Pacemaker Implantation

A pacemaker is a small electronic device connected to the heart. It is used to continuously monitor and help regulate irregular heart rhythms (arrhythmias). When the pacemaker senses the individual’s heartbeat is nearing a dangerously low rate, it delivers a low-energy electrical impulse. This impulse resets your rhythm back to normal.

A pacemaker is composed of two parts: A generator and tiny wires (leads). The generator is a small battery-powered unit that produces the electrical impulses once it senses an irregular heart rhythm. This generator is connected to your heart via tiny wires (leads). It is through these leads that the generator delivers the electrical impulse to your heart.

However, a pacemaker alone will not work for all types of arrhythmias. In those instances, an implantable cardioverter defibrillator (ICD) may be required instead. Most new ICDs can act as both a pacemaker and a defibrillator. For individuals that have slow heartbeats, the ICD will work as a pacemaker by sending a low-energy shock to the heart. If the ICD senses that your heartbeat is too fast or chaotic, it acts as a defibrillator by sending a high-energy electrical output to the heart.

There’s also a newer type of pacemaker, called a biventricular pacemaker. It is used in the treatment of specific types of heart failure. Sometimes in heart failure, the two lower chambers of the heart (ventricles) do not pump in a normal manner. When this happens, less blood is pumped by the heart. A biventricular pacemaker paces both ventricles at the same time, increasing the amount of blood pumped by the heart.

Do you have a question? Request more information and we will connect you with an RWJBarnabas Health cardiovascular expert.

How to Prepare for the Procedure

Before the procedure, your doctor and treatment team will explain to you what to expect before, during and after the procedure and potential risks of the procedure. Talk to your doctor about:

• All medications, herbal products and dietary supplements you are currently taking and ask for their recommendations about each.
• Diabetes and how to adjust your medicine on the day of the procedure.
• Radiation exposure, especially for those that are pregnant.
• Any allergies to medicines, latex, tape, iodine, and anesthetic agents.
• Any history of bleeding disorders.
• Any implanted device (e.g. pacemaker or ICD).
• Any body piercings on your chest or abdomen.

Other recommendations include:

• Eat a normal meal the evening before the procedure. However, do not eat, drink or chew anything after midnight before your procedure. If you must take medications, only take them with sips of water.
• Leave all jewelry at home.
• Remove all makeup and nail polish.
• Wear comfortable clothing when you come to the hospital.
• If you normally wear dentures, glasses, or hearing devices at home, plan to wear them during the procedure.

What to Expect Before the Procedure

To determine whether you need a pacemaker or not, your doctor might perform a variety of diagnostic tests, including:

• Blood tests
• Cardiac Catheterization
• Computed Tomography (CT scan) or Magnetic Resonance Imaging (MRI)
• X-Rays
• Echocardiogram (ECHO)
• Electrocardiogram (EKG/ECG)
• Electrophysiology (EP) study
• Stress Test

What to Expect During the Procedure

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Pacemaker implantation is a non-invasive procedure (no incisions required / small puncture / low to moderate sedation); however, placement of the pacemaker under the skin will require a few small incisions. The procedure itself usually takes 1 to 3 hours to complete. This procedure is usually performed in a cardiac catheterization lab. Check with your doctor about the details of your procedure. In general:

• You will change into a hospital gown.
• A nurse will start the intravenous (IV) line in your arm which will administer medications and fluids during the procedure.
• Usually, you will receive a sedative to help you relax. However, you will likely remain awake during the procedure.
• A local anesthetic will be injected into the skin at the insertion site.
• Once the anesthetic has taken effect, your doctor will make a small incision at the insertion site (usually under the collarbone).
• Through this opening, your doctor will insert a catheter (lead wire included) and advanced into the heart.
• The pacemaker generator will be slipped under the skin through the incision after the lead wire is attached to the generator. Generally, the generator will be placed on the non-dominant side. (If you are right-handed, the device will be placed in your upper left chest. If you are left-handed, the device will be placed in your upper right chest).
• Once the pacemaker is in place, your doctor will test it and program it for your heart rhythm problem. Testing the pacemaker may require speeding up your heart and then shocking it back into rhythm.
• Once the procedure is complete, the skin incision will be closed with a closure device or sutures.

What to Expect After the Procedure

After the procedure, you may be taken to the recovery room for observation or returned to your hospital room. Usually you will be able to go home the day after your pacemaker was implanted. Other recommendations include:

General Guidelines

• A nurse will monitor your vital signs, the insertion site, and circulation and sensation in the affected leg or arm.
• A chest X-ray will be done to check your lungs as well as the position of the device and lead(s).
• Tell your nurse right away if you feel any chest pain or tightness, or any other pain, as well as any feelings of warmth, bleeding, or pain at the insertion site.
• You must stay in bed for several hours as recommended by your doctor.
• Your doctor will give you instructions to follow during your recovery.

Pacemaker Programming

• The pacemaker will require regular evaluation (remotely and/or in person). Your doctor will tell you when and how this is done.

ID CARD

• You will be given an ID card that identifies you as having a pacemaker.
• Make sure to always carry this ID card with you.
• Tell all of your health care provider that you have a pacemaker.

Special Precautions: Several types of devices and machines may interfere with your pacemaker. Try to avoid them, or at least minimize your exposure to them. The American Heart Association lists the following:

• Devices that may interfere with pacemakers: Anti-Theft systems; metal detectors for security; cell phones; MP3 players/headphones; radios; magnets; power-generating equipment; among others.
• Devices that pose little to no risk: Household appliance and electronics; garage, shop and lawn equipment; office machinery and electronics; tanning beds; hot tubs; casino slot machines; massage chairs; salon-style hair dryers; among others.
• Medical procedures that may pose a risk: Extracorporeal shock-wave lithotripsy (EWSL); magnetic resonance imaging (MRI); radiofrequency ablation or microwave ablation; computed tomography (CT) scans; high-frequency, short-wave or microwave diathermy; among others.
• Medical procedures that pose limited risk: Electrocardiogram (EKG/ECG); echocardiogram (ECHO); acupuncture; ultrasounds; laser surgery; external defibrillation; Pet emission tomography (PET scans); bone density tests; among others.

Do you have a question? Request more information and we will connect you with an RWJBarnabas Health cardiovascular expert.