print
1. Preparation
WHAT IS THE IMPLANTATION OF CARDIAC PACEMAKERS/DEFIBRILLATORS?
It is the implantation of devices into the body that are used to rectify irregular beating of the heart, referred to as Cardiac resynchronisation therapy. By using defibrillators or pacemakers a patient’s survival and quality of life is improved should they suffer from heart insufficiency and disorders of the blood-flow system.
PACEMAKERS
A pacemaker may be inserted into the body to control the speed and pattern of the heartbeat by stimulating the heart with an electrical impulse when the heartbeat slows down or maybe even comes to a complete stop.
This device has saved many lives as the heart stopping completely for a prolonged period of time, can cause death to occur.
It is also made up of two parts:
-
A pulse generator, which senses the heartbeat and delivers impulses to the heart.
-
A sensing lead, which sends impulses to and from the heart.
The pacemaker is also battery operated and on “stand by” until the heart rate slows down to below the set rate of the pacemaker. It will then step in and regulate the “pace”. The doctor who conducts the implantation procedure programs the pacemaker to your specific requirements.
DEFIBRILLATORS
Due to the non-availability of immediate defibrillation at the time that a person suffers abnormal rhythm of the heart, a defibrillator can be implanted in the body to defibrillate the heart automatically, slowing down a fast heartbeat.
The implantable defibrillator is made up of two parts:
The defibrillator is battery operated and is on “stand by” mode checking the heart beat. When the heartbeat is too fast, the device activates and will give a “shock” to the heart. It is also programmed according to your condition.
WHY IS IT DONE?
The heart is the powerhouse of the body; the engine that drives blood throughout all parts of the system. It is a very strong muscle, not resting for more than a second, beating tirelessly and relentlessly.
When the heart fails to contract or beat at its regular rhythm, this condition is called Arrhythmia. As this occurs a patient may notice it and some may not.
There are 2 groups, which this condition can be divided into:
Tachyarrhythmia – the heart beats faster than usual.
Bradyarrhythmia – the heart beats slower than usual.
To determine a diagnosis and appropriate treatment specialised procedures are performed called electrophysiology (EP) studies and radiofrequency ablation (RFA). If the cause of arrhythmia is found during an EP study, this may be corrected by RFA that sends radio frequency energy to destroy the small piece of tissue that is causing the problem.
The more life-threatening arrhythmias, such as ventricular tachycardia or ventricular fibrillation (abnormal rhythm), causing inadequate blood flow to the vital organs of the body, such as the brain, kidneys and coronary arteries of the heart may result in a heart attack proving to be fatal. In this situation, treatment is urgent, and this is when it is necessary to administer an electric shock (defibrillation), implant a temporary pacemaker to make the heart beat faster, or medication is given intravenously.
HOW DO I CHOOSE A SPECIALIST?
Your GP, or the doctor you first consult, will be able to recommend and refer you to a Cardio-thoracic surgeon who can perform the procedure.
You may be happy to accept the advice of your GP with regard to a specialist, or you may like to investigate your choices; either option is safe and valid. In Australia each medical speciality has a governing body to which the consultants belong. You can access the Royal Australasian College of Surgeons via their website www.surgeons.org. This is a very informative website.
The list of questions below may help you better understand your treatment, and if necessary decide on a particular doctor. Practical issues you may also like to consider are what hospital a particular doctor operates from, and what their fees are. (If you need more information about fee setting and gap arrangements, please refer to our brochure “what you should know before going into hospital”, which is also available on the HCF website).
To access a list of Cardio-thoracic surgeons who participate in HCF’s Medicover no gap arrangement:
- Call HCF Member Services on 13 13 34
- Visit one of HCF’s customer service branches
-
Please note: Participation in HCF’s no gap initiatives is at the doctor’s discretion. HCF does not guarantee that every medical service provided by these doctors will be a no gap service. Some doctors who participate in the HCF Medicover No Gap arrangement have chosen not to be listed on the HCF website. Patients are encouraged to confirm with their doctor whether they will support HCF’s no gap initiatives for their treatment.
