Pacemaker Implantation

   • Preparation
   • Procedure
   • Recovery
   • Health Maintenance

A pacemaker is a small electronic device that helps the heart to beat at a proper rate. It keeps track of your normal heart beat, and can sense when it becomes too slow. When that happens, the pacemaker generates a small electrical impulse, very similar to the heart's natural impulse. This keeps your heart beating at a normal pace.

Your pacemaker has two main parts: the generator and the lead(s). The generator is a small, flat, lightweight metal case that contains a tiny computer and battery. This is the part that generates the electrical impulses. The leads are wires covered by soft, flexible plastic. Working together to regulate your heart, they monitor how well the heart is beating and will send electrical impulses from the generator to the heart when it senses it is necessary.






Preparation
Prior to your procedure, we may request tests, such as an electrocardiogram (ECG) and blood tests. We will review all medications you are taking, and give you any special instructions concerning them. You'll be told where and when to report for your pacemaker (unless you're in the hospital) and what to do before you arrive. Generally, you'll be asked not to eat or drink anything after midnight the evening before your procedure (except sips of water to swallow your pills).

Just before your procedure, we will discuss your pacemaker insertion - its purpose, benefits, and potential risks. The insertion of a pacemaker is a common, low-risk surgical procedure with a very small risk of complications. These might include puncture of the heart or lung tissue, damage to the vein, infection, bleeding, and/or bruising. Although the rate of complications is very low, you'll be asked to sign a routine consent form. This is a good time to ask questions or talk about any concerns you may have.

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Procedure
Before your procedure, an intravenous line (IV) will be inserted in your arm to administer any medications. The area where the pacemaker will be inserted will be washed with an antiseptic soap and shaved. You will be taken to a special procedure room where you'll be covered with sterile drapes. You’ll be awake through the procedure, but will be given a sedative to help you relax and make you drowsy.

The procedure room personnel, who have been trained specifically in the electrical activity of the heart, will be wearing surgical hats and masks to assure that the environment is kept as clean as possible. Your ECG, heart rate, blood pressure, and oxygen level will be1ˆù,ed throughout the procedure.

A local anesthetic will be injected under the skin to numb the site where the pacemaker will be implanted in the upper part of the chest. Then the electrophysiologist will make a small incision, and form a "pocket" under the skin to hold the generator. The leads will be inserted into a vein under the collarbone and guided into your heart using an x-ray monitor, and tested periodically to determine their best positioning. After the leads are in place, they will be attached to the generator, which will then be gently placed into the skin "pocket". Then the incision will be closed with dissolvable stitches and a small bandage applied.

During the procedure you may feel some pushing and tugging on your skin. However, you should feel very little, if any, discomfort overall. The procedure usually lasts approximately one and one-half hours.

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Recovery
After the procedure, you'll be taken to a hospital room or a recovery area. You'll be kept overnight in the hospital so your heart can be monitored to make sure your pacemaker is functioning well. You'll be asked to limit the use of your arm on the side the pacemaker was inserted to give the leads an opportunity to heal to your heart tissue.

You may feel some discomfort in the incision area when the local anesthetic wears off. If so, the staff will give you some medication to make you more comfortable. Be sure to tell your nurse if you experience any unusual symptoms such as hiccups, dizziness, or chest pain. Before you leave the hospital, you'll be given detailed instructions about caring for your incision site. You'll also be told what signs and symptoms to report, and you'll be given a follow-up plan. You should arrange ahead of time for someone to drive you home.

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Health Maintenance
Your pacemaker will help make sure your heartbeat remains strong and regular, but you also play an important role in staying healthy. Be sure you understand your follow-up plan and keep all appointments for exams and follow-up tests. Follow your instructions, don't hesitate to talk about your concerns, and immediately report any new symptoms.

As always, if you have any questions, be sure to call our office.

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