The pacemaker system includes devices that are implanted in your body:
- A pacing pulse generator is a small battery-powered, computer-like device. It is about the size of a matchbook.
- One or two lead wires will connect the heart muscle to the pulse generator.
Pacemakers are recommended for patients with symptoms from a slow heart rhythm (bradycardia).
- Heart Block is a problem with the electrical pathways of the heart. Normal heartbeats are not passed to the whole heart at the right time. They are blocked. This can make you feel dizzy and tired.
- Chronotropic Incompetence is a problem with the S-A Node, the natural pacemaker of the heart. The heart beats at a rate that is too slow for the activity you are doing. This can make you feel tired when you are working.
- Atrial arrhythmias can cause a heart rate that is fast then slow and irregular. You may feel thumping in your chest (palpitations) and become short of breath. You may even pass out if the rate gets too high.
The pacemaker sends small electrical impulses to the heart. These impulses make the heart contract.
- If the heart does not provide a heart beat at the right time, the pacemaker sends the impulse to make the heart beat at a normal rate.
- If the heart rate is irregular, the pacemaker can send these impulses to help even out the rhythm.
These impulses are tiny and most people cannot feel them.
How to Prepare
Your healthcare provider will give you specific instructions about preparing for your pacemaker surgery. Follow the instructions carefully.
Your healthcare provider determines whether you should continue or stop certain medications, if you should avoid eating or drinking in the hours before surgery and what to expect when you check into the hospital.
It is important for you to tell your doctor if you cannot take aspirin or have a history of bleeding problems. Your doctor also needs to know if you are taking any other medications, have drug allergies, or are allergic to any metals or plastics.
What to Expect
The procedure to implant the pacing system in your body usually takes about an hour. During the surgery, you will be attached to monitors for your heart rate and blood pressure.
An intravenous (IV) line will be started in your arm and you will be given medicine to help you relax and get sleepy. This is called conscious sedation, which means you remain aware of your surroundings and are able to talk to the staff, but you should not feel any pain.
Watch the Video: Pacemaker Implantation [00:16]
Placing the pulse generator and leads
Your doctor will determine the best way to implant your pacemaker. Your age and the size of your heart will be considered. Your doctor will also consider whether you have ever had chest surgery. Your activities and lifestyle may suggest where the pacemaker is implanted.
Your pacemaker will likely be implanted just under the skin beneath the shoulder. Coated wires called leads carry the electrical signals between the device and the heart.
- A "single-chamber" pacemaker has one lead in one chamber of the heart.
- A "dual-chamber" pacing system has leads in both chambers. It senses and paces in both chambers and can mimic what a normal heart does.
Your healthcare provider will clean and numb the site where the pacemaker will be implanted. Then, the doctor will make a small pocket under the skin for the pulse generator and will place the lead or leads.
For most patients, the leads are placed inside the heart. The doctor opens a vein, usually through a small cut near your collarbone. The doctor can then thread the lead through the vein and position it inside your ventricle, the lower chamber of the heart. The tip of the lead rests against the inner heart wall.
If your heart condition requires pacing in two-chambers, another lead is positioned in the upper right chamber (atrium) of your heart. This dual-chamber lead system allows the pulse generator to watch and treat the areas of heart that your doctor has determined need monitoring.
After the leads are in position, they are tested to make sure they sense your heart signals clearly. The leads are then stitched to nearby tissue so that they won't move. Finally, the leads are connected to the pulse generator.
Once the pacing system is in place, it is tested to make sure it is working correctly. You may feel your heart beat faster during these tests.
When the testing is finished, your doctor will close the pocket that holds the pulse generator. You may experience some discomfort from the incision as you recover from the surgery.
Abdominal pacemaker systems
Some patients have the pacemaker implanted in the abdomen. This type of surgery is less common in adults but more common in children or other patients whose body structure makes an implant near the collarbone difficult.
Other patients have the pacemaker leads attached to the outside of the heart. Patients are asleep for such a procedure. How and where to implant your pacemaker system is determined by your doctor based on your individual needs.
What Happens Next
The procedure to implant the pacemaker usually takes about an hour. In most hospitals the doctor talks to the family right after the implant—usually to answer questions and to report how the procedure went. The doctor may also see you in the recovery room, although you may be too groggy to talk very long. You might even forget talking to the doctor.
It's a good idea for a couple of family members or friends to be at the hospital. They can talk to the healthcare provider after the procedure. They can then fill you in on the details when you are more alert and help you gather questions for the next time the healthcare provider sees you.
After the operation, you may be in the hospital for the first day or two. This allows the healthcare providers to watch and record your heart rhythm with an ECG machine. When you are ready, you will be allowed to return home.
Follow the instructions given by your healthcare provider for care of your implant site. This may include keeping the arm on the side of the implant site down, perhaps in a sling. You will return to the clinic in a week to 10 days to check the implant site.
If any of the following are experienced, it is very important to call the healthcare provider.
- Bleeding at the insertion site
- Increased pain
- Any complaint of chest pain
- Shortness of breath
- Feeling cold, have swelling, or numbness on the arm or leg of the insertion site
- The bruising or lump at the insertion site gets larger
- Fever over 100° F
- Return of arrhythmia symptoms
Be sure to talk with your healthcare provider so that you thoroughly understand all of the risks and benefits associated with the implantation of this system. As you recover from your implant surgery, you will find that your device may allow you to return to your normal activities.