WHAT SHOULD I ASK MY SPECIALIST?
-
Do not be afraid to ask your doctor questions about the procedure and any side effects which can occur. It is your right to know all the relevant information, as this is part of informed clinical and financial consent. Your doctor will ask you to sign a consent form.
-
In addition to what the procedure involves, you should also ask about:
-
Most medication should be continued as usual, but some may interfere with the operation. Your doctor will inform you of the medication you should stop. As a guide, the following medication may require special instruction:
-
Aspirin (or any related products)
-
Blood thinners (Warfarin, heparin.)
-
Arthritis medication
-
Pain medication
-
Anti-inflammatory medication
-
Insulin
Don’t forget to mention any homeopathic or herbal remedies you are taking, as these can have interactions and side effects too.
WHERE IS IT DONE?
The procedure can only be done in a hospital. Your expected length of stay is approximately 4 days.
HOW LONG IS THE PROCEDURE?
The procedure for both implantation of a defibrillator and pacemaker is carried out under local anaesthetic and time in theatre may last for 2-3 hours dependent on the number of leads to be positioned, the difficulty of access and the testing of the device.
WHO IS INVOLVED?
The people involved in the procedure are:
-
The Cardio-thoracic surgeon, your Specialist doctor
-
There may be an assistant surgeon
-
Anaesthetist : they give you medication that makes you relaxed and sleepy and look after you whilst the procedure is being carried out
-
Nurses for the procedure and recovery
-
Pathologist for blood tests and/or specimen samples
-
Radiologist for x-rays
HOW DO I PREPARE FOR THE SURGERY?
You may be advised to attend a pre-admission clinic at the hospital, where they will run some basic tests to determine your general health and fitness for surgery. These include an ECG (echocardiogram, recording of your heart rhythm), chest x-ray, and blood tests.
Your doctor will have his/her own specific preparation requirements. These instructions should be strictly followed or the procedure may be unsatisfactory and may have to be repeated later.
WHAT DO I TAKE WITH ME TO THE HOSPITAL?
-
Do not bring any valuables with you
-
Leave all jewellery at home, a wedding ring is acceptable
-
Wear comfortable clothing
-
Bring any medication that you would usually take during the day, under most circumstances you may still be able to take these
-
Bring any relevant x-rays or scans
2. Costs and Charges
WHAT IS IT GOING TO COST?
Ask your doctor whether he will participate in HCF's no gap arrangement for your surgery so that you do not incur any out of pocket expense. If your doctor does not wish to participate, it is your doctor's responsibility to fully inform you of your financial liability and any out of pocket expense prior to you consenting to the surgery.
CARDIAC PACEMAKER ADMISSIONS
For your information, the average charges for claims paid for implantation of Cardiac Pacemaker admissions for the financial year 06/07 are provided below:
|
|
On Average
|
|
|
Charge
|
Medicare Pays
|
HCF Pays
|
3
If your doctor DOES NOT use HCF’s No Gap Arrangement YOU PAY
|
% of all admissions where your doctor DOES NOT use HCF’s No Gap Arrangement
|
4
If your doctor USES HCF’s No Gap Arrangement YOU PAY
|
% of all admissions where your doctor USES HCF’s No Gap Arrangement
|
|
Total Average Hospital Component (accommodation, theatre and hospital related services)
|
$14,548
|
|
$14,447
|
|
|
|
|
|
1
Medical Services Component
|
|
|
|
|
|
|
|
|
Anaesthetic Services
|
$490
|
$214
|
$71
|
$255
|
7.1%
|
$0
|
92.9%
|
|
Cardio-Thoracic Surgical Services
|
$703
|
$419
|
$140
|
$156
|
5.5%
|
$0
|
94.5%
|
|
Diagnostic Procedures
|
$117
|
$68
|
$23
|
$343
|
1.5%
|
$0
|
98.5%
|
|
Pathology Services
|
$174
|
$112
|
$37
|
$63
|
14.1%
|
$0
|
85.9%
|
|
Specialist Consulations
|
$403
|
$228
|
$76
|
$174
|
11.3%
|
$0
|
88.8%
|
|
Radiology Services
|
$396
|
$231
|
$77
|
$54
|
16.9%
|
$0
|
83.1%
|
|
2
Total Average Medical Services
|
$1,698
|
$978
|
$326
|
$190
|
25.3%
|
$0
|
74.7%
|
|
Hospital and Medical Services Average for implantation of Cardiac Pacemaker Admissions
|
$16,246
|
$978
|
$14,773
|
$190
|
25.3%
|
$0
|
5
74.7%
|
Points to Note:
-
Charges are based on HCF claims for a sample size of 91 overnight admissions with an average length of stay of 3.1 days in private participating hospitals (private hospitals that have an agreement with HCF for accommodation, theatre and hospital related services) – covered under Medicare item 38353.
