Implantable pacemaker

What is it?
In this surgical procedure, surgeons implant a device called a pacemaker, which regulates heart rate and rhythm.

Why is it performed?
It is performed to treat abnormal heart rates or rhythms (arrhythmia), particularly if they have not responded well to drug therapy (medication).

What is done?
The pacemaker consists of two parts. The leads are wires with electrodes at the tip that transmit electrical signals to the heart muscle from the pulse generator. These electrical signals cause the heart muscle to contract (pump). The pulse generator (often referred to as the pacemaker) is a small unit with a computer that generates the electrical signal. Most pacemaker implantations are performed under local anesthesia (similar to the anesthesia used by dentists).

What can you expect?
Usually, the procedure is scheduled ahead of time. A week or so before your operation, you will probably be asked to visit your hospital. Various tests, such as blood and urine tests, an electrocardiogram, and other tests may be performed.

Your doctor will explain the risks and benefits of the procedure and you will be asked to sign a consent form. Before the procedure starts, inform your doctor if you:

• have ever had a reaction to any contrast dye, iodine, or any serious allergic reaction (e.g., from a bee sting or from eating shellfish)
• have asthma
• are allergic to any medication
• have any bleeding problems or are taking blood-thinning medication
• have a history of kidney problems or diabetes
• have body piercings on your chest and/or abdomen
• have had any recent change in your health
• are, or may be, pregnant

Endocardial Lead Positioning
This is the most common procedure for implanting a pacemaker. You will be awake throughout the procedure. You will be given a sedative to help you relax and local anesthetics in areas that are involved in the procedure (usually the upper chest area). A thin, flexible tube (catheter) will be inserted into a blood vessel and, using a fluoroscope (similar to an X-ray picture to visualize the catheter), threaded into the heart. Once in the heart, the leads will be attached to the inside lining. The leads will be tested to ensure they are working correctly. From time to time, you may be asked to take deep breaths or cough vigorously in order to test the placement of the leads.

Once the leads are in the best locations, they will be plugged into the pulse generator. The pulse generator will be slipped into a small pocket made just beneath the skin of your upper chest or your abdomen. You may feel slight pressure while the leads and pulse generator are being inserted into the pocket.

Epicardial Lead Positioning
Because a larger incision is made in the chest, this procedure is usually performed under a general anesthesia and you will be asleep. The exterior surface of the heart is exposed and the leads attached directly to the surface (epicardium) of the heart. The pulse generator is usually placed under the skin in the upper abdomen, but may also be placed in the upper chest area.

After the procedure
Once surgery is completed, you will be taken to a recovery room. There may be some soreness around the site where the pulse generator was implanted, but it can be managed with pain medication. Depending upon your condition and which procedure you had, you may stay in the hospital anywhere from several hours to a few days.

When you return home, keep an eye on your incisions. Some bruising is normal but contact your doctor if you experience increased pain, redness, swelling, bleeding or other draining from an incision, fever, and/or chills. Most people are aware of their pacemaker for a short time following its implantation, but this sensation usually decreases with time. For the first few weeks, avoid sudden, jerky movements with your arms, stretching or reaching over your head, or touching or “twiddling with” the pacemaker.

Last reviewed March 2007.