What is Pacemaker Implantation

Pacemaker implantation is a procedure to place a pacemaker inside your chest. A pacemaker is a small computer that sends electrical signals to the heart and helps your heart beat normally. A pacemaker also stores information about your heart rhythms. You may need pacemaker implantation if you:

• Have a slow heartbeat (bradycardia).
• Faint (syncope).
• Have shortness of breath (dyspnea) due to heart problems.

The pacemaker attaches to your heart through a wire, called a lead. Sometimes just one lead is needed. Other times, there will be two leads. There are two types of pacemakers:

• Transvenous pacemaker. This type is placed under the skin or muscle of your chest. The lead goes through a vein in the chest area to reach the inside of the heart.
• Epicardial pacemaker. This type is placed under the skin or muscle of your chest or belly. The lead goes through your chest to the outside of the heart.

Tell a health care provider about:

• Any allergies you have.
• All medicines you are taking, including vitamins, herbs, eye drops, creams, and over-the-counter medicines.
• Any problems you or family members have had with anesthetic medicines.
• Any blood or bone disorders you have.
• Any surgeries you have had.
• Any medical conditions you have.
• Whether you are pregnant or may be pregnant.

What are the risks?

Generally, this is a safe procedure. However, problems may occur, including:

• Infection.
• Bleeding.
• Failure of the pacemaker or the lead.
• Collapse of a lung or bleeding into a lung.
• Blood clot inside a blood vessel with a lead.
• Damage to the heart.
• Infection inside the heart (endocarditis).
• Allergic reactions to medicines.

What happens before the procedure?

Staying hydrated

Follow instructions from your health care provider about hydration, which may include:

• Up to 2 hours before the procedure – you may continue to drink clear liquids, such as water, clear fruit juice, black coffee, and plain tea.

Eating and drinking restrictions

Follow instructions from your health care provider about eating and drinking, which may include:

• 8 hours before the procedure – stop eating heavy meals or foods such as meat, fried foods, or fatty foods.
• 6 hours before the procedure – stop eating light meals or foods, such as toast or cereal.
• 6 hours before the procedure – stop drinking milk or drinks that contain milk.
• 2 hours before the procedure – stop drinking clear liquids.

Medicines

• Ask your health care provider about:
  • Changing or stopping your regular medicines. This is especially important if you are taking diabetes medicines or blood thinners.
  • Taking medicines such as aspirin and ibuprofen. These medicines can thin your blood. Do not take these medicines before your procedure if your health care provider instructs you not to.
• You may be given antibiotic medicine to help prevent infection.

General instructions

• You will have a heart evaluation. This may include an electrocardiogram (ECG), chest X-ray, and heart imaging (echocardiogram, or echo) tests.
• You will have blood tests.
• Do not use any products that contain nicotine or tobacco, such as cigarettes and e-cigarettes. If you need help quitting, ask your health care provider.
• Plan to have someone take you home from the hospital or clinic.
• If you will be going home right after the procedure, plan to have someone with you for 24 hours.
• Ask your health care provider how your surgical site will be marked or identified.

What happens during the procedure?

• To reduce your risk of infection:
  • Your health care team will wash or sanitize their hands.
  • Your skin will be washed with soap.
  • Hair may be removed from the surgical area.
• An IV tube will be inserted into one of your veins.
• You will be given one or more of the following:
  • A medicine to help you relax (sedative).
  • A medicine to numb the area (local anesthetic).
  • A medicine to make you fall asleep (general anesthetic).
• If you are getting a transvenous pacemaker:
  • An incision will be made in your upper chest.
  • A pocket will be made for the pacemaker. It may be placed under the skin or between layers of muscle.
  • The lead will be inserted into a blood vessel that returns to the heart.
  • While X-rays are taken by an imaging machine (fluoroscopy), the lead will be advanced through the vein to the inside of your heart.
  • The other end of the lead will be tunneled under the skin and attached to the pacemaker.
• If you are getting an epicardial pacemaker:
  • An incision will be made near your ribs or breastbone (sternum) for the lead.
  • The lead will be attached to the outside of your heart.
  • Another incision will be made in your chest or upper belly to create a pocket for the pacemaker.
  • The free end of the lead will be tunneled under the skin and attached to the pacemaker.
• The transvenous or epicardial pacemaker will be tested. Imaging studies may be done to check the lead position.
• The incisions will be closed with stitches (sutures), adhesive strips, or skin glue.
• Bandages (dressing) will be placed over the incisions.

