A pacemaker insertion is the implantation of a small electronic device in the chest (just below the collarbone) to help regulate electrical problems with the heart. When a problem develops, such as a slow heart rate, a pacemaker may be recommended to ensure that the heartbeat does not slow to a dangerously low rate.
Reasons for having a pacemaker inserted
A pacemaker may be inserted in order to provide stimulation for a faster heart rate when the heart is beating too slowly, and when other treatment methods, such as medication, have not improved the heart rate.
Problems with the heart rhythm may cause difficulties because the heart is unable to pump an adequate amount of blood to the body. If the heart rate is too slow, the blood is pumped too slowly. If the heart rate is too fast or too irregular, the heart chambers are unable to fill up with enough blood to pump out with each beat. When the body does not receive enough blood, symptoms such as fatigue, dizziness, fainting, and/or chest pain may occur.
Some examples of heart rate and rhythm problems for which a pacemaker might be inserted include:
- Bradycardia – occurs when the heart beats too slow
- Tachy-brady syndrome – alternating fast and slow heart beats
- Heart block – occurs when the electrical signal is delayed or blocked after leaving the SA node; there are several types of heart blocks
There may be other reasons for your physician to recommend a pacemaker insertion.
Risks of pacemaker insertion
Possible risks of pacemaker include, but are not limited to, the following:
- Bleeding from the incision or catheter insertion site
- Damage to the vessel at the catheter insertion site
- Infection of the incision or catheter site
- Pneumothorax – air becomes trapped in the pleural space (outside the lung but within the chest wall); this can cause breathing difficulties and in extreme cases may cause the lung to collapse
If you are pregnant or suspect that you may be pregnant, you should notify your physician. If you are breastfeeding, you should notify your physician.
Patients who are allergic to or sensitive to medications or latex should notify their physician.
For some patients, having to lie still on the procedure table for the length of the procedure may cause some discomfort or pain.
There may be other risks depending upon your specific medical condition. Be sure to discuss any concerns with your physician prior to the procedure.
During your pacemaker insertion
A pacemaker may be performed on an outpatient basis or as part of your stay in a hospital. Procedures may vary depending on your condition and your physician’s practices.
Generally, a pacemaker insertion follows this process:
- You will be asked to remove any jewelry or other objects that may interfere with the procedure.
- You will be asked to remove your clothing and will be given a gown to wear.
- You will be asked to empty your bladder prior to the procedure.
- An intravenous (IV) line will be started in your hand or arm prior to the procedure for injection of medication and to administer IV fluids, if needed.
- You will be placed on your back on the procedure table.
- You will be connected to an electrocardiogram (ECG or EKG) monitor that records the electrical activity of the heart and monitors the heart during the procedure using small, adhesive electrodes. Your vital signs (heart rate, blood pressure, breathing rate, and oxygenation level) will be monitored during the procedure.
- Large electrode pads will be placed on the front and back of the chest.
- You will receive a sedative medication in your IV before the procedure to help you relax. However, you will likely remain awake during the procedure.
- The pacemaker insertion site will be cleansed with antiseptic soap.
- Sterile towels and a sheet will be placed around this area.
- A local anesthetic will be injected into the skin at the insertion site.
- Once the anesthetic has taken effect, the physician will make a small incision at the insertion site.
- A sheath, or introducer, is inserted into a blood vessel, usually under the collarbone. The sheath is a plastic tube through which the pacer lead wire will be inserted into the blood vessel and advanced into the heart.
- It will be very important for you to remain still during the procedure so that the catheter does not move out of place and to prevent damage to the insertion site.
- The lead wire will be inserted through the introducer into the blood vessel. The physician will advance the lead wire through the blood vessel into the heart.
- Once the lead wire is inside the heart, it will be tested to verify proper location and that it works. There may be one, two, or three lead wires inserted, depending on the type of device your physician has chosen for your condition. Fluoroscopy, (a special type of x-ray that will be displayed on a TV monitor), may be used to assist in testing the location of the leads.
- The pacemaker generator will be slipped under the skin through the incision (just below the collarbone) after the lead wire is attached to the generator. Generally, the generator will be placed on the non-dominant side. (If you are right-handed, the device will be placed in your upper left chest. If you are left-handed, the device will be placed in your upper right chest).
