Cardiac rhythm devices – Cardiac resynchronization pacemakers or BI ventricular pacemakers

Hi, my name is Steve.

This is Melanie and this is Michelle and were nurses from the Heart Rhythm Device Clinic at the Mazankowski Heart Institute.

We're here today to tell you why you're getting a device, what device is going to do, and what to expect when living with the device.

Your doctor has recommended that you receive a cardiac rhythm device because you're having problems with your hearts electricity.

The heart sends signals from the top to the bottom.

Your heart has trouble receiving signals and the device that you will receive will help to correct that issue.

The cardiac resynchronization pacemaker, or biventricular pacemaker, prevents your heart from beating too slowly and helps to resynchronize the bottom ventricles to improve your heart, so that it will pump more efficiently.

In fact, some of you receiving this device do not have a slow heart rate.

But you will have this device for the benefit of getting your heart to work more efficiently.

It does not treat fast heart rates.

You can see the pacemaker battery.

There will be 2 or 3 wires which go into your heart. A CRT P [cardiac resynchronization therapy pacemaker] is a pacemaker with an additional lead on the left ventricle.

A traditional pacemaker utilizes leads in the right atrium and right ventricle.

It continuously monitors the heartbeat and when necessary, delivers tiny, unnoticeable electrical signals to keep the heart from beating too slow and to maintain a heart rate prescribed by your physician.

The additional lead in a CRT P is placed on the left ventricle of the heart to coordinate the pumping functions of the two lower chambers, so the heart pumps efficiently.

Before your procedure you will come to cardiac recovery, a pre-op holding area and a recovery area.

You will be put into a gown, put on a heart monitor, have an IV [intravenous], and some other preparation will be done.

You will come to the EP [electrophysiology] procedure room and lie on a table.

You will again be put on a cardiac monitor.

There will be some sterile, green drapes over your face, but you will be awake.

You will be able to talk and the nurses will check on you to see if you are comfortable throughout the procedure.

You'll get some medication to make you relaxed.

After your procedure, you go back to the recovery area for some monitoring before you go home.

You will be seen by a device clinic registered nurse.

You will have a gauze dressing.

Please do not shower or bath for the first 2 days.

After 2 days, wash your hands and remove the tape and gauze.

You will then see little tapes on your skin called steri-strips.

Now you should shower daily to let water run over the incision and gently pat it dry.

It is OK if some soap touches the incision, but do not use lotions or powders until it is fully healed.

Do not soak in water, such as a pool or a bathtub, until it is fully healed, because this can cause infection.

Please see your family doctor in 7 to 10 days to check the incision.

The steri-strips can be removed at this visit, or you can take them off while in the shower at home.

Most of incisions will heal well, but it is important to watch for signs of infection or complications.

Please call the clinic if you have any questions or concerns.

Signs to watch for are: redness, swelling that causes the skin to feel tight, bruising that extends beyond the area of the incision or returns after it is healed.

Also note if the skin feels hot or changes colour.

Watch for drainage, fever, or chills.

Tenderness is normal, but please call if the pain returns or increases significantly after the first few days.

If you are unsure, please call.

This is what we are here for.

It is much easier to catch a problem early instead of late.

The clinic phone number is on the bottom of every appointment letter you receive and it is also on the instruction papers we will give you after your procedure.

These are some examples of incisions that are all healed.

You can see that one shows the skin is a different colour when it is healed.

This is normal.

It is just how some people heal.

The scar fades over time.

We're going to ask you to restrict your arm movement on the side that the device was implanted for the next 6 to 8 weeks.

We don't want you to reach way out, and we don't want you to reach way up over your head.

We also don't want you lifting anything more than 5 pounds or the weight of a milk jug.

If you normally use your arms to help push yourself out of the bed, or you have a walker that you lean on, we ask that you not do that for the 6 to 8 weeks.

That will put pressure on the pectoral muscle and it might dislodge the leads.

We want you to kind of take it easy around the house, avoid doing extraneous or hard work like that, but anything else we do want you to continue walking, and aerobic exercise is just fine.

The 3 most important things for you to remember are: incision care, when to call the clinic, and arm movement and lifting restrictions.

This information is also written on the instruction papers you will receive after the procedure.

You will have a driving restriction.

Your physician will confirm how long the driving restriction will be.

You will be given a temporary ID card for your device which has the serial number of the device.

This is a temporary paper.

The company will mail you a permanent one in a few months.

You should keep it in your wallet at all times.

Then you will show airport security if you're traveling as you go through the security system.

You should let all healthcare professionals know that you have the device.

People often have questions about what objects in the environment will interfere with their device.

Not that many really.

It is completely safe for you to use a microwave.

Household items, such as a television, computer, heating blankets, etc. are safe.

Personal care items such as a razor, hair dryer, and curling iron are safe.

Small handheld hobby tools are usually safe.

If you are not sure, call the 1-800 number on your device card.

You can use your cell phone almost anytime.

What we do ask is that you do not use your cell phone on the side in which the device was implanted.

We also ask that you do not put the cell phone in your breast pocket.

Objects that you do need to avoid being in close contact with are often heavy industrial machinery or industrial magnets.

Avoid TENS [transcutaneous electrical nerve stimulation] or "Dr. Ho" machines because they use direct electrical stimulation.

The best way to find out if a piece of equipment is safe or not is to phone the 1-800 number on your ID card.

The company has specialists that can give you advice.

Another common question people have is, “Can I have an MRI?"

Yes, it may be possible, but that would be for further discussion with your physician.

Your first clinic visit will be approximately 6 weeks after your device procedure.

You will receive, a written appointment letter with instructions.

Our clinic is located on the 2nd floor of the Mazankowski Alberta Heart Institute.

After the initial 6 week visit, generally you will come at 3 months and then again every 6months.

This video was developed for you by the team of registered nurses at the Mazankowski Heart rhythm device clinic.

We offer special thanks to Doctor Sivakumaran, our medical director, for suggesting this project and to Tobie Guinez, our nurse manager, for her support and enthusiasm.

Also, we appreciate our patients whose identity is not shown but who consented to allow pictures to be taken of their incisions.

And heartfelt thanks to Abbott, Boston Scientific, and Medtronic for animations and pictures in this video.