Pacemaker Implantation

What is a pacemaker implantation?

Pacemaker implantation is the procedure for putting a pacemaker under the skin of your chest. A pacemaker is a device that helps the heart muscle pump, or contract, properly. It is powered by a battery. Wires connect the pacemaker to the heart. One set of wires sends information to the pacemaker about the contraction rate of the heart. If your heart rate is too slow or if it is missing beats, another set of wires sends signals to the heart to contract.

When is it used?

You may need an artificial pacemaker because your heart's natural pacemaker does not work properly.

Special cells in the heart, called pacemaker cells, send electrical signals that cause the heart muscle to contract. When the heart contracts, it squeezes blood from the heart out to the body and the lungs.

Sometimes a heart attack, infection, medicine, or disease damages the heart. Because of the damage, the pacemaker cells may not work properly. When these cells do not send signals correctly, your heart rate may be very slow (a problem called bradycardia). When your heart beats too slowly, it may not pump enough blood for your body's needs. Poor blood flow can cause fatigue, shortness of breath, or fainting. An artificial pacemaker can help your heart beat normally again.

How do I prepare for pacemaker implantation?

Plan for your care and recovery after the operation. Allow for time to rest and try to find people to help you with your day-to-day duties.

If you need a minor pain reliever in the week before surgery, choose acetaminophen rather than aspirin, ibuprofen, or naproxen. This helps avoid extra bleeding during surgery. If you are taking daily aspirin for a medical condition, ask your healthcare provider if you need to stop taking it before your surgery.

Follow your provider's instructions about not smoking before and after the procedure. Smokers heal more slowly after surgery. They are also more likely to have breathing problems during surgery. For these reasons, if you are a smoker, you should quit at least 2 weeks before the procedure. It is best to quit 6 to 8 weeks before surgery.

Follow any instructions your. Do not eat or drink anything after midnight and the morning before the procedure. Do not even drink coffee, tea, or water.

What happens during the procedure?

The procedure is usually done with a local anesthetic. You may also be given other medicines to relax you and keep you from feeling pain during the procedure. If you feel discomfort during the procedure, tell your healthcare provider right away.

Your upper chest will be washed and possibly shaved. Your healthcare provider will make a cut in the skin of your chest and separate the tissues to make a place for the pacemaker. The pacemaker system consists of 1 or 2 electrodes and a battery unit. The electrodes (wires that are insulated nearly to their tips) are inserted into a vein under your collarbone. With the help of X-rays, your provider will place the electrodes in your heart. The tips of the electrodes will make contact with your heart muscle. They will transmit an electrical impulse that stimulates the heartbeat. The other ends of the electrodes are connected to the battery unit, which also contains electronic circuits. Your provider will place the battery unit under the skin of your upper chest. He or she will then sew the pocket closed.

What happens after the procedure?

You will usually be able to go home the next morning. In some cases you may be able to go home late the same day.

Before you leave the hospital, your healthcare provider will check your pacemaker using a small table-top computer, called a programmer, and a wand. Your provider will put the wand on your body in the area where the pacemaker was placed. The wand will give information from the pacemaker about what the heart is doing and how well the pacemaker is working. If needed, your provider can adjust the pacemaker with the programmer and the wand. This test is not painful, and it usually takes just a few minutes.

You may learn how to check the function of the pacemaker with a telephone. The pacemaker can also be checked at follow-up visits with your provider.

Your provider will explain how the pacemaker might affect your lifestyle and when the battery in the pacemaker may need to be replaced. The pacemaker battery usually lasts 4 to 12 years. You will have plenty of time before the battery is fully used up to plan for replacement. When a battery needs to be replaced, the whole pacemaker will be replaced. Most often, this procedure is very simple. Your healthcare provider reopens the pocket holding the pacemaker and disconnects the old device from its leads. A new pacemaker is attached to the existing leads, and the pocket is closed with stitches.

You will need to have regular checkups to make sure the pacemaker is working properly. Ask your provider what other steps you should take.

What are the benefits of this procedure?

Your heart may beat in a healthy rhythm, and you may be able to go back to a more normal lifestyle.

What are the risks associated with this procedure?

• A local anesthetic may not numb the area quite enough and you may feel some minor discomfort during the implantation. Also, in rare cases, you may have an allergic reaction to the drug used in this type of anesthesia. Local anesthesia is considered safer than general anesthesia.
• The wire could puncture one of the lungs, the vein, or the heart cavity.
• Like any electrical or mechanical device, the pacemaker may need a replacement if it stops working properly.
• The pacemaker wire may become dislodged or break.
• You may have infection or bleeding.

You should ask your healthcare provider how these risks apply to you.

How can I take care of myself when I have a pacemaker?

Be aware that some devices may interfere with pacemakers:

• Cell phones. Keep your cell phone at least 6 inches away from your pacemaker. When you are talking on your cell phone, hold it on the opposite side of the body from your pacemaker. When your phone is turned on but not in use, do not carry it in your breast pocket.
• Power equipment. Pacemakers may not work properly near power-generating equipment and arc welding equipment.
• Magnetic resonance imaging (MRI). MRI uses a powerful magnet to produce images of internal organs. The magnet can interrupt the pacing of pacemakers.
• Radiation. X-rays generally do not affect pacemakers, but radiation therapy for cancer may damage pacemaker circuits.
• Short-wave or microwave diathermy (deep heat treatment) signals may interfere with or damage the pacemaker.

Devices that generally do not damage pacemakers or change pacing rates include:

• CB radios and ham radios
• electric drills
• electric blankets and heating pads
• electric shavers
• metal detectors (Passing through the metal detector at airports will not damage a pacemaker, but the metal in it may sound the alarm.)
• microwave ovens
• televisions and remote controls.

Lithotripsy to dissolve kidney stones may be done safely with some reprogramming of the pacing. Electroconvulsive (shock) therapy appears to be safe for people who have pacemakers.

Tell all your healthcare providers and dentists that you have a pacemaker. Be sure to carry an ID card with you that says you have a pacemaker.

When should I call my healthcare provider?

Call your provider right away if:

• Your pulse is too slow, too fast, or irregular.
• Your symptoms return.
• The site where the pacemaker was put in becomes red or swollen or begins leaking fluid, pus, or blood.

Call during office hours if:

• You have questions about the procedure or its result.
• You want to make another appointment.