The procedure may vary among health care providers and hospitals.

What happens after the procedure?

• Your blood pressure, heart rate, breathing rate, and blood oxygen level will be monitored until the medicines you were given have worn off.
• You will be given antibiotics and pain medicine.
• ECG and chest x-rays will be done.
• You will wear a continuous type of ECG (Holter monitor) to check your heart rhythm.
• Your health care provider will program the pacemaker.
• Do not drive for 24 hours if you received a sedative.

Care After Pacemaker Implantation

This sheet gives you information about how to care for yourself after your procedure. Your health care provider may also give you more specific instructions. If you have problems or questions, contact your health care provider.

What can I expect after the procedure?

After the procedure, it is common to have:

• Mild pain.
• Slight bruising.
• Some swelling over the incision.
• A slight bump over the skin where the device was placed. Sometimes, it is possible to feel the device under the skin. This is normal.

Follow these instructions at home:

Medicines

• Take over-the-counter and prescription medicines only as told by your health care provider.
• If you were prescribed an antibiotic medicine, take it as told by your health care provider. Do not stop taking the antibiotic even if you start to feel better.

Wound care

• Do not remove the bandage on your chest until directed to do so by your health care provider.
• After your bandage is removed, you may see pieces of tape called skin adhesive strips over the area where the cut was made (incision site). Let them fall off on their own.
• Check the incision site every day to make sure it is not infected, bleeding, or starting to pull apart.
• Do not use lotions or ointments near the incision site unless directed to do so.
• Keep the incision area clean and dry for 2–3 days after the procedure or as directed by your health care provider. It takes several weeks for the incision site to completely heal.
• Do not take baths, swim, or use a hot tub for 7–10 days or as otherwise directed by your health care provider.

Activity

• Do not drive or use heavy machinery while taking prescription pain medicine.
• Do not drive for 24 hours if you were given a medicine to help you relax (sedative).
• Check with your health care provider before you start to drive or play sports.
• Avoid sudden jerking, pulling, or chopping movements that pull your upper arm far away from your body. Avoid these movements for at least 6 weeks or as long as told by your health care provider.
• Do not lift your upper arm above your shoulders for at least 6 weeks or as long as told by your health care provider. This means no tennis, golf, or swimming.
• You may go back to work when your health care provider says it is okay.

Pacemaker care

• You may be shown how to transfer data from your pacemaker through the phone to your health care provider.
• Always let all health care providers know about your pacemaker before you have any medical procedures or tests.
• Wear a medical ID bracelet or necklace stating that you have a pacemaker. Carry a pacemaker ID card with you at all times.
• Your pacemaker battery will last for 5–15 years. Routine checks by your health care provider will let the health care provider know when the battery is starting to run down. The pacemaker will need to be replaced when the battery starts to run down.
• Do not use amateur radio equipment or electric welding torches. Other electrical devices are safe to use, including power tools, lawn mowers, and speakers. If you are unsure of whether something is safe to use, ask your health care provider.
• When using your cell phone, hold it to the ear opposite the pacemaker. Do not leave your cell phone in a pocket over the pacemaker.
• Avoid places or objects that have a strong electric or magnetic field, including:
  • Airport security gates. When at the airport, let officials know that you have a pacemaker.
  • Power plants.
  • Large electrical generators.
  • Radiofrequency transmission towers, such as cell phone and radio towers.

General instructions

• Weigh yourself every day. If you suddenly gain weight, fluid may be building up in your body.
• Keep all follow-up visits as told by your health care provider. This is important.

Contact a health care provider if:

• You gain weight suddenly.
• Your legs or feet swell.
• It feels like your heart is fluttering or skipping beats (heart palpitations).
• You have chills or a fever.
• You have more redness, swelling, or pain around your incisions.
• You have more fluid or blood coming from your incisions.
• Your incisions feel warm to the touch.
• You have pus or a bad smell coming from your incisions.

Get help right away if:

• You have chest pain.
• You have trouble breathing or are short of breath.
• You become extremely tired.
• You are light-headed or you faint.