-
As a private patient in a non-participating hospital you may incur an out of pocket expense for the hospital component (accommodation, theatre and hospital related services).
1 These medical services are in-patient services only.
2 The medical charges are based on averages and each episode of care is different, i.e.you may not have all of these medical services, and/or you may also have other medical services not indicated here. Therefore, the total average medical service charge ($1,698) differs from the sum of the individual average charges as shown.
3 Doctors who do not use the HCF no-gap arrangement have a higher average out of pocket charge, as their charges are higher than those doctors who use the no-gap arrangement and incur nil out of pocket charges to the patient. Therefore, the sum of the average benefits plus the average out of pocket charge you pay will not equate to the charge as shown in the table.
4 Doctors’ charges vary so always ask your doctor whether he/she will participate in HCF’s No Gap Arrangements.
HCF Medicover Schedule of Benefits lists all services for extra benefit in excess of the Commonwealth Medicare Benefits Schedule (CMBS) fee, which providers, registered under the HCF Medicover No Gap arrangement will receive as full payment for services provided. This also applies to unregistered providers should they charge within the schedule of benefit listed. This arrangement ensures that our members incur no out of pocket expense.
5 This percentage indicates the total coverage of hospital and medical services for all implantation of cardiac pacemaker admissions. The percentages shown for each type of medical service are much higher as they are calculated for those services only and not the entire admission, which includes all medical services and the hospital services. In an admission you may have one medical service with an out of pocket expense, which then excludes the whole admission from being fully covered. Hence the significant difference in percentage for individual types of medical services as compared to the total admission fully covered.
CARDIAC DEFIBRILLATOR ADMISSIONS
For your information, the average charges for claims paid for implantation of Cardiac Defibrillator admissions for the financial year 06/07 are provided below.
|
|
On Average
|
|
|
Charge
|
Medicare Pays
|
HCF Pays
|
3
If your doctor DOES NOT use HCF’s No Gap Arrangement YOU PAY
|
% of all admissions where your doctor DOES NOT use HCF’s No Gap Arrangement
|
4
If your doctor USES HCF’s No Gap Arrangement YOU PAY
|
% of all admissions where your doctor USES HCF’s No Gap Arrangement
|
|
Total Average Hospital Component (accommodation, theatre and hospital related services)
|
$62,423
|
|
$62,274
|
|
|
|
|
|
1
Medical Services Component
|
|
|
|
|
|
|
|
|
Anaesthetic Services
|
$1,057
|
$469
|
$156
|
$373
|
9.1%
|
$0
|
90.9%
|
|
Cardio-Thoracic Surgical Services
|
$2,948
|
$1,605
|
$535
|
$675
|
8.3%
|
$0
|
91.7%
|
|
Diagnostic Procedures
|
$129
|
$69
|
$23
|
$138
|
12.5%
|
$0
|
87.5%
|
|
Pathology Services
|
$471
|
$300
|
$100
|
$108
|
26.3%
|
$0
|
73.7%
|
|
Specialist Consulations
|
$573
|
$322
|
$107
|
$262
|
12.5%
|
$0
|
87.5%
|
|
Radiology Services
|
$630
|
$346
|
$115
|
$89
|
54.5%
|
$0
|
45.5%
|
|
2
Total Average Medical Services
|
$5,526
|
$2,959
|
$986
|
$298
|
66.7%
|
$0
|
33.3%
|
|
Hospital and Medical Services Average for implantation of Cardiac Defibrillator Admissions
|
$67,949
|
$2,959
|
$63,260
|
$298
|
66.7%
|
$0
|
5
33.3%
|
Points to Note:
-
Charges are based on HCF claims for a sample size of 24 overnight admissions with an average length of stay of 5.9 days in private participating hospitals (private hospitals that have an agreement with HCF for accommodation, theatre and hospital related services) – covered under Medicare item 38390.
