Pacemaker and Implantable Cardioverter Defibrillator (ICD) Insertion for Children

What is a pacemaker and ICD insertion for children?

Pacemaker insertion

An artificial pacemaker is a small device placed in the body and connected to the heart with wires (leads).  It sends electrical signals to the heart to take control of the heartbeat in the event it slows significantly. Sometimes a pacemaker may be used to control a fast heartbeat. The insertion of a pacemaker requires minor surgery.

Implantable cardioverter defibrillator (ICD) insertion

An implantable cardioverter defibrillator (ICD) is a small device similar to a pacemaker. It is placed in the body and connected to the heart with leads. If the heartbeat is irregular, the ICD sends one or more brief shocks to correct it. If the heartbeat is too slow, the ICD keeps the heart beating at a more normal rate. The insertion of an ICD requires minor surgery.

Why might my child need a pacemaker or an ICD?

The heart has a natural pacemaker. When the natural pacemaker doesn’t work as it should, the heartbeat may be too fast, too slow, or irregular (arrhythmia). Your child may need a pacemaker or ICD for some types of arrhythmias. This is especially true for arrhythmias that cause severe symptoms.

An artificial pacemaker keeps the heartbeat regular. An ICD corrects sudden irregular heart rhythms that may be life threatening. It also keeps the heartbeat regular.

What are the risks of a pacemaker/ICD insertion for a child?

The complications of having either device put in the body may occur with any surgery. They include:

  • Bleeding, swelling, or bruising at the site of the insertion
  • Infection 
  • Reactions to medicines

And with an ICD, unnecessary shocks may actually cause arrhythmias or heart damage.

The wires attaching the devices to the heart are permanent. But in some cases, the leads may need to be removed. This might be for infection or if the tissue is penetrated. This can be very high risk.

How do I get my child ready for a pacemaker/ICD insertion?

What you do depends on your child’s age. If your child is old enough, explain what will happen in a way that he or she can understand. You might ask the cardiologist or nurse to help explain the procedure to your child, too.

Make sure your child follows all instructions about eating, drinking, and taking medicines before the device insertion. If your child becomes sick before the procedure, call the provider’s office.

What happens during a pacemaker/ICD insertion for a child?

Pacemaker/ICD insertion is done in the hospital. This is either in a heart lab or an operating room.

Before the procedure, your child will get medicine (sedative) to relax him or her. And he or she will likely be given medicine to sleep (general anesthesia) once in the lab or operating room. 

The devices have 2 main parts. They are the wires (leads) and the generator. 

  • In older children, the healthcare provider makes a cut (incision) and stitches the generator under the skin just below the collarbone. The leads are passed through a vein and into the heart.
  • In younger children, the provider makes an incision and may put the generator in the abdomen. The leads may be placed on the surface of the heart.

While still in the lab or operating room, the provider will check it to make sure the device is working correctly.

What happens after a pacemaker/ICD insertion for a child?

After the pacemaker or ICD is inserted, your child will be watched closely for a few hours. He or she may be sleepy for several hours. Some children go home the same day. Some stay in the hospital overnight. Before you take your child home you will get information about:

  • The pacemaker or ICD, including the model and any special instructions
  • Caring for the wound, including making sure it stays clean and dry
  • Watching for infection, including such as watching for redness, swelling, drainage, or fever
  • Follow-up appointments
  • Limits on activities

Next steps

Before you agree to the test or the procedure for your child make sure you know:

  • The name of the test or procedure
  • The reason your child is having the test or procedure
  • What results to expect and what they mean
  • The risks and benefits of the test or procedure
  • When and where your child is to have the test or procedure
  • Who will do the procedure and what that person’s qualifications are
  • What would happen if your child did not have the test or procedure
  • Any alternative tests or procedures to think about
  • When and how will you get the results
  • Who to call after the test or procedure if you have questions or your child has problems
  • How much will you have to pay for the test or procedure

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