Heart implants such as pacemakers and defibrillators are medical devices that are placed inside the body to regulate heart rhythm and prevent sudden cardiac death. While these devices are life-saving for many people, there are potential risks associated with having a heart implant including the possibility of heart problems after implantation. In the opening paragraphs, we’ll provide quick answers to some common questions about heart implants and potential heart complications.
Can a pacemaker cause heart failure?
While rare, it is possible for a pacemaker to contribute to heart failure in some cases. Pacemakers control heart rate by sending electrical signals to make the heart beat. If a pacemaker is not optimally programmed or functioning properly, it can lead to a non-ideal heart rate or rhythm which reduces the heart’s pumping ability over time. However, most experts agree that pacemakers provide significant benefits that outweigh this small risk.
Do defibrillators negatively affect heart function?
Implantable cardioverter defibrillators (ICDs) monitor heart rhythm and deliver shocks when needed to correct dangerous arrhythmias. There is little evidence that ICDs have negative effects on heart function when used appropriately. Rarely, the location of ICD leads can affect pumping efficiency if placed in non-ideal locations. But this risk is minimized by precise lead placement using imaging guidance during implantation.
Can scar tissue from implants increase heart problems?
Scar tissue is part of the normal healing process after any cardiac implant procedure. Small amounts of scarring are expected and usually do not cause issues. In rare cases, significant scarring can develop that could interfere with the implant’s function or heart function in the area. However, the risk is very low with today’s minimally invasive implantation techniques guided by precise imaging.
Common Heart Problems Associated with Implants
While major complications are rare, some potential heart problems can occur related to implants. Here we summarize the most common heart issues that may happen after pacemaker or ICD implantation.
Abnormal heart rhythms
An abnormal heart rhythm (arrhythmia) is the most common heart complication after device implantation. This occurs if the leads move out of place or scar tissue interferes with conduction. A lead may also fracture or become infected. Medication adjustments or lead repositioning usually fixes arrhythmia issues.
Heart injury during surgery
The implantation procedure itself carries some risk of heart damage, though minimal with today’s advanced techniques. Possible injuries include cardiac perforation, valve damage, or blood clots. Perforation that affects the pericardium may require surgery to correct.
Blood clots
Clots can form on the device or leads, often soon after placement. Clots may travel to other areas of the body like the heart or lungs. This risk is reduced by prescribing blood-thinning medication after implantation.
Heart infection
Infection is an uncommon but serious complication. Bacteria can enter the bloodstream and infect the device, heart valves, or lining of the heart. Indications of infection are fever, redness, warmth or drainage at the incision site. Antibiotics or surgery may be required.
Erosion
Rarely, constant pressure from an implant can erode through the wall of the heart. This may cause chest pain, infection, or cardiac tamponade. Close monitoring after surgery is needed to detect erosion early.
| Complication | Incidence Rate | Main Symptoms |
|---|---|---|
| Abnormal heart rhythms | 2-7% | Racing or fluttering sensations, dizziness, fainting |
| Heart injury during surgery | 0.6-1.2% | Chest pain, shortness of breath, fluid buildup |
| Blood clots | 0.6-3.5% | Arm/leg pain, swelling, skin discoloration |
| Heart infection | 1-2% | Fever, chills, headache, fatigue |
| Erosion | 0.1-0.8% | Chest pain, collapsed lung, fluid around heart |
Risk Factors for Heart Complications
Certain factors may increase a person’s likelihood of experiencing heart problems after pacemaker or ICD implantation. These include:
Pre-existing heart conditions
Those with a history of heart failure, congenital heart defects, or prior heart surgery have higher complication risks. Underlying heart disease makes the heart more vulnerable to trauma during implantation.
Other medical conditions
Diabetes, kidney disease, and vascular disease can limit blood flow and healing, increasing chances of heart damage or infection. Patients on steroids or with a weakened immune system are also at increased risk.
Advanced age
Older patients are more prone to surgical complications and infections in general. The heart muscle may also be weaker making it more susceptible to trauma.
Device type
Dual chamber pacemakers and cardiac resynchronization therapy (biventricular pacing) have higher complication rates than single chamber ventricular pacemakers. ICDs have risks associated with the defibrillation leads.
Implant location
Non-standard implant locations like abdominal placement can increase difficulty and surgical risks compared to pectoral implants. Epicardial lead placement also has higher risks.
Prevention of Heart Complications
There are important preventive measures patients and doctors can take to minimize risks of complications:
Careful patient selection
Thoroughly assessing risks versus benefits of implantation for more complex cases. Determine if alternatives like medication can be tried first.
Experienced implanter
Having surgery performed by a highly qualified implanter at a hospital experienced in device procedures reduces risks.
Antibiotics before surgery
Antibiotics prior to implantation lower the odds of device-related infection.
Blood thinners post-surgery
Medications help prevent dangerous blood clots from forming after device placement.
Regular follow-up
Routine monitoring of the device and heart function allows early detection and treatment of any complications.
Diagnosing Heart Problems After Implant Surgery
If heart complications are suspected after pacemaker or ICD surgery, the doctor will perform various tests to make a diagnosis. These may include:
Physical exam
Listening to the heart and feeling for fluid buildup or swelling. Checking the incision site for signs of infection. Assessing heart rhythm.
Electrical testing
Running tests on the pacemaker/ICD system to ensure proper lead function and optimal programming.
Blood tests
Evaluating blood cell counts, electrolytes and markers of heart muscle damage that could indicate injury or heart strain.
Imaging tests
Echocardiograms check heart structure, function, and valve abnormalities. Chest x-rays look for fluid around the heart or lead dislodgement. CT scans provide detailed images of the implant site.
Heart monitor
A Holter monitor records heart rhythm for 24-48 hours during normal activity to identify arrhythmias.
Identifying any heart abnormalities early is crucial for successful treatment and prevention of future complications.
Treating Heart Problems After Implantation
Treatment depends on the specific type of heart complication but may involve:
Medication
Drugs that treat heart failure, irregular heart rhythms, high blood pressure or prevent blood clots may be prescribed. Antibiotics administered intravenously are used for infections.
Lead repositioning
If leads have shifted or there is interference with electrical signaling, the leads can be surgically moved back into proper position.
Device reprogramming
adjusting pacemaker settings can optimize heart rate response. Changing ICD detection sensitivity may reduce unwanted shocks for arrhythmias.
Surgery
Serious complications like cardiac perforation, erosion, tamponade or severe infection may warrant surgical repair, lead removal, or even device removal.
Ablation therapy
Catheter ablation burns away small areas of faulty heart tissue causing abnormal heart rhythms. This allows normal conduction to resume.
Ongoing monitoring and follow-up is key after any interventions to confirm treatment effectiveness and watch for potential new issues.
Conclusion
While cardiac implants like pacemakers and ICDs greatly improve quality of life for many people, heart complications can sometimes occur after implantation. However, when performed by an experienced surgeon at a center specializing in implantation procedures, the overall risk of serious heart problems is quite low. Careful monitoring and follow-up after surgery allows quick intervention for any device-related complications to avoid ongoing heart damage or function loss. Patients should speak with their doctor about their individual risk profile before getting a device implanted so they can make the most informed decision.
