Cardiac Device Implantation for Hypertrophic Cardiomyopathy

The goal of an implantable cardioverter defibrillator (ICD) is to detect and correct a potentially life-threatening, rapid, and chaotic heartbeat called ventricular fibrillation.

There are now two kinds of defibrillators that are implanted by our device specialists: intravenous defibrillator and subcutaneous defibrillator. The intravenous defibrillator is placed below the clavicle and connected to the inside of the heart using leads or wires. The subcutaneous defibrillator is placed under the skin in the region of the left armpit. The leads of the subcutaneous device are implanted outside the chest cavity and ribs, and not attached to the inside of the heart.

Both defibrillators sense the presence of rapid, irregular heartbeats that originate in the heart’s lower chambers, or ventricles, which pump blood to the body. When needed, they automatically deliver an electrical shock to the heart, correcting the heart’s rhythm. This is called defibrillation.

An important difference between the subcutaneous and intravenous defibrillator is that the subcutaneous device cannot pace the heart. For this reason, it is not appropriate for people who require the action of a pacemaker, which sends electrical pulses to the heart when the organ beats too slowly, restoring its normal rate.

The procedure takes 30 to 60 minutes and requires an overnight stay in the hospital. For 2 weeks afterward, your doctor advises you to avoid driving and lifting items heavier than 10 pounds.

A pacemaker is a battery-operated device that is implanted in the chest and sends electrical signals to your heart through two wires called leads. A pacemaker helps correct a slow heart rhythm called bradycardia.

A dual-chamber pacemaker—which has a lead that attaches to an atrium and another that’s connected to a ventricle—may be recommended for people who experience exercise intolerance or shortness of breath; for those whose symptoms aren’t relieved with medication; or for people who are not able to have open heart surgery. A pacemaker is also commonly recommended for people who have very slow heart rates, generally less than 48 beats per minute, as a result of HCM slowing the generation of heart beats.

Your NYU Langone heart surgeon typically makes a small incision to implant the pacemaker under the skin below the left or right collarbone. They then connect the device’s leads to the heart.

The doctor administers a sedative and a local anesthetic, which is applied at the incision and implantation site. It takes 30 to 60 minutes for the doctor to complete the procedure, and you typically stay in the hospital overnight. Your doctor may restrict your activities, such as driving, for up to two weeks after the procedure.

If your NYU Langone doctor has implanted a pacemaker or defibrillator to manage HCM, experts at the Heart Rhythm Center provide ongoing cardiac device management to ensure that the device continues to maintain your heart’s rhythm. These devices can be monitored at your doctor’s office or remotely through wireless technology.