-
As a private patient in a non-participating hospital you may incur an out of pocket expense for the hospital component (accommodation, theatre and hospital related services).
1 These medical services are in-patient services only.
2 The medical charges are based on averages and each episode of care is different, i.e. you may not have all of these medical services, and/or you may also have other medical services not indicated here. Therefore, the total average medical service charge ($5,526) differs from the sum of the individual average charges as shown.
3 Doctors who do not use the HCF no-gap arrangement have a higher average out of pocket charge, as their charges are higher than those doctors who use the no-gap arrangement and incur nil out of pocket charges to the patient. Therefore, the sum of the average benefits plus the average out of pocket charge you pay will not equate to the charge as shown in the table.
4 Doctors’ charges vary so always ask your doctor whether he/she will participate in HCF’s No Gap Arrangements.
HCF Medicover Schedule of Benefits lists all services for extra benefit in excess of the Commonwealth Medicare Benefits Schedule (CMBS) fee, which providers, registered under the HCF Medicover No Gap arrangement will receive as full payment for services provided. This also applies to unregistered providers should they charge within the schedule of benefit listed. This arrangement ensures that our members incur no out of pocket expense.
5 This percentage indicates the total coverage of hospital and medical services for all implantation of cardiac defibrillator admissions. The percentages shown for each type of medical service are much higher as they are calculated for those services only and not the entire admission, which includes all medical services and the hospital services. In an admission you may have one medical service with an out of pocket expense, which then excludes the whole admission from being fully covered. Hence the significant difference in percentage for individual types of medical services as compared to the total admission fully covered.
2. Day of procedure
WHAT HAPPENS TO ME AT THE HOSPITAL?
When you arrive at the hospital, the admissions clerk will attend to the paperwork associated with your stay.
On admission to the hospital a nurse will orientate you to your surroundings and request your medical history, current medication and any known allergies. The consent for the operation is attended to by the surgeon. An anaesthetist will visit you prior to your operation to discuss your anaesthetic. In most cases a local anaesthetic is given which means that you will be awake throughout the procedure but will not feel anything. In rare cases a general anaesthetic is used if necessary. You will also discuss the type of pain relief you will receive after the operation.
An intravenous line will be put into the back of your hand so that you can be given sedation, antibiotics and fluid replacement.
WHAT CAN I EXPECT DURING IMPLANTATION OF A PACEMAKER/DEFIBRILLATOR?
You will be taken into the anaesthetic bay where, if you haven’t already had one inserted, a small plastic tube called a cannula will be placed into a vein in your arm or hand. A sedative, the first part of your anaesthetic, will be put through the cannula. You will be given an injection of local anaesthetic, so you will be aware of the implantation process. You will then be moved into the operating theatre itself.
Your doctor will advise which of these 2 types of defibrillators or pacemakers will be used:
● Single Chamber – one lead for placement in the lower chamber of the heart
● Dual Chamber – two leads for placement, one in the upper chamber and one in the lower chamber
The procedure for implanting a defibrillator or a pacemaker are the same, therefore the following process applies to both procedures.
