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Photo of a pacemakerArrhythmias, which are abnormal heart rates or rhythms, are caused by issues with the electrical system of the heart. While there are many types of arrhythmias and a variety of treatment options, some arrhythmias may require a pacemaker or implantable cardiac defibrillator (ICD) to keep the heart beating as it should.

Pacemakers and ICDs are small devices that typically are implanted under the skin on the chest. They use electrical signals through wires, called leads, to address the electrical problems in the heart causing the arrhythmia.

The Difference Between a Pacemaker and ICD

The main purpose of a pacemaker is to make sure the heart rate does not get too slow. It also can monitor and record the rate and rhythm of the heart. Depending on the pacemaker, it may have one, two or three wires used to send electrical pulses to the heart.

An ICD has the ability to act as a pacemaker. However, it also has the ability to detect dangerously fast heart rates, called ventricular tachycardia or ventricular fibrillation, and stop them.

"Ventricular tachycardia or ventricular fibrillation can be fatal," said Adam Shapira, MD, medical director of electrophysiology services at Baylor Scott & White The Heart Hospital – Plano. "ICDs can detect these arrhythmias and terminate them either by pacing someone at a deliberately fast rate to try to terminate the arrhythmia or by shocking someone back into a normal rhythm."

Getting a Pacemaker or ICD

Several factors are used to determine whether you may need a pacemaker or an ICD, including your medical history and what other medical problems you may have, such as heart failure. Typically, only those considered high risk for a life-threatening ventricular arrhythmia and sudden cardiac death need an ICD.

"Of the people who need a medical device, a small subset need defibrillators," Dr. Shapira said. "Far more people need pacemakers."

The placement of a pacemaker or an ICD requires a minor surgery. Physicians thread the pacemaker or ICD wires through a vein into the heart. The pacemaker or ICD device is then placed under the skin on the chest using a small incision. Most people go home within a day or two.

Physicians on the medical staff at Baylor Scott & White Heart – Plano perform a high volume of pacemaker and ICD procedures with outcomes that compare favorably (if not better) to those seen at much larger institutions. The hospital also offers advanced technology in the area of pacemakers and ICDs, such as leadless pacemaker technology. For appropriate candidates, leadless pacemakers offer the same function as a normal pacemaker but using a device that is the size of a multivitamin with no attached wires.

Living with a Pacemaker or ICD

While there are some precautions required with a pacemaker or ICD, pacemakers and ICDs typically do not restrict everyday tasks. You may have to be careful around some equipment that could interfere with your device, like MRI scans, magnets and metal detectors.

It may be recommended that you carry a device ID card with you. You also should let health professionals, such as radiology technicians or dentists, know about your pacemaker or ICD.

"Having a medical device initially is a lifestyle, but after a while, the devices tend to become more of an afterthought." Dr. Shapira said.

In addition to these lifestyle factors, it is important to have regular checks with your physician to maintain your device. Once implanted, the average device has a battery life of anywhere from approximately five to 12 years.

Dedicated Arrhythmia Care

Find out more about the diagnosis and treatment of heart arrhythmias​ at Baylor Scott & White Heart – Plano.


Main phone number: 469.814.3278  469.814.3278 (HEART)

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