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 defibrillator, pacemaker or implantable Loop recorder, its potential benefits and possible risks. The risks of implanting a defibrillator, pacemaker or loop recorder 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 to the procedure and you may need to be seen by the anesthetist. 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.
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. Your doctor or nurse coordinator will tell you which medications you are allowed to take on the morning of the procedure. Medications can be taken with a sip of water unless you are instructed otherwise by your doctor. Your doctor or nurse coordinator 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
Defibrillator implants, Pacemaker Implants and Implantable Loop Recorders are done in the Operating Room (OR) or the
Cardiovascular Investigations Unit (Cath Lab) on the 2nd floor Eaton Building.
You will initially check in at the Surgical Admissions Unit on the 2nd Floor Munk Building or the
Cardiovascular Investigations Unit (Cath Lab) or the Cardiac Short Stay Unit on the 5th Floor Munk Building, depending on where your surgery is being performed. 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 Your Defibrillator or Pacemaker Implant or Implantable Loop Recorder
When you check-in, the receptionist will give you a name band to wear. You will be assigned a room to wait until it's time for your procedure. You will be asked to change into a hospital gown. Your family should keep your valuables with them.
When you have finished changing, a nurse will prepare you for the test and the surgeon will explain the procedure and ask for your consent.
You may need additional blood tests on the morning of the procedure if indicated.
We give you medication (a local anesthetic) to help you relax or keep you sedated when you enter the operating room or Cardiovascular Investigations Unit (Cath Lab) and you will remain under local anesthetic during the procedure.
During and After the Defibrillator or Pacemaker Implantation or Implantable Loop Recorder
The surgery is done in the operating room or 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 surgeon will make two incisions. The first is to implant the lead(s). One end of the lead goes in your heart. The other will be plugged into the Defibrillator or Pacemaker. The second incision makes a "pocket" or pouch just under your skin.
The basic surgical 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 recovery room for approximately 1 hour before returning to your room in the Cardiology Unit, Cardiovascular Investigations Unit (Cath Lab) or 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 nursing staff will monitor your heart rhythm 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. Please avoid above-the-shoulder arm movements for four weeks, and avoid lifting objects over five pounds for six weeks.
The Results of Your Surgery
Your physician or nurse coordinator will speak to you following the surgery. There will be a final testing of the device by the pacemaker/defibrillator clinic staff before your discharge, to confirm that the device is working automatically. You may also require a chest x-ray at this time.
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 physician or nurse coordinator will tell you what to do in an emergency.
Before discharge, you will be given specific instructions by your doctor or nurse coordinator about when you can start taking your medications again.
How Long Will Your Procedure Be?
Surgery usually takes 1 to 2 hours; however, you will be here all day. Most patients are discharged the same day, but an overnight stay can last 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.
How to Prepare
Recovery time varies between about 4 to 6 weeks. You can return to daily activity gradually. Remember to rest when you are tired. Always follow your physician 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.
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.
