Techniques of pacemaker and ICD implantation and removal

A conventional permanent pacing and implantable cardioverter-defibrillator (ICD) system consists of a generator and one or more leads that connect it to the endocardial or epicardial surface of the heart. This chapter examines the transvenous single-and dual-chamber pacemaker and ICD implantation, as well as newer techniques of leadless pacemaker and His bundle pacemaker implantation from a broad perspective. The perspective emphasizes the practical considerations influencing the safety and efficacy of this procedure. Implantable cardiac pacemakers have shown remarkable technological improvements over the past 60 years. The chapter also discusses about the indications for and methodology of removing implanted pacing devices. With rare exceptions, any patient with a cardiovascular implantable electronic device (CIED)-related infection should have the entire system, including the leads, removed. Immediate availability of cardiac surgery rescue along with proper use of the superior vena cava (SVC) occlusion balloon can prevent mortality in patients with SVC and myocardial complications.