ABSTRACT
This chapter discusses implantation of pacemakers and implantable cardioverter-defibrillators (ICDs). Patients must have an indication for pacemaker or implantable cardioverter-defibrillator (ICD) according to ACC/AHA guidelines. Once patients are in the EP lab, there should be meticulous attention paid to sterility. The implantation site should be clear of any superficial wounds, be clipped and not shaven, and be prepped with either betadine or chlorohexidine and a head-to-toe drape. Most devices are placed in a left prepectoral pocket since most patients are right-handed and implantation of the leads is easier from the left versus the right side. For ICDs, defibrillation efficacy testing can be performed to assure that the ICD can detect and terminate ventricular fibrillation with an adequate safety margin for defibrillation. After implantation, the device is usually interrogated through the device, for atrial and ventricular sensing, capture thresholds, and impedance. This helps identify problems such as early lead dislodgement or a loose set-screw prior to the patient leaving the lab.
