How to Prepare
Sometime prior to your procedure your doctor or the nurse coordinator will review your medical history. He or she will also explain the purpose of the biventricular defibrillator or biventricular pacemaker, also called a Cardiac Resynchronization Therapy (CRT) Device, its potential benefits and possible risks. These are special devices used to treat heart failure. They have 3 leads and are used in addition to medication. The extra or third lead known as an LV (Left Ventricular) lead, is implanted in the LV and sends small electrical signals to the left and right ventricles to help them contract at the same time and help your heart pump more efficiently. The risks of implanting a biventricular defibrillator or biventricular pacemaker are small and relatively safe. Most patients undergoing these procedures do not experience complications.
You will need to have a
blood test,
ECG,
chest x-ray, and an ultrasound of the heart, also called an
echocardiogram before the procedure and you will be seen by the anesthetist on admission to the hospital. Your doctor's office or the Triage Office will arrange these tests for you prior to your procedure. If you have any questions, you can call your doctor's office or call the Triage Office at 416 340 4800 ext. 8436.
Most patients are admitted 1 to 2 days before their procedure. Occasionally, patients are seen in the
Pre-Admission Cardiology Clinic on the 5th floor of Norman Urquhart before the procedure and are then admitted to the
Cardiac Short Stay Unit on the 5th floor of Peter Munk Building on the day of the procedure. This decision will be made by your doctor or nurse coordinator. A letter with the instructions and appointments will be mailed to you or they can be sent by email.
If there are any changes in the booking of your test, you will be called by the Triage Office.
If you cannot go to your test, call the Triage Office as soon as you know.
Take a shower the night before or the morning of your test.
Please bring with you all of your current medications in the original containers. This includes prescription medications, over-the-counter medications, vitamin or mineral supplements and herbal remedies.
You can have NOTHING to eat or drink from midnight the night before your procedure. You will be instructed by your doctor or the APN as to which medications you are allowed to take on the morning of the procedure. Medications can be taken with sips of water unless you are instructed otherwise by your doctor or the APN. Your doctor or the APN will give you instructions about your blood thinner or diabetes pills.
Blood Thinners such as Coumadin® (Warfarin), Pradaxa® (Dabigatran), Eliquis® Apixaban and Xarelto® (Rivaroxaban) are usually stopped 1 to 3 days before the procedure. You will be given specific instructions about what to do by your doctor or the nurse coordinator.
If you take any medication (pills or insulin) for your diabetes, call the Triage Office or the doctor who is arranging your procedure for instructions. Ask what you will need to do about your medication and breakfast on the day of the test.
If you need an interpreter, bring a friend or family member on the day of the procedure. You'll be sedated during this procedure. Your friend or family member will be instructed on how to care for you or assist with your care after the procedure on discharge and will be required to drive and/or accompany you home. They can also help you gather information, take notes and ask questions.
You can back a small bag with personal toiletries for your hospital admission. DO NOT bring large sums of money or valuables to the hospital.
If you are discharged the same day as your procedure, you'll need to arrange for someone to stay with you during the night, after you have had your procedure.
Checking In
Biventricular Defibrillator Implants or Biventricular Pacemaker Implants are done in the Cardiovascular Investigations Unit (Cath Lab) on the 2nd floor Eaton Building at
Toronto General Hospital or in the Cath Lab on the 16th Floor at Mount Sinai Hospital.
If your procedure is being performed at Toronto General Hospital, you will initially check in on the
Cardiac Short Stay Unit on the 5th floor of the Munk Building or the
Cardiology Inpatient Unit on the 5th floor of the Munk Building. Please check in at the nurses' station.
If your procedure is being performed at Mount Sinai Hospital, you will be advised to check on the cardiology inpatient unit on the 16th Floor at Mount Sinai Hospital, on the day prior to the procedure. Please check in at the nurses' station.
Please have the following ready:
- Health card (OHIP card). If you do not have an OHIP card, please bring another form of government-issued photo ID (such as a driver's license, passport, or other provincial health card). Please arrive 15 minutes before your appointment.
