Pacemaker Implantation

A pacemaker implantation is a procedure in which the health care provider places a pacemaker in your chest.

This procedure is most often done when your heart rate is too slow. As a result of the abnormal rate, your heart pumps less blood, causing symptoms such as fatigue, shortness of breath, or fainting.

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 provider if you need to stop taking it before your surgery.

Follow any instructions your health care provider may give you. If you are to have general anesthesia, eat a light meal, such as soup or salad the night before the procedure. Do not eat or drink anything after midnight and the morning before the procedure. Do not even drink coffee, tea, or water. 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 this reason, 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. Also, your wounds will heal much better if you do not smoke after the surgery.

No special preparation is needed for local anesthesia.

You will be given medicines to relax your muscles and keep you from feeling pain during the operation. If you feel discomfort during the procedure, tell your health care provider immediately.

The nurse will wash your upper chest and sometimes shave the area. The health care provider will make a cut in the skin over the upper chest and separate the tissues to make a place for the pacemaker. The artificial pacemaker system consists of one or two electrodes and a battery unit. The electrodes -- wires that are insulated nearly to their tips -- are inserted into a vein located under your collarbone. With the help of x-rays, the health care provider places them in your right atrium and right ventricle. The tips of the electrodes make contact with your heart muscle and transmit the electrical impulse that stimulates the heartbeat. The other ends of the electrodes are connected to the pacemaker unit, which contains batteries and electronic circuits. The health care provider places this unit beneath the skin of your upper chest.

You may stay in the hospital for 1 to 3 days, depending on your condition. You will remain in bed and your heart will be monitored. The day after the procedure you will be encouraged to walk in preparation for leaving the hospital.

Before you leave the hospital, your health care provider will check your pacemaker using a small table-top computer, called a programmer, and a wand. The wand is about the same size as a remote control. Your provider puts the wand on your body, about where the pacemaker is located. This allows your health care provider to get information from the pacemaker about what the heart is doing and how well it is working. If needed, your health care provider can adjust the pacemaker using the programmer and the wand. It is not painful, and it usually takes just a few minutes.

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

Your health care provider may explain how having a pacemaker might affect your lifestyle and when the battery in the pacemaker may need to be replaced.

Ask your health care provider what other steps you should take and when you should come back for a checkup.

Your heart may beat in a healthy rhythm, and you may resume a more normal lifestyle.

• There are some risks when you have general anesthesia. Discuss these risks with your health care provider.
• A local anesthesia may not numb the area quite enough and you may feel some minor discomfort. 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.
• The pacemaker is implanted because the heart rhythm is abnormal. This may be associated with other heart problems, which could worsen despite correction of the rhythm.
• Like any electrical/mechanical device, the pacemaker may need a replacement if it stops working properly.
• The pacemaker wire may become dislodged and/or break.
• There is a risk of infection and/or bleeding.

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

Call the health care provider immediately if your pulse becomes abnormally slow, fast, or irregular, or your original symptoms return.

Call the health care provider during office hours if:

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