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Biventricular Pacemaker and ICD (Biventricular ICD) 

Outline of man's chest showing showing biventricular pacemaker ICD  in chest with three leads going into heart chambers.

You have a condition called heart failure (also known as congestive heart failure, or CHF). This condition causes symptoms such as getting tired very quickly and being short of breath. To help treat these symptoms, your doctor is recommending a biventricular pacemaker and implantable cardioverter defibrillator or ICD. (This is sometimes called a “biventricular ICD”). A biventricular pacemaker and ICD is a small, lightweight, battery-operated device. This device helps keep your heart pumping normally. Read on to learn more about this device and how it works.

Understanding the Heart

The heart is made up of 4 sections (chambers) that pump to move blood through the heart. The top 2 chambers are the left atrium and right atrium. The bottom chambers are the left ventricle and right ventricle. The heart has an electrical system. This system sends signals that make the atria and ventricles pump in sync. This causes the heart to beat and move blood through the heart and lungs and out to the body.

How the Device Works

Due to heart failure, your heart is weakened. As a result, the ventricles don’t pump in sync the way they should. A biventricular pacemaker and ICD help keep the heart pumping the way it should. The pacemaker part of the device keeps the heart from beating too slowly. It sends regular synchronized signals to keep the heart beating at a steady pace. This also improves how well the parts of the heart beat together. The ICD part of the device stops dangerously fast heart rhythms. If the device detects an abnormally fast heartbeat, it will send a "shock" to the heart. The shock stops the fast rhythm and restores a normal heartbeat.

Before the Procedure

Tell your doctor about all medications you take. Also mention whether you have allergies to any medications.

During the Procedure

  • An intravenous (IV) line is placed in your hand or arm. It delivers fluids and medications.

  • You will be given medication so you don’t feel pain. This is called anesthesia. Most likely, you will receive sedating medication that will make you drowsy or lightly asleep. Local anesthetic medication is also injected to numb the skin on your chest where the incision will be made.

  • Once the medication takes effect, an incision is made where the device will be implanted. This is most often on the left side of the chest under the collarbone.

  • The doctor then makes a small “pocket” for the generator under the skin.

  • The device’s wires (leads) are guided through the incision into a vein to the heart. Using X-ray monitors that show the wires inside the body, the doctor guides a lead into each ventricle. A lead may also be placed in the right atrium.

  • The generator is attached to the leads. Impulses are sent through the leads to test the generator. This testing may cause your heart to race.

  • The generator is then placed into the pocket under the skin.

  • The incision is closed with sutures (stitches), surgical glue, or staples. It is then covered with a bandage.

After the Procedure

You will be taken to a room to rest. Nurses check on you. They can give you pain medication if you need it. Tell the nurses if you feel pain from your incision. Also say if you have chest pain, shortness of breath, twitching, or hiccups. Once you are ready, you will be taken to a hospital room. There, your device may be tested again to ensure the settings are correct. You will then likely stay overnight in the hospital.

Recovering at Home

Once you are ready to leave the hospital, have an adult family member or friend drive you home. You will be given instructions for how to care for yourself at home. These may include:

  • Avoid raising your arm above your shoulder on the side of your incision until your doctor says it is OK to do so. This gives the leads a chance to secure themselves inside your heart.

  • Don’t take a bath or use a hot tub, Jacuzzi, or swimming pool for 7 days.

  • Care for your incision as instructed by your doctor.

  • Check your incision for signs of infection every day for a week. This includes redness, swelling, severe pain, drainage, or warmth.

  • Talk to your doctor about taking pain medication.

  • Talk to your doctor before you start an exercise program or do any activity that requires excessive arm movement, such as tennis and golf.

  • Ask your doctor when you can return to work and driving.


Make follow-up appointments as directed by our staff. During your follow-up visits, your doctor downloads information from your device’s computer and checks the settings. Be sure to mention how the device is working for you. You will be told how often you need to visit for follow-up.

Life with a Biventricular Pacemaker and ICD

  • You will be directed to take precautions so that your device functions properly. This includes keeping your cell phone away from your generator. Avoid strong magnets, such as those used in an MRI or in hand-held security wands. Also avoid strong magnetic fields, such as those made by radio transmitting towers, ham radios, and heavy-duty electrical equipment.

  • You will receive a special card that allows you to bypass metal detectors in airports and other places with security screening. Carry the card with you and show it to security personnel before you are screened.

  • The battery inside the device is checked regularly. If the battery is low, there is plenty of time to change it before it runs down. Changing a battery is like implantation surgery, but it takes less time.

When to Call the Doctor

Call your doctor if you have any of the following:

  • Chest pain or trouble breathing (call 911)

  • Redness, swelling, severe pain, drainage, or warmth at the incision site

  • A fever of 101°F (38.3°C) or higher

  • Pain around the generator that gets worse

  • Bleeding or severe swelling of the incision site

  • Swelling in the arms or hands on the side of the incision

  • Sudden weight gain

  • Twitching chest or abdominal muscles

  • Frequent or constant hiccups

  • A shock from your device

  • A very fast heartbeat that doesn’t stop

Online Medical Reviewer: Fetterman, Anne, RN, BSN
Online Medical Reviewer: Image reviewed by StayWell medical illustration team.
Online Medical Reviewer: MMI board-certified, academically affiliated clinician
Last Review Date: 2/19/2014
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