- The ECG will be observed to ensure that the pacer is working correctly.
- The skin incision will be closed with sutures, adhesive strips, or a special glue.
- A sterile bandage/dressing will be applied.
While you are in the hospital
After the procedure, you may be taken to the recovery room for observation or returned to your hospital room. A nurse will monitor your vital signs.
You should immediately inform your nurse if you feel any chest pain or tightness, or any other pain at the incision site. After the period of bed rest has been completed, you may get out of bed. The nurse will assist you the first time you get up, and will check your blood pressure while you are lying in bed, sitting, and standing. You should move slowly when getting up from the bed to avoid any dizziness from the period of bed rest.
You will be able to eat or drink once you are completely awake.
The insertion site may be sore or painful, but pain medication may be administered if needed.
Your physician will visit with you in your room while you are recovering. The physician will give you specific instructions and answer any questions you may have.
Once your blood pressure, pulse, and breathing are stable and you are alert, you will be taken to your hospital room or discharged home.
If the procedure is performed on an outpatient basis, you may be allowed to leave after you have completed the recovery process. However, if there are concerns or problems you may stay in the hospital for an additional day or longer.
You should arrange to have someone drive you home from the hospital following your procedure.
When you return home
You should be able to return to your daily routine within a few days. Your physician will tell you if you will need to take more time in returning to your normal activities. In addition, you should not do any lifting or pulling on anything for a few weeks. You may be instructed to limit movement of the arm on the side that the pacemaker was placed, based on your physician’s preferences.
You will most likely be able to resume your usual diet, unless your physician instructs you differently.
It will be important to keep the insertion site clean and dry. You will be given instructions about bathing and showering.
Your physician will give you specific instructions about driving.
Ask your physician when you will be able to return to work. The nature of your occupation, your overall health status, and your progress will determine how soon you may return to work.
Notify your physician to report any of the following:
- Fever and/or chills
- Increased pain, redness, swelling, or bleeding or other drainage from the insertion site
- Chest pain/pressure, nausea and/or vomiting, profuse sweating, dizziness and/or fainting
Your physician may give you additional or alternate instructions after the procedure, depending on your particular situation.
The following precautions should always be considered. Discuss the following in detail with your physician, or call the company that made your device:
- Always carry an ID card that states you have a pacemaker. In addition, you may want to wear a medical identification bracelet indicating that you have a pacemaker.
- Let screeners know you have a pacemaker before going through airport security detectors. In general airport detectors are safe for pacemakers, but the small amount of metal in the pacemaker and leads may set off the alarm. If you are selected for additional screening by hand-held detector devices, politely remind the screeners that the detector wand should not be held over your pacemaker for longer than a few seconds, as these devices contain magnets and thus may affect the function or programming of your pacemaker.
- You may not have a magnetic resonance imaging (MRI) procedure. You should also avoid large magnetic fields such as power generation sites and industrial sites such as automobile junkyards that use large magnets.
- Abstain from diathermy (the use of heat in physical therapy to treat muscles).
- Turn off large motors, such as cars or boats, when working on them (They may create a magnetic field).
- Avoid high-voltage or radar machinery, such as radio or television transmitters, electric arc welders, high-tension wires, radar installations, or smelting furnaces.
- If you are having a surgical procedure performed, inform your surgeon that you have a pacemaker well before the operation. Also ask your cardiologist’s advice on whether anything special should be done prior to and during the surgery, as the electrocautery device that controls bleeding may interfere with the pacemaker. Sometimes the pacemaker's programming will be temporarily changed (using a magnet) during the surgery to minimize the possibility of interference from the electrocautery.
- You may have to take antibiotic medication before any medically invasive procedure to prevent infections that may affect the pacemaker.
- When involved in a physical, recreational, or sporting activity, you protect yourself from trauma to the pacemaker. A blow to the chest near the pacemaker can affect its functioning. If you are hit in that area, you may want to see your physician.
- Cell phones in the US with less than 3 watts of output do not seem to affect pacemakers or the pulse generator, but as a precaution, cell phones should be kept at least 6 inches away from your pacemaker. Avoid carrying a cell phone in your breast pocket over your pacemaker.
- Always consult your physician when you feel ill after an activity, or when you have questions about beginning a new activity.
Always consult your physician if you have any questions concerning the use of certain equipment near your pacemaker.