The device is implanted under the left or right collarbone, just under the skin. The skin in the area selected is prepared and an incision is made to put the lead(s) into a vein, which leads to the heart. The lead(s) is then threaded through this vein into the heart. The doctor is able to view the process on a monitor.
When the lead(s) is placed into the heart, it is tested to ensure effective working order before they are connected to the “pulse generator”. Once all checks have been made the device is placed under the skin and the incision is closed.
3. Aftercare
WHAT HAPPENS AFTER THEATRE?
Depending on the extent of surgery and your general health, you may be admitted to the intensive care unit after your surgery. This is a precautionary measure only, as the care you receive will be very similar to that which is provided on the surgical ward.
Whether you wake in Intensive Care or in the recovery unit prior to being transferred back to the ward, you will have frequent monitoring of your blood pressure, pulse, respiration and temperature.
In most cases, you will have to stay overnight after the surgery. The next day, before you are discharged, your doctor will check to ensure that everything is in place by doing an x-ray of your chest.
By law you are not allowed to drive until your specialist provides confirmation to do so in writing.
In the first few weeks tissue will grow around the tips of the leads placed in the heart. To prevent movement or dislodgement of the leads and to ensure healing occurs please adhere to the following:
● You must not lift more than 2kgs
● Do not raise your arm (closest to the implanted device) higher than your shoulder
● Avoid vigorous, repetitive movements of the arm.
Check your incision daily in the first few weeks. Contact your doctor immediately if you experience:
● Redness
● Drainage or new discolouration around your wound
● Swelling
● Extreme tenderness
● Pain or heat around the wound
● Chills or fever
At every visit to your specialist, the battery of the device will be checked, although the battery lasts for approximately 5 years and is not rechargeable. Should the battery need changing, the same procedure as the implantation is carried out. An external machine also checks the device and programs it.
You will be provided with detailed information on how to monitor, maintain and replace your defibrillator or pacemaker.
1. Preparation
WHAT IS THE IMPLANTATION OF CARDIAC PACEMAKERS/DEFIBRILLATORS?
It is the implantation of devices into the body that are used to rectify irregular beating of the heart, referred to as Cardiac resynchronisation therapy. By using defibrillators or pacemakers a patient’s survival and quality of life is improved should they suffer from heart insufficiency and disorders of the blood-flow system.
PACEMAKERS
A pacemaker may be inserted into the body to control the speed and pattern of the heartbeat by stimulating the heart with an electrical impulse when the heartbeat slows down or maybe even comes to a complete stop.
This device has saved many lives as the heart stopping completely for a prolonged period of time, can cause death to occur.
It is also made up of two parts:
The pacemaker is also battery operated and on “stand by” until the heart rate slows down to below the set rate of the pacemaker. It will then step in and regulate the “pace”. The doctor who conducts the implantation procedure programs the pacemaker to your specific requirements.
DEFIBRILLATORS
Due to the non-availability of immediate defibrillation at the time that a person suffers abnormal rhythm of the heart, a defibrillator can be implanted in the body to defibrillate the heart automatically, slowing down a fast heartbeat.
The implantable defibrillator is made up of two parts:
The defibrillator is battery operated and is on “stand by” mode checking the heart beat. When the heartbeat is too fast, the device activates and will give a “shock” to the heart. It is also programmed according to your condition.
WHY IS IT DONE?
The heart is the powerhouse of the body; the engine that drives blood throughout all parts of the system. It is a very strong muscle, not resting for more than a second, beating tirelessly and relentlessly.
When the heart fails to contract or beat at its regular rhythm, this condition is called Arrhythmia. As this occurs a patient may notice it and some may not.
There are 2 groups, which this condition can be divided into:
Tachyarrhythmia – the heart beats faster than usual.
Bradyarrhythmia – the heart beats slower than usual.
