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Guide to Generator Change of a Pacemaker/ICD

Current pacemakers and implantable cardioverter defibrillators (ICDs) provide significant advance warning about the battery status of your device. With proper follow-up, you will have several months to schedule your procedure. In most cases, you will not be required to stay overnight in the hospital.

What if the Battery Runs Low?

The battery of a pacemaker or ICD is an integral part of the circuitry. Therefore, the entire device is replaced. The pacemaker/ICD leads that extend into the heart are disconnected from the old generator and connected to the new generator.

Sometimes the pacemaker/ICD leads will fail. In this case, the lead(s) must be replaced. Usually, lead failure is known prior to generator replacement from evaluation of your device in the office. Occasionally, an unknown lead problem is detected during surgery. If a new lead is placed, we will recommend that you remain in the hospital overnight.

Before your Pacemaker/ICD Generator Replacement
  • Do not eat any food or drink any fluids after midnight the day before your test.

  • Anticipate that the entire procedure and recovery time will take two to four hours.

  • Because you will receive anesthesia with the procedure, a family member or friend must be available to accompany you home after the procedure. No exceptions can be made to this requirement. If no one is available to accompany you, the procedure will have to be rescheduled.

During the Procedure
  • One of our nurses will take you to a procedure room and a physician or nurse practitioner will discuss the procedure with you and review your medical history.

  • If you are a woman of childbearing age, a urine pregnancy test will be performed.

  • You will be asked to sign a consent form.

  • After you change into a hospital gown, an intravenous line (IV) will be placed in your forearm. A blood pressure monitor will be placed on your arm, and ECG stickers will be placed on your chest to monitor your heart rhythm. Large sticky patches will be placed on your chest and back.

  • You will be positioned in a comfortable upward position on the procedure bed. The nurses will clean the site where your device is with sterile soap and a sterile drape will be positioned from your chin to your toes.

  • You will be given sedating medication through your IV. Local anesthesia will be injected under the skin where the pacemaker will be placed.

  • During the surgery you will be drowsy. You will be given medication to prevent any discomfort.

  • Once the procedure is complete, you will be taken to your hospital room or the recovery room.

Please note: Some patients with pacemakers require the pacemaker for every heartbeat, although most patients are not this dependent upon their pacemakers. For pacemaker-dependent patients, a temporary pacemaker, placed through a catheter in the groin, is used to pace the heart during the brief period between the disconnection of the old pacemaker and the connection of the new one. If you require such a temporary pacemaker, we will discuss this procedure with you.

After the Procedure
  • You may eat as soon as you are awake following the procedure.

  • Unless you have received a new lead, your arm does not need to be immobilized after the surgery.

  • A nurse practitioner from the Lab will discuss your discharge and follow-up instructions.

  • You will receive a temporary identification card for your new device. This card has vital information and you should carry it at all times. The device company will mail you a permanent card within a few weeks of your surgery.

  • You will be given a prescription for antibiotics to be taken for five days following surgery.

After You Return Home
  • Most often, a surgical adhesive is used over the wound. If this is the case, you may shower the next day.

  • Before your follow-up appointment, if you develop any fever, bleeding, severe pain in the area of the incision, palpitations, or fainting spells, please call our office immediately at (212) 746-2158, (212) 746-2655, or (212) 746-2169. A physician is available at all times.

  • At your one-week follow-up, a nurse practitioner or clinical nurse specialist will evaluate your pacemaker at the Device Clinic. Please bring a list of your medications.


Cardiac Electrophysiology Laboratory
Starr 4, Cardiovascular Center
520 East 70th Street
New York, NY 10021

Phone: (212) 746-2158, (212) 746-2655, (212) 746-2169
Fax: (212) 746-6951
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New York-Presbyterian. The University Hospitals of Columbia and Cornell