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Why It’s Done

What is a Pacemaker?

A pacemaker is a device that sends small electrical impulses to the heart muscle to maintain a suitable heart rate or to stimulate the lower chambers of the heart (ventricles).

A pacemaker may also be used to treat fainting spells (syncope), congestive heart failure, and hypertrophic cardiomyopathy.

Types of Pacemakers

  • Single Chamber Pacemaker
  • Dual Chamber Pacemaker
  • Biventricular Pacemaker

Description

Your doctor will decide what type of pacemaker you need based on your heart condition. Your doctor also determines the minimum rate to set your pacemaker. When your heart rate drops below the set rate, the pacemaker generates an impulse that passes through the lead to the heart muscle. This causes the heart muscle to contract, creating a heartbeat.

Monitors Used During the Procedure

  • Defibrillator/Pacemaker/Cardioverter: Attached to one sticky patch placed on the center of your back and one on your chest. This allows the doctor and nurse to pace your heart rate if it is too slow, or deliver energy to your heart if the rate is too fast.
  • Electrocardiogram/EKG/ECG: Attached to several sticky electrode patches placed on your chest as well as inside your heart. Provides a picture on the monitors of the electrical impulses traveling through the heart.
  • Blood pressure monitor: Connected to a blood pressure cuff on your arm. Checks your blood pressure throughout the procedure.
  • Oximeter monitor: Attached to a small clip placed on your finger. Checks the oxygen level of your blood.
  • Fluoroscopy: A large X-ray machine will be positioned above you to help the doctors see the leads on an X-ray screen during the procedure.

FAQs

If the electrical pathway is interrupted for any reason, changes in the heart rate and rhythm occur that make a pacemaker necessary.

Before the procedure begins, a nurse will help you get ready. You will lie on a bed and the nurse will start an IV in a vein in your arm or hand.

To prevent infection and to keep the pacemaker insertion site sterile:

  • An antibiotic will be given through the IV at the beginning of the procedure
  • The left or right side of your chest will be shaved
  • A special soap will be used to cleanse the area
  • Sterile drapes are used to cover you from your neck to your feet
  • A soft strap will be placed across your waist and arms to prevent your hands from coming in contact with the sterile area

Yes. A medication will be given through your IV to relax you and make you feel drowsy, but you will not be asleep during the procedure.

A pacemaker can be implanted using the endocardial or epicardial approach.

The endocardial (transvenous) approach is the most common method. A local anesthetic is given to numb the area. An incision is made in the chest where the leads and pacemaker are inserted. The lead(s) is inserted through the incision and into a vein, then guided to the heart with the aid of the fluoroscopy machine. The lead tip attaches to the heart muscle, while the other end of the lead (attached to the pulse generator) is placed in a pocket created under the skin in the upper chest.

The epicardial approach is a less common method in adults, but more common in children. During this surgical procedure, general anesthesia is given to put you to sleep. The surgeon attaches the lead tip to the heart muscle, while the other end of the lead (attached to the pulse generator) is placed in a pocket created under the skin in the abdomen.

Although recovery with the epicardial approach is longer than that of the transvenous approach, minimally invasive techniques have enabled shorter hospital stays and quicker recovery times.

The doctor will determine which pacemaker implant method is best for you.

You will feel an initial burning or pinching sensation when the doctor injects the local numbing medication. Soon the area will become numb. You may feel a pulling sensation as the doctor makes a pocket in the tissue under your skin for the pacemaker.

When the leads are being tested, you may feel your heart rate increase or your heart beat faster. Please tell your doctor what symptoms you are feeling. You should not feel pain. If you do, tell your nurse right away.

The pacemaker implant procedure may last around 2 hours.

Yes. You will be admitted to the hospital and stay overnight after the procedure. Usually you will be able to go home the day after your pacemaker was implanted.

Risks

What are the possible risks of the procedure?

A pacemaker implant is generally a very safe procedure. However, as with any invasive procedure, there are risks.

Special precautions are taken to decrease your risks. Please discuss your specific concerns about the risks and benefits of the procedure with your doctor.

The Risks of Having a Pacemaker

All medical procedures and devices can create possible problems, and the risk of a problem with a pacemaker is low.

