UNC Electrophysiology Services

Implantable Devices

Implantable devices provide electrical stimulation to particular areas of the heart to help maintain normal heart rate and/or rhythm to a heart that’s diseased or damaged. The small generator devices are typically placed under the skin in the left upper chest and attached to small wires that carry current back to the heart. There are three primary categories of implantable devices: Pacemakers , implantable cardioverter defibrillators (ICD) , and biventricular pacemakers or ICDs.

The team of electrophysiologists, nurses, technicians, and administrative staff at UNC have extensive experience in implanting and supporting all three types of devices. UNC is also one of the few hospitals to offer lead extractions. This delicate procedure may be performed when there’s damage to the lead; when there’s an infection on the lead or device; or in occasional cases where additional leads are needed but there’s insufficient room in the vein behind the collarbone.

Because heart disease is a complex condition, often with multiple options for treatment, UNC electrophysiologists work closely with other members of the heart and vascular team–heart failure specialists, general cardiologists, interventional cardiologists, cardiothoracic surgeons, and others–to ensure that the treatment plan for every patient offers the best long-term prognosis for quality of life.

Following is a short explanation of each of the three types of implantable devices:

Pacemakers help maintain the heart rate when it is too slow by delivering small electrical impulses to stimulate the heart. Single-chamber pacemakers use one lead in either the right upper (atrium) or right lower (ventricle) chamber- the latter is most common. Dual-chamber pacemakers utilize one lead in the right atrium and one in the right ventricle.

Bi-ventricular pacemakers are similar to dual-chamber pacemakers, but with a third lead placed in a cardiac vein that wraps around the back of the heart to stimulate the left ventricle. This allows synchronized pacing, known as cardiac resynchronization therapy (CRT), of both the right and left ventricles in patients with advanced heart failure.

Implantable cardioverter defibrillators, like pacemakers, monitor and pace the heart if necessary. In the event that it detects a fast and potentially dangerous heart rhythm, however, ICDs can also deliver enough energy (via cardioversion or defibrillation) to the heart to restore normal rhythm . There are three types of ICDs: Single chamber, dual chamber, and bi-ventricular. Which is prescribed depends on which chambers require pacing support.

Physicians

Paul Mounsey, MD
Anil K. Gehi, MD
Eugene H. Chung, MD