Patient education: Pacemaker insertion (The Basics)

What is pacemaker insertion? — This is surgery to put a pacemaker in the body. A pacemaker is a device that sits under the skin near the heart (figure 1). It can treat an abnormal heart rate. "Heart rate" means how fast the heart is beating.

Most pacemakers have 2 parts:

●Pulse generator (picture 1) – This part sends electrical signals to the heart.

●Lead – This is a wire that connects to the pulse generator on 1 end. The other end of the lead is attached to the inside of the heart. Some devices have more than 1 lead.

To do this surgery, the doctor makes a small cut, or "incision," in the skin. The incision is usually made just below the collarbone. Sometimes, it is made on the upper belly. Then, the doctor places the pacemaker under the skin and connects it to the heart.

How do I prepare for pacemaker insertion? — The doctor or nurse will tell you if you need to do anything special to prepare.

Before your procedure, your doctor will ask you about your health history. This involves asking you questions about any health problems you have or had in the past, past surgeries, and any medicines you take. Tell them about:

●Any medicines you are taking – This includes any prescription or over-the-counter medicines you use, plus any supplements you take. It helps to write down and bring a list of any medicines you take, or bring a bag with all of your medicines with you.

●Any allergies you have

●Any bleeding problems you have – Certain medicines, including some herbs and supplements, can increase the risk of bleeding. Some health conditions also increase this risk.

Your doctor will also do an exam. They might send you to get tests, such as:

●Electrocardiogram ("ECG") – This test records your heart rate and rhythm.

●Blood tests

You will also get information about:

●Eating and drinking before your procedure – In many cases, you will need to "fast" before surgery. This means not eating or drinking anything for a period of time. In some cases, you might be able to have small sips of water to take your medicines during this time. Your doctor or nurse will let you know whether you need to fast and for how long.

●Lowering the risk of infection – In some cases, you might need to wash the area with a special soap.

●What help you will need when you go home – For example, you might need to have someone else bring you home or stay with you for some time while you recover.

Ask the doctor or nurse if you have questions or if there is anything you do not understand.

What happens during pacemaker insertion? — When it is time for the procedure:

●You will get an "IV," which is a thin tube that goes into a vein. This can be used to give you fluids and medicines.

●You will get anesthesia medicines. This is to make sure that you do not feel pain during the procedure. Most of the time, pacemaker insertion is done with "local" anesthesia to numb the area. You will also get medicines to make you relax and feel sleepy, called "sedatives."

In some cases, general anesthesia is used. This means getting medicines to put you to sleep for the procedure.

●You might get medicines to help control pain after the procedure.

●The doctors and nurses will monitor your breathing, blood pressure, and heart rate during the procedure.

●The doctor will make an incision about 2 inches (5 to 6 cm) long to make a pocket for the pacemaker. Usually, this incision is just below the collarbone. But sometimes, it is on the upper abdomen.

●The doctor will insert the pulse generator under the skin and connect it to the leads. The other ends of the leads pass through veins to your heart. The ends of the leads are implanted into your heart tissue. The doctor will do X-rays to check that the leads are in the right place.

●The doctor will check that the pacemaker is working properly.

●The doctor will close your incision and cover it with a clean bandage.

What happens after pacemaker insertion? — After your procedure, you will be taken to a recovery room. The staff will watch you closely as your anesthesia wears off.

As you recover:

●You might feel groggy or confused for a short time. You might also feel nauseous or vomit. The doctor or nurse can give you medicine to help with this.

●The staff will help you get out of bed and start moving around when you are ready.

●You will get medicine if needed to help with pain. You might need other medicines, too.

●When you are ready to eat, you will start with clear liquids. Then, you can start eating as you are able. You might feel better if you start with bland foods.

What are the risks of pacemaker insertion? — Your doctor will talk to you about all of the possible risks, and answer your questions. Possible risks include:

●Infection

●Bleeding

●Blood clots around the pacemaker lead

●Pneumothorax – This is when air leaks out of the lung. Sometimes, the end of a lead pokes a hole in the lung when it is being inserted.

●Heart perforation – This happens when the end of a lead pokes a hole in the heart.

●Problems with the pacemaker

More on this topic

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Patient education: Cardiac resynchronization therapy (The Basics)
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Patient education: Pacemakers (Beyond the Basics)
Patient education: Implantable cardioverter-defibrillators (Beyond the Basics)
Patient education: Atrial fibrillation (Beyond the Basics)
Patient education: Syncope (fainting) (Beyond the Basics)