Pacemaker Implantation

The heart is made of muscle tissue that is stimulated to pump blood by electrical currents. The electrical stimulus causes the muscle to contract and pump blood to the rest of the body. This process is what makes the heartbeat.

A pacemaker can be implanted temporarily to treat a slow heartbeat after an event, like a heart attack, surgery, or medication overdose. Or it can be implanted permanently to correct a slow or irregular heartbeat. It can also be used to help treat heart failure.

Cardiologists implant pacemakers inside your chest just below the collarbone to help raise a slow heartbeat to a normal speed. This ensures your blood flow does not drop to a dangerously low rate.

A pacemaker comprises three parts: a pulse generator, one or more leads, and an electrode on each lead. These three parts work together to signal the heart to beat normally when it is too slow or irregular.

Why choose Presbyterian for your pacemaker implantation?

Presbyterian Heart and Vascular Care has a skilled electrophysiology team who can provide a wide range of cardiac rhythm treatments. Their electrophysiology cardiologists are trained in many different techniques and procedures, many of which can provide you with a shorter recovery period and the opportunity to recover at home.

Who is eligible for a pacemaker implantation?

You may need a pacemaker if your heart is beating too slowly. Several tests can find the cause of your irregular heartbeat. These tests include:

• Echocardiogram: A small instrument called a transducer is placed on your chest to transmit sound waves (echoes) from your heart to a machine that uses the wave patterns to compose images of your heartbeat on a monitor.


• Electrocardiogram (EKG): Sensor pads with wires attached, called electrodes, are placed on your chest to measure your heart's electrical impulses.


• Stress test: Some heart problems are only evident during exercise. For a stress test, an electrocardiogram is taken before and immediately after exercise.


• Holter monitoring: This is a portable version of an EKG. It's useful in testing rhythm changes that happen at any time of day or night. You wear the monitor, and it records your heart activity as you live your life.

What conditions can be treated with pacemaker implantation?

Some conditions that cause an abnormal heart rate include:

• Bradycardia: This is when the sinus node (SA node) in your heart causes the heart to beat too slowly.


• Tachy-brady syndrome: This is when your heart alternates between fast and slow heartbeats.


• Heart block: This happens when the electrical signal is delayed or blocked after leaving the SA node.


• Fainting spells (syncope): Syncope is a temporary loss of consciousness when there is not enough blood flow to the brain. It usually happens when blood pressure is too low (hypotension).


• Heart failure: A pacemaker for people with heart failure can pump more blood to the body and help them live longer.


• Hypertrophic cardiomyopathy: This is when the heart muscle becomes thick, making it hard for the heart to pump.

How do I prepare for a pacemaker implantation?

Before the procedure:

• Tell your doctor if you are allergic to any medications.


• You should not eat the night and morning before the procedure.


• Tell your doctor of any medications and supplements that you are taking.


• Tell your doctor if you have heart valve disease or a history of bleeding disorders or if you are taking any anticoagulant (blood-thinning) medications, aspirin, or other medications that affect blood clotting.


• Your doctor may want you to get a blood test before the procedure to determine how long it takes your blood to clot.


• You may receive a sedative before the procedure to help you relax.


• You may spend a night in the hospital after the surgery to ensure the pacemaker is working as expected.

What should I expect during my pacemaker implantation?

Pacemaker implantation follows this process:

1. The area where the pacemaker will be placed is shaved and cleaned.


2. An intravenous (IV) line will be started in your hand or arm for liquid medication to enter your bloodstream.


3. You will be connected to an electrocardiogram (EKG) monitor that records the heart's electrical activity.


4. Electrode pads will be placed on the front and back of your chest.


5. You will receive a sedative to help you relax but will likely be awake during the procedure.


6. At the incision site, a sheath 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. The lead wire is inserted through the sheath into the blood vessel and guided into the heart.


7. Once the lead wire is inside the heart, it will be tested to see if it works.


8. The pacemaker generator will be slipped under the skin through the incision after the lead wire is attached to the generator.

How do I care for myself after my pacemaker implantation?

Your doctor will you give you specific instructions, based on your situation, but should be able to return to your daily routine within a few days. Avoid 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.

You will most likely be able to eat your usual food.

It will be important to keep the site where you were operated on clean and dry. You will be given instructions about bathing and showering.

Your doctor will give you specific instructions about driving.

Ask your doctor when you can return to work. The kind of job you have and your overall health status can decide how soon you can return to work. If your job is very physical, you may have to wait longer.

Tell your doctor if you have any of the following:

• Palpitations.


• Fever and/or chills.


• Chest pain/pressure, nausea and/or vomiting, a lot of sweating, dizziness, and/or fainting.


• Increased pain, redness, swelling, or bleeding or continued drainage from the place where your pacemaker was implanted.

If you're worried about electrical interference, it is rarely a problem.

These things are unlikely to cause problems with your pacemaker: microwave ovens:

• Televisions.


• Remote controls.


• Radios, toasters.


• Electric blankets.


• Electric shavers.


• Electric drills.


• Airport security.

However, keep your pacemaker at least 6 inches (15 centimeters) away from your cellphone. And make sure all your doctors and dentists know you have a pacemaker. Certain medical procedures could interfere with your pacemaker.

It's a good idea to carry an ID card stating that you have a pacemaker in case you have a medical emergency.