Pacemaker and Implantable Cardioverter Defibrillator (ICD) Insertion for Children

A child with an arrhythmia may need a pacemaker or an implantable cardioverter defibrillator (ICD). These devices require a simple surgery to implant. They can increase a slow heartbeat or correct a possibly life-threatening fast or chaotic beat.

What is a pacemaker and ICD insertion for children?

Pacemaker insertion

An artificial pacemaker is a small device placed in the body and connected to the heart with wires (leads). It monitors the heart's own electrical signals and sends electrical impulses to the heart to take control of the heartbeat in the event it slows below the pacemaker programmed heart rate. The insertion of a pacemaker requires minor surgery.

ICD insertion

An implantable cardioverter defibrillator (ICD) is a small device similar to a pacemaker. It's placed in the body and connected to the heart with leads. If the heartbeat is too fast, the ICD sends either a burst of rapid signals or a brief shock to correct it. If the heartbeat is too slow, the ICD functions similar to a pacemaker and keeps the heart beating at a more normal rate. The insertion of an ICD requires minor surgery.

Why might my child need a pacemaker or an ICD?

The heart has a natural pacemaker as well as the ability to conduct electricity throughout the heart. When the natural pacemaker doesn't work as it should or the conduction system fails, the heartbeat may be too slow. A pacemaker may be needed to return the heart rate to a normal range and maintain adequate blood flow to the rest of the body.

Some conditions that either develop before birth or early on in life may cause the pumping muscles of the heart (the ventricles) to become damaged. Certain genetic problems can also predispose your child to fast, dangerous heart rhythms. An ICD may be needed to help restore the heartbeat to normal rhythm should one of these dangerous heart rhythms occur. Your child may need a pacemaker or ICD for a variety of different types of abnormal heart rhythms (arrhythmias). This is especially true for arrhythmias that cause severe symptoms.

What are the risks of a pacemaker/ICD insertion for a child?

The complications of having either device put in the body include:

  • Bleeding, swelling, or bruising at the site of the insertion

  • Infection

  • Reactions to medicines

  • Damage to the lungs underneath the device

  • Bleeding or damage to the heart when the wires are inserted

  • Abnormal heart rhythm when the wires are placed within the heart

And with an ICD, unnecessary shocks may cause arrhythmias.

The wires attaching the devices to the heart are intended to be permanent. But in some cases, the leads may become damaged over time and need to be removed. The pacemaker or ICD may also become infected and need to be removed.

How do I get my child ready for a pacemaker/ICD insertion?

What you do depends on your child's age. If your child is old enough, explain what will happen in a way that they can understand. You might ask the cardiologist or nurse to help explain the procedure to your child, too.

Make sure your child follows all instructions about eating, drinking, and taking medicines before the device insertion. If your child becomes sick before the procedure, call your healthcare provider's office.

What happens during a pacemaker/ICD insertion for a child?

Pacemaker/ICD insertion is done in the hospital. This is either in a cardiac catheterization lab or an operating room.

Before the procedure, your child will get medicine (sedative) to help them relax. And they will likely be given medicine to sleep (general anesthesia) once in the lab or operating room.

The devices have 2 main parts: the wires (leads) and the generator. 

  • In older children, the healthcare provider makes a cut (incision) and stitches the generator under the skin just below the collarbone. The leads are passed through a vein and into the heart.

  • In younger children, the healthcare provider makes an incision and may put the generator in the abdomen. The leads may be placed on the surface of the heart.

While still in the lab or operating room, the provider will check the device to make sure it's working correctly.

What happens after a pacemaker/ICD insertion for a child?

After the pacemaker or ICD is inserted, your child will be watched closely for a few hours. They may be sleepy for several hours and stay in the hospital overnight. Before you take your child home, you'll get information about:

  • The pacemaker or ICD, including the model and any special instructions

  • How to care for the wound, including making sure it stays clean and dry

  • Symptoms of infection, such as redness, swelling, drainage, or fever

  • Follow-up appointments

  • Limits on activities

Next steps

Before you agree to the test or the procedure for your child, make sure you know:

  • The name of the test or procedure

  • The reason your child is having the test or procedure

  • What results to expect and what they mean

  • The risks and benefits of the test or procedure

  • When and where your child is to have the test or procedure

  • Who will do the procedure and what that person’s qualifications are

  • What would happen if your child didn't have the test or procedure

  • Any alternative tests or procedures to think about

  • When and how you'll get the results

  • Who to call after the test or procedure if you have questions or your child has problems

  • How much you'll have to pay for the test or procedure