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Pacemaker Insertion

Definition

This is a procedure to insert an artificial pacemaker. A pacemaker is a small, battery-operated device. It helps maintain a normal heartbeat by sending electrical impulses to the heart.
Pacemaker Insertion
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Reasons for Procedure

A pacemaker can be inserted when:
  • The body's natural pacemaker, the sinoatrial (SA) node, is not working properly—this can cause the heart to beat too slowly
  • There are malfunctions in the atrioventricular (AV) node, which is the part of the heart’s electrical system that sends signals from the SA node to the ventricles—this leads to a slow heartbeat
  • Heart performance in people with severe symptoms of heart failure and a weakened heart muscle, known as cardiomyopathy, needs to be improved—his is called biventricular pacing, or cardiac resynchronization therapy
  • Heart surgery is being done

Possible Complications

Problems from the procedure are rare, but all procedures have some risk. Your doctor will review possible problems such as:
  • Excess bleeding
  • Infection
  • Pacemaker malfunction
  • Inappropriate stimulation of the diaphragm, the large muscle between the chest and abdominal cavities
  • Rupture in the heart muscle—rare
Your chances for problems are higher for:

What to Expect

Prior to Procedure

You may have:
Leading up to your procedure:
  • Talk to your doctor about your medicines. You may need to stop some up to 1 week in advance.
  • The night before, eat a light meal. Don't eat or drink anything after midnight.

Anesthesia

Local anesthesia is used to numb the area.

Description of the Procedure

You will lie flat on a table. A small cut will be made beneath the collarbone. The pacemaker is placed through the cut. The wires (called leads) will be threaded through a vein from the collarbone to the heart. Lastly, the cut will be stitched closed.

Immediately After Procedure

Your heart rate and blood pressure will be monitored.

How Long Will It Take?

About 2 hours

How Much Will It Hurt?

The anesthesia will prevent pain during the procedure. Medicines will help with pain afterward.

Post-procedure Care

The pacemaker will be programmed to fit your pacing needs. Once everything is working properly and you have no problems, you can go home.
  • Avoid strenuous activity, especially involving the upper body, for 4-6 weeks.
  • Avoid excessive movement of the arm and shoulder on the side of the pacemaker for 2 weeks. This will help you to avoid dislodging the leads. You may be given a sling to wear to help remind you.
  • Now that you have a pacemaker, you may need to avoid:
    • MRI scans
    • Heat therapy—often used in physical therapy
    • High-voltage or radar machinery such as electric arc welders, high-tension wires, radar installations, or smelting furnaces
    • Contact with radio or television transmitters
  • Do not carry a cell phone in a pocket directly over the device. Keep your phone on the side away from the device. Also, headphones worn with MP3 players may cause interference.
  • Turn off car or boat motors when working on them. They may temporarily confuse your device.
  • Tell your doctor or dentist that you have a device before a surgical procedure.
  • Check with your doctor about the safety of going through airport security detectors with your device.
A hard ridge may form on the skin along the cut. This usually recedes as the wound heals.

Call Your Doctor

Call your doctor if any of these occur:
  • Fever or chills
  • Redness, swelling, pain, excess bleeding, or pus from the wound
  • Pain that you cannot control with the medicines you were given
  • Coughing, breathing problems, or chest pain
  • Heartbeat irregularities
If you think you have an emergency, call for emergency medical services right away.

RESOURCES

American Heart Association
http://www.heart.org
Heart Rhythm Society
https://www.hrsonline.org

CANADIAN RESOURCES

Canadian Cardiovascular Society
http://www.ccs.ca
Heart and Stroke Foundation
http://www.heartandstroke.ca

References

Pacemaker. American Heart Association website. Available at: http://www.heart.org/HEARTORG/Conditions/Arrhythmia/PreventionTreatmentofArrhythmia/Pacemaker%5FUCM%5F448480%5FArticle.jsp#.W0O4YtVKhQI. Updated December 21, 2016. Accessed July 9, 2018.
Pacemaker insertion. Johns Hopkins Medicine website. Available at: https://www.hopkinsmedicine.org/healthlibrary/test%5Fprocedures/cardiovascular/pacemaker%5Finsertion%5F92,p07980. Accessed July 9, 2018.
Pacemakers. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T906162/Pacemakers. Updated January 11, 2018. Accessed July 9, 2018.

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