be sure to follow all
of your provider’s instructions. You will need to care for your wound. You may also
need to take antibiotics for a few days after the procedure. You should keep the wound
dry until your provider says it's OK to shower or get it wet. This will help minimize
the risk of infection.
Tell your provider right away if you have heavy bleeding from your incision or drainage
from the incision, a fever, or other severe symptoms. You will likely have a checkup
a week or so after your surgery. Your provider will monitor your ICD or pacemaker
regularly, as before.
Before you agree to the test or the procedure make sure you know:
The name of the test or procedure
The reason you are having the test or procedure
What results to expect and what they mean
The risks and benefits of the test or procedure
What the possible side effects or complications are
When and where you are to have the test or procedure
Who will do the test or procedure and what that person’s qualifications are
What would happen if you did not have the test or procedure
Any alternative tests or procedures to think about
When and how you will get the results
Who to call after the test or procedure if you have questions or problems
How much you will have to pay for the test or procedure