Biventricular Pacemaker Implantation

Biventricular pacemaker implantation is a procedure to place (implant) a pacemaker near the heart. A biventricular pacemaker is a type of pacemaker used in people with heart failure due to weak heart muscles. This procedure may be done to:

  • Treat symptoms of severe heart failure, such as shortness of breath.

  • Correct a heartbeat that may be too slow or irregular.

A pacemaker is a small, battery-powered device that helps control the heartbeat. If the heart beats irregularly or too slowly, the pacemaker will pace the heart so that it beats at a normal rate or a programmed rate. A biventricular pacemaker will synchronize the lower chambers of the heart (ventricles) so they contract at the same time. This can help them pump more efficiently. The parts of a biventricular pacemaker include:

  • The pulse generator. The pulse generator contains a small computer that is programmed to keep the heart beating at a certain rate. The pulse generator also produces the electrical signal that triggers the heart to beat. This is implanted under the skin of the upper chest, near the collarbone.

  • Wires (leads). There may be two or three leads placed in the heart—one to the right atrium, one to the right ventricle, and one through the coronary sinus to reach the left ventricle of the heart. The leads are connected to the pulse generator. They transmit electrical pulses from the pulse generator to the heart.

Tell a health care provider about:

  • Any allergies you have.

  • All medicines you are taking, including vitamins, herbs, eye drops, creams, and over-the-counter medicines.

  • Any problems you or family members have had with anesthetic medicines.

  • Any bleeding problems you have.

  • Any surgeries you have had.

  • Any medical conditions you have.

  • Whether you are pregnant or may be pregnant.

What are the risks?

Generally, this is a safe procedure. However, problems may occur, including:

  • Infection.

  • Swelling, bruising, or bleeding at the pacemaker site, especially if you take blood thinners.

  • Allergic reactions to medicines or dyes.

  • Damage to blood vessels or nerves near the pacemaker.

  • Failure of the pacemaker to improve your condition.

  • Collapsed lung.

  • Blood clots.

  • Lead failures. This may require more surgery.

What happens before the procedure?

Staying hydrated

Clear liquid drinks, including water, tea, coffee, and juice.
Follow instructions from your health care provider about hydration, which may include:

  • Up to 2 hours before the procedure – you may continue to drink clear liquids, such as water, clear fruit juice, black coffee, and plain tea.

Eating and drinking restrictions

Follow instructions from your health care provider about eating and drinking, which may include:

  • 8 hours before the procedure – stop eating heavy meals or foods, such as meat, fried foods, or fatty foods.

  • 6 hours before the procedure – stop eating light meals or foods, such as toast or cereal.

  • 6 hours before the procedure – stop drinking milk or drinks that contain milk.

  • 2 hours before the procedure – stop drinking clear liquids.


Ask your health care provider about:

  • Changing or stopping your regular medicines. This is especially important if you are taking diabetes medicines or blood thinners.

  • Taking medicines such as aspirin and ibuprofen. These medicines can thin your blood. Do not take these medicines unless your health care provider tells you to take them.

  • Taking over-the-counter medicines, vitamins, herbs, and supplements.

General instructions

  • Take steps to improve your health and fitness as told. Stopping smoking, eating a healthy diet, and exercising regularly can help speed up your recovery time and reduce the risk of complications.

  • You may have tests, including:

    • Blood tests.

    • Chest X-rays.

    • Echocardiogram. This is a test that uses sound waves (ultrasound) to produce an image of the heart.

  • Ask your health care provider:

    • How your surgery site will be marked.

    • What steps will be taken to help prevent infection. These may include:

      • Removing hair at the surgery site.

      • Washing skin with a germ-killing soap.

      • Taking antibiotic medicine.

  • Plan to have a responsible adult take you home from the hospital or clinic.

  • If you will be going home right after the procedure, plan to have a responsible adult care for you for the time you are told. This is important.

What happens during the procedure?

Body outline with a close-up of the heart and a pacemaker, showing a pulse generator and the leads going into the heart.
  • An IV will be inserted into one of your veins.

  • You will be connected to a heart monitor. Large electrode pads will be placed on the front and back of your chest.

  • You will be given one or more of the following:

    • A medicine to help you relax (sedative).

    • A medicine to make you fall asleep (general anesthetic).

    • A medicine that is injected into an area of your body to numb the area (local anesthetic).

  • An incision will be made in your upper chest, near your heart.

  • The leads will be guided into your incision, through your blood vessels, and into your heart. Your health care provider will use an X-ray machine (fluoroscope) to guide the leads into your heart.

  • The leads will be attached to your heart muscles and to the pulse generator.

  • The leads will be tested to make sure that they work correctly.

  • The pulse generator will be implanted under your skin, near your incision.

  • The heart monitor will be watched to ensure that the pacemaker is working correctly.

  • Your incision will be closed with stitches (sutures), skin glue, or adhesive tape.

  • A bandage (dressing) will be placed over your incision.

The procedure may vary among health care providers and hospitals.

What happens after the procedure?

  • Your blood pressure, heart rate, breathing rate, and blood oxygen level will be monitored until you leave the hospital or clinic.

  • You may continue to receive fluids and medicines through an IV.

  • You will be given pain medicine as needed.

  • You will have a chest X-ray done. This is to make sure that your pacemaker is in the right place.

  • You will be given a pacemaker identification card. This card lists the implant date, device model, and manufacturer of your pacemaker.

  • If you were given a sedative during the procedure, it can affect you for several hours. Do not drive or operate machinery until your health care provider says that it is safe.


  • A pacemaker is a small, battery-powered device that helps control the heartbeat.

  • A biventricular pacemaker is used in people with heart failure to get the ventricles of the heart to pump more efficiently.

  • Follow instructions from your health care provider about taking medicines and about eating and drinking before the procedure.

  • You will be given a pacemaker identification card that lists the implant date, device model, and manufacturer of your pacemaker.

This information is not intended to replace advice given to you by your health care provider. Make sure you discuss any questions you have with your health care provider.

Leave a Reply

Your email address will not be published. Required fields are marked *