Biventricular Pacemaker for Cardiac Resynchronization Therapy

A pacemaker is a surgically implanted electronic device that provides an unnoticeable electrical current that causes your heart to beat. A biventricular pacemaker is a special type of pacemaker that paces both sides of the lower chambers of the heart (the right and left ventricles) to help treat heart failure. This type of pacing is called "biventricular pacing," and the therapy provided by biventricular pacing is called cardiac resynchronization therapy or cardiac resynchronization therapy. 

Cardiac resynchronization therapy is useful for patients in whom there is uncoordinated activation of the heart muscle and who experience heart failure. By pacing both lower chambers of the heart, cardiac resynchronization therapy helps re-coordinate the contraction of your heart muscles so that the walls of your heart beat at the same time. Cardiac resynchronization therapy may reduce shortness of breath, improve symptoms and may even prolong life.

Certain types of biventricular pacing devices also provide the ability to shock the heart. These devices are called biventricular defibrillators and function in the same manner as implantable cardioverter defibrillators (ICDs) by providing a prompt electrical shock when you experience dangerous and fast heart rhythm problems from the bottom chamber of your heart.

The electrical system of your heart is critical in telling your heart muscle when to beat, and the electrical system functions with every beat of the heart. Weakened and stretched heart muscles can cause heart failure (called cardiomyopathy). Patients with heart failure also often have problems with their heart electrical system that prevent the electrical signal from reaching both sides of your heart simultaneously. When this timing is slowed, portions of your heart muscle do not beat at the same time (called dyssynchrony). The goal to enhance the performance of the heart muscle is for all of the heart muscle to beat at the same time. Biventricular pacing attempts to restore a coordinated pumping action of your heart (called resynchronization).

Why choose Ohio State for a biventricular pacemaker?

Ohio State’s Wexner Medical Center is one of the leading medical centers in electrophysiology. Electrophysiology is a specialization of cardiology that focuses on the electrical system of the heart. Ohio State’s Ross Heart Hospital has a dedicated staff of heart rhythm experts (called electrophysiologists), heart failure physicians, nursing staff, a device management team, research scientists and pharmacists that provide a complimentary team approach to evaluating patients who may need a biventricular pacemaker. Our electrophysiology program is the largest program in Ohio, and one of the top three in the nation, with extensive experience in managing a wide spectrum of heart rhythm problems.

What to expect during a biventricular pacemaker procedure

Preparing for your procedure

The day before and morning of your procedure, you will need to use a special soap called CHG. It is sold by the brand name of Hex-A-Clens or Hibiclens and is available at most pharmacies. Please scrub from the neck down, avoiding your eyes and ears.

You will be asked to not eat or drink anything after midnight the evening before your procedure. Your physician will give you specific instructions on which medicines, if any, you should stop taking before the test. If you are taking Coumadin, also called warfarin, do not stop this medicine unless directed by your doctor. If you are not given specific instructions, please take your medicines as you normally would with a small amount of water. Please tell your doctor if you are diabetic and on medication.

Do not smoke or use tobacco products for 24 hours before your procedure.

If you have an allergy to shellfish, iodine or contrast dye, please tell your doctor before your procedure. You may need to take three doses of prednisone before your procedure, and your doctor will need to write a prescription for this medicine.

If you use a sleep apnea machine, please bring the device with you to the hospital. It will likely be used during your procedure and your hospitalization.

During your procedure

Implantation of a biventricular pacemaker and possibly a defibrillator is performed in a special room in the Electrophysiology Lab at Ohio State’s Ross Heart Hospital:

• Prior to the procedure, you are given an antibiotic through the IV (intravenous line)
• The skin at the site where the device will be placed is shaved on the left or right side of the upper chest, and cleansed with a special soap
• Your waist and arms are secured with a soft strap to prevent your hands from touching the sterile area
• You are given a local anesthetic (pain-relieving medication) to numb the incision area as well as medication to help you relax and sleep
• An incision is made in the chest where the leads and device are inserted. The leads (wires that deliver the electrical impulse to provide biventricular pacing) are inserted through the incision and into a vein and then guided to the heart with the aid of X-ray. Two leads are guided to the right atrium and right ventricle. A third lead is guided through the coronary sinus to the left ventricle.
• The lead tips are in contact with the heart muscle, while the other ends of the leads are attached to the pacemaker or defibrillator
• The pacemaker or defibrillator is placed under the skin in the upper chest

After your procedure

After your biventricular pacing implantation, you will return to your hospital room and be monitored overnight. Patients usually spend only one night in the hospital. The day after your procedure, an X-ray of the device is completed and the device is tested by our Device Clinic staff. You will need to arrange to have an adult drive you home the day you are discharged.