Before the Procedure

Taking Medication

If you take Coumadin, the results of your INR test (a blood test to evaluate the blood clotting) must be within a suitable range before the implant procedure can be performed. Usually you will be instructed to stop taking aspirin or Coumadin (warfarin) a few days before the procedure. Other blood thinners that will need to be held include dabigatran, rivaroxaban, apixaban, and edoxaban.

Your heart specialist may also ask you to stop taking other medications, such as those that control your heart rate. If you have diabetes, ask the nurse how to adjust your diabetes medications or insulin.

Do not discontinue any of your medications without first talking to your health care provider. Ask your doctor which medications you should stop taking and when to stop taking them.

How to Prepare

  • Eat a normal meal the evening before your procedure
  • Do not eat, drink, or chew anything after midnight before your procedure.
  • This includes gum, mints, water, etc.
  • If you must take medication(s), take with small sips of water
  • When brushing your teeth, do not swallow any water
  • Remove all makeup and nail polish

What to Bring

  • A family member to wait with you before the procedure
  • Comfortable, easy-to-fold clothing
  • Toiletries and any other items you would like to make your stay more comfortable. Please note, this will be kept with whoever accompanies you
  • A one-day supply of your prescribed medications
  • Do not bring any jewelry, watches, and/or valuables

After the Procedure

What to Expect After the Procedure

In your hospital room, a special monitor (telemetry monitor), will continually monitor your heart rhythm. The telemetry monitor consists of a small box connected by wires to your chest with sticky electrode patches. The box displays your heart rhythm on several monitors in the nursing unit. The nurses will be able to observe your heart rate and rhythm.

You will also have a monitor (small recorder) attached to your chest with sticky electrode patches. The holter monitor records your heart rhythm for 12 hours to ensure that the pacemaker is functioning properly.

A chest X-ray will be done after the device implant to check your lungs and the position of the device and leads. Before you are discharged, the monitor will be removed, and the results will be given to your doctor.

For your safety, a responsible adult must drive you home. Ask your doctor when you may resume driving.

Care for the Insertion Site

You may feel discomfort at the device implant site during the first 48 hours after the procedure. Call your doctor or nurse if your symptoms are prolonged or severe.

Keep the area where the device was implanted clean and dry. Do not scrub the area. Steri-strips may be covering the wound site; they may be removed 3 weeks after the date of the implant. Do not cover the wound unless you have been instructed to do so. You do not need to keep the wound covered with a bandage. Do not use creams, lotions, or ointments on the wound site.

Look at the area daily to make sure it is healing properly. Call your doctor if you notice:

  • Increased drainage, bleeding, or oozing from the insertion site
  • Increased opening of the incision where the device was implanted
  • Redness, swelling, or warmth around the device insertion site
  • Increased body temperature (greater than 101 degrees Fahrenheit)

You may take a shower 5 days after the procedure.

How the Leads Are Tested

After the leads are in place, they are tested to make sure they function properly and can increase your heart rate. This lead function test is called pacing. Small amounts of energy are delivered through the leads into the heart muscle. This energy causes the heart to contract.

Once the leads have been tested, the doctor will connect them to the pacemaker. The rate and settings of your pacemaker are determined by your doctor. After the pacemaker implant procedure, the doctor uses an external device to program final pacemaker settings.

Activity Guidelines

After the leads are in place, they are tested to make sure they function properly and can increase your heart rate. This lead function test is called pacing. Small amounts of energy are delivered through the leads into the heart muscle. This energy causes the heart to contract.

Once the leads have been tested, the doctor will connect them to the pacemaker. The rate and settings of your pacemaker are determined by your doctor. After the pacemaker implant procedure, the doctor uses an external device to program final pacemaker settings.

For the first week after your procedure:

  • You may move your arms normally and do not have to restrict arm motion during normal activities. However, do not hold your arms above shoulder level for more than several minutes at a time
  • Stop any activity before you become over-tired
  • Try to walk as much as possible for exercise
  • Do not drive for at least one week after your procedure

For the first two weeks after your procedure:

  • Do not lift objects that weigh more than 10 pounds for 2 weeks after the procedure
  • Avoid activities that require pushing or pulling heavy objects
  • Avoid golfing, swimming, tennis, and bowling

Your doctor will tell you when:

  • You can resume driving
  • You can resume more strenuous activities or heavy lifting
  • You can go back to work

Follow Up

A follow-up device check appointment will be scheduled 2-4 weeks after the implant procedure.

