Pacemaker or defibrillator generator replacement

Pacemakers and implantable defibrillators run on a battery built into the generator, which cannot be recharged. Their lifespan varies with the model and use, often between 5 and more than 10 years. At regular check-ups, the cardiologist monitors battery wear: when it approaches its end, the device signals it and a replacement is scheduled, not as an emergency but within the indicated time frame. Generator replacement is a short procedure performed under local anaesthesia. The doctor reopens the scar from the original implantation, removes the old generator from its pocket under the skin, disconnects the leads and tests that they work properly. If they are in good condition, they are reconnected to the new generator, which is placed back in the pocket before closure. If a lead is faulty, a new lead can be added at the same time. For a patient who depends on their pacemaker, back-up pacing is arranged during the short disconnection period. For a defibrillator, shock therapies are switched off during the procedure and the heart rhythm is monitored continuously, with an external defibrillator at hand. It is also an opportunity to check that the type of device is still suited to the current condition of the heart. At Clinique Pasteur Tunis, generator replacement is performed by the electrophysiology team under strict aseptic conditions, and follow-up of the new device continues in clinic.