What is a pacemaker implantation?

A pacemaker implantation is a procedure in which the doctor places a pacemaker in your chest cavity.

When is it used?

This procedure is done when the rhythm of your heart is not normal, usually when it is too slow. As a result of the abnormal rhythm, your heart beats inefficiently, causing symptoms such as fatigue, shortness of breath, or passing out.

An alternative to this procedure is to take drugs to control the heart rhythm or to choose not to have treatment, recognizing the risks of your condition. You should ask your doctor about these choices.

How do I prepare for pacemaker implantation?

Plan for your care and recovery after the operation, especially if you are to have general anesthesia. Allow for time to rest and try to find people to help you with your day-to-day duties.

Follow any instructions your doctor may give you. If you are to have general anesthesia, eat a light meal, such as soup or salad, the night before the procedure. Do not eat or drink anything after midnight and the morning before the procedure. Do not even drink coffee, tea, or water.

No special preparation is needed for local anesthesia.

What happens during the procedure?

You will be given a general or local anesthetic. A general anesthetic will relax your muscles and make you feel as if you are in a deep sleep. It will prevent you from feeling pain during the operation. A local anesthetic, usually combined with mild sedatives, also will keep you from feeling pain during the operation. If you feel discomfort during the procedure, tell your doctor immediately.

The nurse will wash your upper chest and sometimes shave the area. The doctor will make a cut in the skin over the upper chest and separate the tissues to make a place for the pacemaker generator. The doctor will place a wire into a vein and guide it to the inner surface of the heart cavity. The doctor connects this wire to the pacemaker generator and places this unit beneath the skin.

What happens after the procedure?

You may stay in the hospital for 1 to 3 days, depending on your condition. You will remain in bed and your heart will be monitored. The day after the procedure you will be encouraged to walk in preparation for leaving the hospital.

Before you are discharged, your doctor may check the pacemaker with a monitoring device to have a baseline (starting point) with which to compare in follow-up. You may learn how to use a telephone transmitter to call the doctor's office and check the function of the pacemaker, or this may be done when you visit your doctor's office.

Your doctor may explain how having a pacemaker might affect your lifestyle and the expected or average time before the battery in the pacemaker may need to be replaced.

You should ask your doctor what other steps you should take and when you should come back for a checkup.

What are the benefits of this procedure?

Your heart may beat in a healthy rhythm, and you may resume a more normal lifestyle.

What are the risks associated with this procedure?

• There are some risks when you have general anesthesia. Discuss these risks with your doctor.

• A local anesthesia may not numb the area quite enough and you may feel some minor discomfort. Also, in rare cases, you may have an allergic reaction to the drug used in this type of anesthesia. Local anesthesia is considered safer than general anesthesia.

• The wire could puncture one of the lungs, the vein, or the heart cavity.

• The pacemaker is implanted because the heart rhythm is abnormal. This may be associated with other heart problems, which could worsen despite correction of the rhythm.

• Like any electrical/mechanical device, the pacemaker may need a replacement if it stops working properly.

• The pacemaker wire may become dislodged and/or break.

• There is a risk of infection and/or bleeding.

You should ask your doctor how these risks apply to you.

When should I call the doctor?

Call the doctor immediately if your pulse becomes abnormally slow, fast, or irregular, or your original symptoms return.

Call the doctor during office hours if:

• You have questions about the procedure or its result.

• You want to make another appointment.