1. Conelius, Jaclyn PhD, FNP-BC, CCDS, FHRS

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What are the differences between a permanent pacemaker (PPM) and an implantable cardioverter defibrillator (ICD)?


* A pacemaker is a small implantable device that usually sits under the skin on the upper left side of a patient's chest. It continuously monitors the patient's heart rhythm and when their heart rate drops to below the set limit (usually 50-60 bpm) it will send out an electrical impulse to pace the heart. An ICD acts in the same way as a pacemaker with the added feature of shocking the heart out of a prolonged lethal arrhythmia such as ventricular tachycardia/ventricular fibrillation when it detects it (Reiffel & Dizon, 2002; Wood & Ellenbogen, 2002).


How often does a PPM/ICD need to be checked?


* All PPM/ICD should be checked in the office every 6 months. If the wireless option is used, they can be checked in between office visits remotely. When the wireless option is not chosen, the patient must have it checked in the office every 3 months.


How is a PPM/ICD checked?


* A certified practitioner in the physician's office checks a PPM/ICD with an interrogation machine specific to the manufacturer of the device. The newer PPMs/ICDs can be checked wirelessly (implanted after 2009) and remotely from a small box that sits at the bedside, which is also provided by the manufacturer. Older pacemakers implanted prior to 2009 are checked through the phone line while speaking to a technician on the other end.


How long will the batteries last in a PPM and/or ICD?


* Generally, batteries last 5 to 10 years. How long a pacemaker lasts depends on how much it is working to pace the heart and how it is programmed. Batteries in ICDs last longer or shorter depending on how many shocks they have delivered. Receiving therapy for a lethal arrhythmia such as a shock will drain the ICD battery faster (American Heart Association, 2015).


Does the presence of a PPM/ICD replace the need for taking cardiac medications?


* The medications that are prescribed by providers still need to be taken as directed. Sometimes, certain medications will be adjusted after a patient receives a device but that depends on the specific diagnosis. For example, some patients who received a pacemaker for bradycardia will have their beta-blocker discontinued prior to surgery. Once they have the pacemaker implanted and it begins pacing, their beta-blocker will be restarted.


Is travel allowed when a patient has a PPM/ICD?


* Yes, travel is allowed, but patients must be sure to show security personnel their ID card stating that they have a medical device, prior to going through the security devices.


Is it acceptable to exercise with a PPM and/or ICD?


* Patients must discuss exercise amount and frequency with their providers. There may be ways to program the device based on the type and amount of exercise to be performed. For example, one feature of the device is "rate-response" that can be adjusted based on exercise capability.




American Heart Association. (2015). Implantable cardioverter defibrillator. Retrieved from[Context Link]


Reiffel J. A., Dizon J. (2002). Cardiology patient page. The implantable cardioverter-defibrillator: Patient perspective. Circulation, 105(9), 1022-1024. [Context Link]


Wood M. A., Ellenbogen K. A. (2002). Cardiology patient pages. Cardiac pacemakers from the patient's perspective. Circulation, 105(18), 2136-2138. [Context Link]