- Your name, address and birth date
Before the Biventricular Defibrillator or Biventricular Pacemaker Implantation
When you check in, the receptionist will give you a name band to wear and you will be assigned to a room. You will be asked to change into a hospital gown. Your family should keep your valuables with them. The doctor or nurse coordinator will explain the procedure and the doctor will ask for your consent.
A nurse will prepare you for the procedure.
You may need additional blood tests on the morning of the procedure.
We give you medication (a local anesthetic) to help you relax or keep you sedated when you enter the Cardiovascular Investigations Unit (Cath Lab) and you will remain under local anesthetic during the procedure.
During and After the Biventricular Defibrillator or Biventricular Pacemaker Implantation
The procedure is done in the
Cardiovascular Investigations Unit (Cath Lab). The environment is kept cool to keep the machines working properly, so you may feel cool as well. During the procedure, the nurses will monitor your heart rhythm and blood pressure. Sterile sheets will be put on you to keep the insertion site clean.
Once you are sedated, the doctor will make two incisions. The first is to implant the 3 leads. One end of the leads goes into your heart. The first lead goes to the Right Ventricle (RV), the second lead goes to the Right Atrium (RA) and the third lead goes to the Left Ventricle (LV). The other end of the leads will be plugged into the Defibrillator or Pacemaker. The second incision makes a "pocket" or pouch just under your skin.
The basic procedure involves: inserting the leads; testing the leads to ensure the best position on, or in, the heart; connecting the leads to the defibrillator or pacemaker device; testing the automatic function of the device; closing the incision; programming the device.
When you wake up from the anesthetic, you will be drowsy and feel some discomfort. You will be in the Cardiovascular Investigations Unit (Cath Lab) recovery room or holding area for approximately 1 hour before returning to your room on the inpatient Cardiology Unit, or on the Cardiac Short Stay Unit.
When you return to your room, you'll be allowed to have something to eat and drink. You will be connected to a telemetry monitor to monitor your heart and its activity until you are discharged from the hospital.
The doctor or nurse coordinator will give you instructions on when to restart your medications.
The Nursing staff will monitor your heart rhythm, blood pressure and respiration rate and provide medication to control pain at the site of the incision. You will be able to sit in a chair and walk, as tolerated, within 2 to 4 hours.
The Results of Your Procedure
The doctor or the nurse coordinator will speak to you following the procedure. There will be final testing of the device by the pacemaker/defibrillator clinic staff before your discharge to confirm the ability of the device to function automatically. You will also have a chest x-ray.
You will be given a device Identification (ID) Card that should be carried with you at all times. The ID card provides emergency phone number and information about your device. Before you are discharged, your doctor or APN will discuss with you what to do in an emergency.
Prior to discharge, you will be given specific discharge instructions by your doctor, the nurse coordinator or the nurse involved in your care.
How Long Will Your Procedure Be?
Surgery usually takes 2 to 4 hours, and you are kept in the hospital overnight. Hospitalization varies from 1 to 2 days.
We do everything that we can to stay on time. Unfortunately, your appointment may be delayed by unforeseen circumstances. We recommend that you come prepared for delays.
Recovering at Home
Recovery time varies between about 4 to 6 weeks. You can return to daily activity gradually and you should rest when you are tired. Always follow your doctor's or nurse coordinator's instructions for mobility and activity levels.
While you are recovering, do not drive. Keep trips short and wear a seatbelt. Keep your incision dry. If you have removable stitches, you should have them removed by your family doctor 7 to 10 days following the implant. Avoid powders, creams and ointments at the incision site. If you have bandages, remove them within a few days or follow the instructions given to you on discharge.
Dress each day. Walk slowly up and down stairs. You can resume sexual activity as desired, applying no pressure to the left upper body. Avoid strenuous activities such as lifting heavy objects, vigorous push-pull movements (vacuuming), above-the-shoulder activities (tennis, golf) and overhead reaching and stretching for 6 weeks.
Emergency Plans
Always carry your Identification (ID) Card and always wear your medical alert necklace or bracelet. You should carry a list of medications and dosages with you and keep emergency phone numbers on hand. If you have a defibrillator, know what to do when the device delivers a shock. Inform significant co-workers, travelling companions, and others of the defibrillator. When travelling by air, inform airline security personnel of the device. Encourage family members to take a CPR course.
