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Cardiolucent

Treatment

Implantable Devices (Pacemaker, ICD)

Pacing, defibrillation, and resynchronization — selecting the right device and managing it long term.

Implantable cardiac devices fall into three main categories: pacemakers, which provide electrical stimulation when the heart's natural rhythm is too slow; implantable cardioverter-defibrillators (ICDs), which detect and terminate life-threatening ventricular arrhythmias; and cardiac resynchronization therapy (CRT) devices, which coordinate ventricular contraction in selected heart failure patients with conduction delay. Many devices combine functions (CRT-D, dual-chamber pacemakers). The decision to implant a device involves careful weighing of indication, expected benefit, and procedural risk. Dr. Kedan evaluates the indication, coordinates the procedure through Cedars-Sinai electrophysiology, and provides longitudinal device follow-up integrated with overall cardiovascular care.

What This Treatment Approach Includes

  • Indication review: bradyarrhythmia, atrioventricular block, primary or secondary sudden death prevention
  • Echocardiogram, EKG, ambulatory rhythm monitoring, and risk stratification
  • Discussion of device options — single-chamber, dual-chamber, CRT, ICD, CRT-D, leadless pacemaker, subcutaneous ICD
  • Pre-procedure planning: anticoagulation, antibiotic prophylaxis, anesthesia clearance
  • Coordination with Cedars-Sinai electrophysiology for implantation
  • Remote device monitoring and periodic in-office interrogation
  • Lifestyle and activity guidance based on device type

How It Works

Pacemakers deliver small electrical impulses through leads (or a leadless capsule in the right ventricle) to stimulate the heart when the natural rhythm is too slow. ICDs continuously monitor for life-threatening ventricular arrhythmias and deliver pacing, cardioversion, or defibrillation as needed to terminate them. CRT devices place a third lead on the left ventricle to coordinate contraction in patients with reduced ejection fraction and left bundle branch block, improving cardiac efficiency and symptoms.

Who This Is For

  • Symptomatic bradycardia from sinus node dysfunction or atrioventricular block — pacemaker
  • Complete heart block or high-degree AV block — pacemaker
  • Reduced ejection fraction (≤ 35%) despite optimized therapy — ICD for primary prevention
  • Survivor of sudden cardiac arrest or hemodynamically significant VT — ICD for secondary prevention
  • Heart failure with reduced EF and left bundle branch block — CRT or CRT-D
  • Hypertrophic cardiomyopathy with high sudden death risk markers — ICD
  • Certain inherited arrhythmia syndromes (long QT, Brugada) with risk features — ICD

Monitoring and Follow-Up

After implantation, the device is interrogated in person within a few weeks, then transitions to remote monitoring with periodic in-office checks. Remote monitoring catches arrhythmias, lead malfunction, and battery depletion early. ICDs and CRT-Ds in particular benefit from continuous data review — many actionable events are identified between in-person visits. Dr. Kedan integrates the device data with overall cardiovascular care, adjusting medications and addressing arrhythmia or heart failure trends in real time.

How Cardiolucent Manages This

Device patients often see an electrophysiologist for device interrogation and a separate cardiologist for general care, with limited communication between them. Dr. Kedan stays the continuity cardiologist, reviews device data alongside imaging and labs, and coordinates with the electrophysiologist at Cedars-Sinai. Extended visits make pre-implant decision-making thorough — including the harder conversations about ICD therapy at end of life — and direct access keeps post-implant questions from waiting weeks.

Common Questions

Frequently Asked Questions

What is the difference between a pacemaker and an ICD?
A pacemaker delivers electrical stimulation when the heart rate is too slow. An ICD continuously monitors for dangerous fast ventricular rhythms and delivers a shock or pacing to terminate them. Many ICDs also include pacemaker functions, but a standard pacemaker does not include defibrillation capability.
Who needs a pacemaker?
Pacemakers are indicated for symptomatic slow heart rates from sinus node dysfunction, second- or third-degree atrioventricular block, certain conduction system diseases, and some post-procedural conduction abnormalities. The decision is based on rhythm documentation and symptoms — not on heart rate alone.
Who needs an ICD?
ICDs are used for primary prevention in patients with reduced ejection fraction (≤ 35%) despite at least 3 months of optimized medical therapy, and for secondary prevention in survivors of cardiac arrest or hemodynamically significant ventricular tachycardia. Specific inherited conditions (long QT, hypertrophic cardiomyopathy with high-risk features, Brugada syndrome) also warrant consideration.
What is cardiac resynchronization therapy (CRT)?
CRT is a special device with a third lead placed on the left ventricle to coordinate the contraction of both ventricles. It is used in heart failure patients with reduced ejection fraction and left bundle branch block or other significant conduction delay. It can substantially improve symptoms, ejection fraction, and survival in appropriate candidates.
How is the device implanted?
Most devices are implanted under local anesthesia with sedation, through a small incision below the collarbone. Leads are advanced through a vein into the heart, the generator is placed in a pocket under the skin, and the incision is closed. Most patients go home the next day. Leadless pacemakers and subcutaneous ICDs use different implant techniques without transvenous leads.
What are the main risks?
Procedure risks include bleeding, infection, pneumothorax, cardiac perforation, and lead displacement. Long-term risks include device or lead malfunction, infection, and inappropriate shocks in ICDs. Risks are individualized and discussed in detail by the implanting electrophysiologist.
How long does the battery last?
Pacemaker batteries typically last 8 to 12 years; ICD batteries last 5 to 8 years depending on use. Battery status is monitored at each device check, and replacement (called a generator change) is a shorter procedure than the original implant because the leads usually remain in place.
What activities are restricted with a device?
Most activities are unrestricted after the initial healing period. Strong magnetic fields (some industrial settings, certain MRI machines) require caution — most modern devices are MRI-conditional, meaning MRI can be performed with specific protocols. Contact sports and shoulder-overhead activity may have restrictions early after implant. Specific guidance is reviewed at each visit.
What is remote monitoring, and is it worth it?
Remote monitoring transmits device data wirelessly, allowing the cardiology team to detect arrhythmias, lead problems, and battery changes between visits. It reduces unscheduled hospital visits and identifies clinically actionable events earlier. It is standard of care for modern device patients and Dr. Kedan integrates the data with general cardiovascular follow-up.
How do I start a device evaluation with Dr. Kedan?
Schedule a consultation at the Beverly Hills office with prior EKGs, rhythm monitor data, and echocardiogram. Cardiolucent is a concierge practice and does not bill Medicare or insurance, though a detailed superbill is provided for out-of-network reimbursement. The procedure itself is performed at Cedars-Sinai. Call (310) 304-5555 or use the contact form.

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Medical Disclaimer

The information on this site is for general educational purposes only and is not medical advice, diagnosis, or treatment. Reading this site does not create a doctor–patient relationship. Always consult a qualified healthcare professional for personal guidance. If this is an emergency, call 911. Mentions of medications, devices, or procedures are informational and not endorsements. Full medical disclaimer.

†Some listed indications involve investigational/off-label use. Learn more.