To determine a diagnosis and appropriate treatment specialised procedures are performed called electrophysiology (EP) studies and radiofrequency ablation (RFA). If the cause of arrhythmia is found during an EP study, this may be corrected by RFA that sends radio frequency energy to destroy the small piece of tissue that is causing the problem.
The more life-threatening arrhythmias, such as ventricular tachycardia or ventricular fibrillation (abnormal rhythm), causing inadequate blood flow to the vital organs of the body, such as the brain, kidneys and coronary arteries of the heart may result in a heart attack proving to be fatal. In this situation, treatment is urgent, and this is when it is necessary to administer an electric shock (defibrillation), implant a temporary pacemaker to make the heart beat faster, or medication is given intravenously.
HOW DO I CHOOSE A SPECIALIST?
Your GP, or the doctor you first consult, will be able to recommend and refer you to a Cardio-thoracic surgeon who can perform the procedure.
You may be happy to accept the advice of your GP with regard to a specialist, or you may like to investigate your choices; either option is safe and valid. In Australia each medical speciality has a governing body to which the consultants belong. You can access the RoyalAustralasianCollege of Surgeons via their website www.surgeons.org. This is a very informative website.
The list of questions below may help you better understand your treatment, and if necessary decide on a particular doctor. Practical issues you may also like to consider are what hospital a particular doctor operates from, and what their fees are. (If you need more information about fee setting and gap arrangements, please refer to our brochure “what you should know before going into hospital”, which is also available on the HCF website).
To access a list of Cardio-thoracic surgeons who participate in HCF’s Medicover no gap arrangement:
- Call HCF Member Services on 13 13 34
- Visit one of HCF’s customer service branches
-
Please note: Participation in HCF’s no gap initiatives is at the doctor’s discretion. HCF does not guarantee that every medical service provided by these doctors will be a no gap service. Some doctors who participate in the HCF Medicover No Gap arrangement have chosen not to be listed on the HCF website. Patients are encouraged to confirm with their doctor whether they will support HCF’s no gap initiatives for their treatment
WHAT SHOULD I ASK MY SPECIALIST?
-
Do not be afraid to ask your doctor questions about the procedure and any side effects which can occur. It is your right to know all the relevant information, as this is part of informed clinical and financial consent. Your doctor will ask you to sign a consent form.
-
In addition to what the procedure involves, you should also ask about:
-
Most medication should be continued as usual, but some may interfere with the operation. Your doctor will inform you of the medication you should stop. As a guide, the following medication may require special instruction:
-
Aspirin (or any related products)
-
Blood thinners (Warfarin, heparin.)
-
Arthritis medication
-
Pain medication
-
Anti-inflammatory medication
-
Insulin
Don’t forget to mention any homeopathic or herbal remedies you are taking, as these can have interactions and side effects too.
WHERE IS IT DONE?
The procedure can only be done in a hospital. Your expected length of stay is approximately 4 days.
HOW LONG IS THE PROCEDURE?
The procedure for both implantation of a defibrillator and pacemaker is carried out under local anaesthetic and time in theatre may last for 2-3 hours dependent on the number of leads to be positioned, the difficulty of access and the testing of the device.
WHO IS INVOLVED?
The people involved in the procedure are:
-
The Cardio-thoracic surgeon, your Specialist doctor
-
There may be an assistant surgeon
-
Anaesthetist : they give you medication that makes you relaxed and sleepy and look after you whilst the procedure is being carried out
-
Nurses for the procedure and recovery
-
Pathologist for blood tests and/or specimen samples
-
Radiologist for x-rays
HOW DO I PREPARE FOR THE SURGERY?
You may be advised to attend a pre-admission clinic at the hospital, where they will run some basic tests to determine your general health and fitness for surgery. These include an ECG (echocardiogram, recording of your heart rhythm), chest x-ray, and blood tests.
Your doctor will have his/her own specific preparation requirements. These instr