Pacemakers and defibrillators are implantable electronic devices used to regulate the heart. These complex, programmable, battery-powered devices are increasingly being used to manage cardiac arrhythmias. Pacemakers are generally used to treat slow heart rhythms, whereas defibrillators protect patients from unstable, rapid heart rhythms that frequently result in sudden death.
Implantable pacemakers and defibrillators are connected to the heart by leads - metal wires encased by insulating material. Pacemakers and defibrillators are generally highly reliable and longlasting, but regular maintenance is important to ensure that the devices perform correctly and meet each patient's needs.
Each week, more than 50 patients are seen in the Pacemaker and Defibrillator Clinic, and more than 3,500 implanted devices are tracked through the program's database. The Pacemaker and Defibrillator Clinic is housed within the Department of Cardiovascular Medicine, located at both Lahey Clinic Medical Center in Burlington, Mass., and Lahey Clinic Medical Center, North Shore, in Peabody, Mass.
The Pacemaker and Defibrillator Clinic was established at Lahey to centralize the care of patients with implanted cardiac rhythm devices. The Clinic has two main functions:
The Clinic maintains a database of all patients and their implanted cardiac rhythm devices. This system enables the identification of potential problems with certain devices and the precise tracking of all patients with such implants, in the rare event of a device recall or warning. The Pacemaker and Defibrillator Clinic does not address issues related to heart medications or general cardiac symptoms. All patients with active medical problems unrelated to the functioning of an implantable pacemaker or defibrillator are referred to their primary cardiologist or internist, as appropriate.
Patients are seen by a staff of highly specialized nurses, working under the supervision of electrophysiologists - physicians specializing in heart rhythm disturbances - within the Department of Cardiovascular Medicine. A typical visit to the Pacemaker and Defibrillator Clinic lasts approximately 15 minutes. Given that the primary purpose of these appointments is to download data from the device and check its electrical functions, visits do not require the presence of a physician. However, a supervising physician is available to address any patient concerns or device issues. Clinic visits take place in a comfortable setting, with the patient sitting in a recliner. Patients are briefly connected to skin electrodes when the ECG signal is being recorded. Communication with the pacemaker or defibrillator is achieved through the skin using radio waves. Each device is checked and its settings altered using a programming wand held over the skin. Depending on the clinical situation, the patient may be asked to walk around for a few minutes to evaluate the device's response to exercise. An annual chest X-ray is recommended to check on the lead system. In patients who have had an implanted defibrillator for more than one year and who have not yet received any therapy from the device, the performance of a formal system test is recommended. The frequency of visits to the Pacemaker and Defibrillator Clinic varies according to the age of the device and the needs of the patient. Generally, we see all patients four to six weeks after device implantation, and then at 3-, 6- and 12-month intervals thereafter. After the first year following implant, most devices are followed every 6 or 12 months, depending on the type of system. Patients who have worn a pacemaker for more than two years can have the battery assessed every few months by telephone, from their home.
As one of the first hospitals to adopt Medtronic’s Carelink® Network, an internet-based cardiac device monitoring service, Lahey was at the forefront of providing this innovative and convenient method of care to cardiac device patients. Remote monitoring makes it easy for doctors to obtain important device-related and physiologic patient data that formerly would have required patients to come for an office visit. Today, Lahey physicians continue to monitor cardiac device patients around the world using both internet-based and wireless technologies including radiofrequency (RF) and Bluetooth. To learn more about remote monitoring, talk to your Lahey health care provider.
The Pacemaker and Defibrillator Clinic is located in the Cardiology area (5 East Clinic) of Lahey Clinic Medical Center, 41 Mall Road, Burlington, MA 01805.
Patients are referred to the Pacemaker and Defibrillator Clinic at the time of implant. Patients who received implants elsewhere should be referred to Lahey Clinic by their primary care physician or cardiologist.