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Pacemaker Implantation

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Pacemaker Implantation at EHMC's Arrhythmia Center

What is a pacemaker?

EHMC's Arrhythmia Center offers pacemakers for patients whose hearts are beating too slowly. These devices are used to take over the role of the heart's natural pacemaker or its electrical hub when either part fails to function correctly. A pacemaker consists of two main parts:

  • A pulse generator, about the size of two silver dollars stacked, which contains a small computer, electronic circuitry, and a battery. They are battery-powered, and most use lithium batteries that last for 5 to 10 years. When the battery runs out, the entire generator is replaced. The generator is responsible for generating the electric impulses that correct the slow heartbeat. This unit is usually implanted under the skin in the upper chest. The memory in the generator stores vital information about how the pacemaker has worked in regulating your heart rhythm. This information is periodically retrieved, non-invasively, and analyzed to determine if your pacemaker is working properly or if it needs to be reprogrammed.
  • One, two or three pacing leads, which carry electrical impulses from the generator to your heart to maintain the proper heart rate. Single-chamber pacemakers have one lead that is inserted into either the right atrium or right ventricle. Dual-chamber pacemakers have two leads, one inserted into the right atrium and one into the right ventricle. Resynchronization (Biventircular) pacemakers, used for patients with heart failure, have three leads, one inserted into the right atrium, one into the right ventricle, and one overlying the left ventricle. Your doctor will discuss which type is right for you.

How does a pacemaker work?

When your heart beats too slowly, the leads from the pacemaker sense this and send signals from the heart to the pulse generator. Upon receiving these signals, the generator sends electrical impulses through the leads into the heart to stimulate it so it will beat at the proper rate.

How is a pacemaker implanted?

Pacemakers are implanted in the Cardiac Electrophysiology Laboratory on the 1st Floor of EHMC, using local anesthesia and sedation. This approach obviates the need for surgical procedures in the operating room that require general anesthesia. (Open-chest surgery may be used to implant pacemakers in patients who are having another type of heart surgery, such as bypass surgery.) The Arrhythmia Center assumes full responsibility for preparation, implantation, discharge planning, and long-term follow-up of all implanted devices.

[SUGGESTED GRAPHIC: ILLUSTRATION OF PACEMAKER IMPLANTED IN CHEST WITH LEADS IN HEART]

Before Your Procedure

Pacemaker implantation, including preparation and recovery time, may take several hours. Be sure to plan accordingly and to bring a care partner with you to the hospital.

  1. You will undergo Pre-Admission Testing several days to a week before the procedure. This testing will include blood tests, and a medical history assessment. You will also be asked to sign a form giving EHMC consent to perform the procedure.
  2. Do not eat or drink anything after midnight the night before your procedure. You may be permitted to take your regular medications with a sip of water; check with your doctor.
  3. On the day of your procedure, report to the Admitting Department on the first floor of EHMC at the scheduled time.
  4. The Admitting Clerk will direct you to the Cardiac Electrophysiology Laboratory on the 1st Floor of EHMC when the team is ready to perform your procedure.

During the Procedure

  1.  When you arrive at the Cardiac Electrophysiology Laboratory, you will be assisted to a special x-ray table and attached to a heart monitor and blood pressure cuff.
  2. You will receive an intravenous sedative to make you feel drowsy and relaxed during the procedure. A local anesthetic will be injected into the area where the generator will be implanted.
  3. Your doctor will make a small incision, most often in the upper chest and create a pocket under your skin in which to insert the generator of the pacemaker.
  4. He will then insert the pacemaker leads into a vein through this incision. Guided by an x-ray camera, your doctor will pass the leads through the vein and position them into the appropriate area of your heart.
  5. After testing the leads to ensure that they can sense the heart's signals clearly, your doctor will attach them to the pulse generator.
  6. The pulse generator is programmed to treat your particular arrhythmia, and is then inserted into the pocket of skin in your chest or abdomen. After ensuring that the device works correctly, your doctor will close the incision and cover it with a sterile dressing.
  7. When the procedure is over, you will be brought on a stretcher to a room in EHMC to recover.

After the Procedure

  1. Once in your room, the staff will monitor you closely, taking your blood pressure, pulse, and temperature frequently and checking your incision for bleeding or swelling. Your care partner should stay with you in the room.
  2. You will be able to eat once you awaken fully from the sedation.
  3. Keep the arm on the side of the incision close to your body. Avoid excessive movement, pulling, or straining.
  4. Do not try to get out of bed alone; a staff member will help you get out of bed for the first time after your procedure.
  5. If you feel palpitations, chest pain, or any unusual sensations, tell your nurse immediately.
  6. You will stay at least one night in the hospital so we can monitor you after your pacemaker implantation.

Going Home

  1. Your doctors will meet with you before your discharge and discuss the results of your pacemaker implantation. Our nurse practitioner, Aileen Ferrick, will meet with you after the procedure to provide you with specific discharge instructions. She is also available before the procedure, and can be reached by calling 201-894-3533.
  2. To care for your incision, keep the protective Steri-Strips dry and open to air, allowing them to fall off on their own over the next couple of weeks. You may shower, but do not bathe or swim. Lightly pat the strips dry after showering.
  3. The incision will usually heal over the next two weeks. The sutures will dissolve on their own and do not need to be removed.
  4. If your incision bleeds or develops signs of infection (swelling, increased pain, redness, drainage, increased temperature, or opening), call us at 201-894-3533, 24 hours a day to speak with a physician.
  5. You can usually resume your normal activities the following day, or as directed by your doctor. Avoid lifting or straining, heavy housework, sports, or exercise for the next two weeks. Between two and six weeks, avoid any exercise or repetitive movements that place significant strain on the affected side (such as swimming, golf, or tennis).
  6. Be sure to schedule a follow-up appointment with us for two weeks after the procedure. She can be reached at 201-894-3533.
  7. You will need to see us every 3-6 months at the Arrhythmia Center's offices, or contact us by telephone, so the data stored in your pacemaker can be retrieved and analyzed. For more information, visit the section on Follow-up Programs on this site.