This first follow-up appointment is critical. Adjustments will be made that will help your device last longer.

About the Device

Device Checks

If you have a single or dual chamber pacemaker:

  • After your first follow-up appointment, your pacemaker should be checked every 3 months from home
  • Please make sure that you are set up with a remote monitoring transmitter at the time of your first follow-up for a device check
  • You will receive instructions on how to use remote monitoring during the your first follow-up appointment

Call your healthcare provider if you have any of these signs of infection:

  • Increased drainage, bleeding, or oozing from the insertion site
  • Increased opening of the incision where the device was implanted
  • Redness, swelling, or warmth around the device insertion site
  • Increased body temperature (greater than 101 degrees Fahrenheit)

The following symptoms may be related to your device:

  • Dizziness
  • Palpitations
  • Fast or slow heart rates
  • Lose or nearly lose consciousness before receiving therapy from the device
  • Have numbness or tingling of the arm closest to the device

If you have a telephone transmitter please call the transmitter line 8 a.m. – 5 p.m., Monday through Friday to check your device.

If you have a remote monitor please call the clinic between the hours of 8 a.m. – 5 p.m., Monday through Friday and we will instruct you to sent us a transmission.

What to Do With Your Device If You Need Surgery?

Your cardiologist will tell you if programming changes are needed before or after your surgery.

Your pacemaker should be checked within 3 months before your surgery; please schedule an appointment with your cardiologist.

If you have an ICD, the shock therapies will need to be programmed off during surgery. Please contact your doctor’s office so they can make arrangements for this.

How Long Your Device Will Last?

Depending on how often they are used, pacemakers usually last 8-10 years.

Living With the Device

Depending on how often they are used, pacemakers usually last 8-10 years.

Cell Phones

While your cell phone may not affect your pacemaker, to be safe, use your cell phone on the side opposite of where the device was implanted. Cell phones should not be placed directly against the chest or on the same side as your device.

Headphones

Certain types of headphones may contain a magnetic part that can affect pacemaker function. Keep headphones 1-2 inches away from your pacemaker. Do not keep your headphones in the breast pocket of a shirt or drape them around your neck.

Security Devices

If you must pass through entrances where anti-theft devices or metal detectors are being used for security, be sure to walk quickly through them. If hand-held metal detector scanning is necessary, tell the security personnel that you have a pacemaker. You should not hold the metal detector near the device for any length of time.

Powerful Magnets, Magnetic Fields, and Equipment

You will need to avoid strong electric or magnetic fields, such as:

  • Some industrial equipment
  • Ham radios
  • High intensity radiowaves
  • Arc resistance welders.

In strong magnetic fields, the device stops monitoring your heart rhythm. Once you are out of these fields, normal device function resumes and there is no damage to the device.

Magnetic Resonance Imaging (MRI)

Some devices are compatible with MRIs. If you have been instructed to have an MRI, contact your implanting physician about the type of device that you have implanted and if this type of testing is safe for you.

Hybrid Cars

Stay about 2 feet away from the engine and do not keep your smart key near your device. Do not put it in a pocket that is over your device.

We know these are very conservative recommendations and there have been no reports of adverse outcomes due to exposure to either of these environments. However, this information has been recommended by current sources and is the best information we have at this time.

If you have any questions about the use of equipment around your device, check your device manufacturer website and ask your doctor or nurse.

Electric Fence for Pets

Stay at least a foot away.

We know these are very conservative recommendations and there have been no reports of adverse outcomes due to exposure to either of these environments. However, this information has been recommended by current sources and is the best information we have at this time.

If you have any questions about the use of equipment around your device, check your device manufacturer website and ask your doctor or nurse.

Carry an ID Card

You will receive a temporary ID card that tells you what type of device and leads you have, the device manufacturer, the date of the device implant, and the name of the doctor who implanted the pacemaker.

Within three months you will receive a permanent ID card from the device company. It is important to carry this card at all times in case you need medical attention or to tell people you have a pacemaker.

Let your healthcare providers know you have an implanted device. In rare occasions they may want to adjust your treatment plan because you have a pacemaker or defibrillator.

Airport Security

For patients who travel outside of Houston, our cardiology specialists recommend taking a few precautions. Should the security personnel use a wand to clear people, show them your card, and ask them to avoid placing the wand over your implanted heart device. Ask security if there is another method for clearance.