Pacemaker Implantation

ExitCare ImageThe heart has its own electrical system, or natural pacemaker, to regulate the heart beat. Sometimes, the natural pacemaker system of the heart fails and causes the heart to beat too slowly. If this happens, a pacemaker can be surgically placed to help the heart beat at a normal or programmed rate. A pacemaker is a small, battery powered device that is placed under the skin. The pacemaker is programmed to sense and "fire" when the heart rate falls below a certain heart rate. When the pacemaker triggers a heart beat, it is called "capture." Parts of a pacemaker include:

  • Wires or leads. The leads are placed in the heart and transmit electricity to the heart. The leads are connected to the pulse generator.

  • Pulse generator. The pulse generator contains a computer and a memory system. The pulse generator also produces the electrical signal that triggers the heart to beat.

A PACEMAKER MAY BE PLACED IF :

  • You have a slow heart beat (bradycardia).

  • You have fainting (syncope).

  • Shortness of breath (dyspnea) due to heart problems.

LET YOUR CAREGIVER KNOW ABOUT:

  • Allergies to all medicine, food, latex, tape, contrast dye or iodine.

  • All medicines taken including:

  • Prescription medicines.

  • Over-the-counter medicines.

  • Steroid medicine, including injections or creams applied to the skin.

  • Eyedrops.

  • Vitamins or herbs.

  • Health conditions such as heart, kidney, respiratory and diabetes problems.

  • History of bleeding problems or blood clots.

  • Problems with general anesthesia.

  • Previous surgery.

  • Possibility of being pregnant.

RISKS AND COMPLICATIONS

The risks, benefits and other treatment options will be discussed before the procedure. Complications are rare but can include:

  • Bleeding.

  • Unable to place the pacemaker under local sedation.

  • Infection.

BEFORE THE PROCEDURE

  • You will have blood work drawn before the procedure.

  • If you smoke, quit.

  • Do not eat or drink anything for 6 hours before the surgery or as told by your caregiver.

  • Ask if it is okay to take medicines with a sip of water in the morning of your procedure.

  • If you are diabetic, follow your caregiver's recommendation on taking insulin.

  • On average, it takes about an hour to place a pacemaker.

PROCEDURE

The surgery to place a pacemaker is considered a minimally invasive surgical procedure. It is done under a local anesthetic, which is an injection at the incision site that makes the skin numb. You are also given sedation and pain medicine that makes you drowsy and forgetful during the procedure.

  • An intravenous line (IV) will be started in your hand or arm so sedation and pain medicine can be given during the pacemaker procedure.

  • A numbing medicine will be injected into the skin where the pacemaker will be placed. A small incision is then made into the skin. The pacemaker is usually placed under the skin near the collarbone.

  • After the incision is made, the leads are inserted into a large vein and are guided into the heart using X-ray.

  • Using the same incision to place the leads, a small pocket is created under the skin to hold the pulse generator. The leads are then connected to the pulse generator.

  • The incision site is then closed. A dressing is placed over the pacemaker site. The dressing is removed 24 to 48 hours afterwards.

AFTER THE PROCEDURE

  • You will be taken to a recovery area after the pacemaker implant. Your vital signs such as blood pressure, heart rate, breathing and oxygen levels will be monitored.

  • A chest X-ray is done after the pacemaker is implanted. This is to make sure the pacemaker and leads are in the correct place.

  • Most but not all people stay overnight in the hospital and go home the next day after a pacemaker implant.