Implanting and Extracting Cardiac Devices: Technique and Avoiding Complications

The physician implanting a cardiac rhythm device must have a thorough working knowledge of cardiac pacing, defibrillation, and resynchronization, as well as a complete understanding of sterile technique and the specific surgical skills necessary for pulse generator implantationThis chapter includes a discussion of lead extraction as an implant-related procedureLead extraction is usually performed under general anesthesiaWhen the left ventricular lead is advanced, gentle pressure should cause mild buckling in the coronary sinus and proximal ventricular vein so that the lead conforms to the curvature of the venous systemAdvances in cardiac implantable electronic devices technology over the last few years have resulted in leadless pacemakers and totally subcutaneous implantable cardioverter-defibrillatorsThe chapter discusses techniques relevant to implantation and removal of newer devicesAfter implantation, the incision is covered with sterile gauze and tape or a “coverlet.” This is removed the next morning, and if the incision is dry it is left uncovered.