Pacemaker and Implantable Cardioverter Defibrillator (ICD)

Inside the heart there are nodes, or special cells, which produce electrical impulses. These impulses regulate the heartbeat. When the nodes become damaged or don’t work as they should, a child may have an irregular heartbeat. This condition is known as an arrhythmia.

Pacemakers or implantable cardioverter defibrillators (ICDs) can help children who have certain kinds of arrhythmias. These small, implanted devices regulate the heartbeat or prevent certain arrhythmias from occurring. They are safe, effective long-term treatments for heart rhythm disorders.

Why Would a Child Need a Pacemaker or Implantable Cardioverter Defibrillator?

Your child’s pediatric cardiologist will explain why a pacemaker or ICD may help your child. Often, children may need one of these devices if they:

• Developed an arrhythmia after heart surgery
• Had an illness that damaged the heart nodes
• Have an arrhythmia that doctors can’t correct with an ablation procedure (destroys faulty heart tissue with heat or cold energy)
• Were born with a heart node defect

What Does a Pacemaker Do?

A pacemaker is a small device that creates electrical impulses. These impulses regulate your child’s heartbeat. Your child’s pediatric electrophysiologist (heart rhythm specialist) programs the pacemaker to the correct settings for your child.

Pacemakers are useful if a child’s heartbeat is too slow. When the pacemaker detects a pause between beats that is too long, it sends an electrical impulse to the heart. This impulse prompts the heart to beat. A pacemaker ensures a child’s heartbeat stays within a normal range.

What Does an Implantable Cardioverter Defibrillator Do?

An ICD does two things to help with arrhythmias:

• It controls dangerously fast or erratic arrhythmias by providing a safe electric shock to the heart. The shock resets the heart rate to a normal pace.
• It functions like a pacemaker, prompting the heart to beat if the heart rate is too slow.

Doctors may recommend an ICD for a child who is at risk of having a life-threatening ventricular arrhythmia, such as:

• Brugada syndrome (rare heart rhythm disorder)
• Congenital heart defects (heart defects present at birth)
• History of a heart attack or sudden cardiac arrest
• Long QT syndrome (a type of arrhythmia)
• Other heart conditions that can cause sudden cardiac arrest

The ICD may store information about your child’s heart rate. This information helps doctors choose the best settings for it.

What Happens During Pediatric Pacemaker or ICD Implantation?

Implanting a pacemaker or ICD is a minor surgical procedure. The insertion may take place in a cardiac catheterization lab or an operating room.

Our electrophysiologists:

1. Make a small incision under the collarbone and insert the device
2. Guide the device’s leads (wires) through a nearby vein, using X-rays to ensure proper placement
3. Attach the ends of the leads to the correct places inside the heart

Our pediatric cardiac anesthesiologists keep children safe and comfortable during this procedure. Afterward, children may have some soreness at the incision site. If they do, we provide pain relieving medication for your child. Read more about pediatric cardiac anesthesiology.

ICD and Pacemaker Battery Life and Changing Batteries

Pacemakers and ICDs run on batteries that last for several years. Our pediatric electrophysiologists see your child regularly to check the battery. When the battery level starts to go down, we schedule a procedure to replace it.

Children usually need general anesthesia for the battery change.

Living with a Pacemaker or ICD

After children get their pacemaker or ICD, our pediatric electrophysiologists coordinate follow-up care. These visits ensure the device continues to work properly. Children may also see other heart specialists, depending on their heart condition and other health needs.

Many children live full lives with a pacemaker or ICD. Ask your child’s cardiologist if you have questions about their device.

Arrhythmia Treatment at Children’s Hospital Los Angeles

Learn more about the arrhythmia treatment options we offer in our Electrophysiology Program.