Pacemaker Implantation

Your Care Explained > Tests and Procedures : Pacemaker Implantation

Over 3 million American women are living healthy, happy lives with pacemakers installed.

Why? When heart damage or abnormalities are affecting your heart’s electrical system, the heart may be beating too slowly to meet the normal demands of the body. An electronic pacemaker can stimulate your heart to increase its rate to meet your body’s needs. It is usually implanted in a relatively simple outpatient procedure.

What to Expect:

  • This may be an outpatient procedure.
  • You will be awake, but sedated.
  • Your heart and pacemaker will be monitored after.
  • Someone else will have to take you home.
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Listen and Learn:

Detailed information on Pacemaker Implantation, including the reasons and preparation for the procedure, how the procedure is performed, and after care. (MP3 Audio File) >

A decade ago, women were less likely than men to receive state-of-the-art pacemakers. However, more recent studies indicate the gap is closing, especially at hospitals like Brigham and Women’s where cardiologists are aware that women can get comparable benefits without increased risk.

Preparing for Pacemaker Implantation

A few days before your pacemaker is installed you’ll meet with your physician to discuss your procedure. He or she will explain how your pacemaker works and how it will be implanted. You’ll be able to ask any questions that you might have about the procedure. It’s a good idea to write them down in advance, since it’s sometimes hard to remember everything you wanted to ask when you’re in the office.

You’ll be asked to sign a form acknowledging that you understand the procedure and granting your permission to have it done. Read it carefully and ask questions if something isn’t clear.

Let your doctor know what medications—including over-the-counter drugs and herbal remedies—you’re taking, as well as any substances you’re allergic to. If you’re pregnant or have heart valve disease, it’s important to let your doctor know.

You’ll probably have a blood test to determine how fast your blood clots.

If your insertion is to be done on an outpatient basis, you’ll need to arrange for someone to drive you home. When you arrive for your procedure, you will be given an ID bracelet to wear. You will be asked to remove your clothing and any jewelry that may interfere with the procedure, and will be given a gown to wear. You’ll have a chance to empty your bladder before the procedure.

During the Procedure

An intravenous (IV) line will be started in your hand or arm prior to the procedure for injection of medication and to administer IV fluids, if needed. You will be helped to a padded table and positioned on your back. You will be connected to an electrocardiogram (ECG or EKG), which will monitor your heart during the procedure. Other vital signs—heart rate, blood pressure, breathing rate and oxygenation level—will be monitored as well. Large electrode pads will be placed on your chest and upper back. A nurse will cleanse the area around your collarbone with antiseptic soap, and then drape sterile towels and a sheet around this area.

You will receive a sedative medication in your IV before the procedure to help you relax. However, you will likely remain awake while the pacemaker is inserted.

A local anesthetic will be injected into the skin at the insertion site. Once it has taken effect, the doctor will make a small incision under your collarbone either on the right or left side of your chest. Depending on the type of pacemaker system you need, either one or two leads will be placed through a large vein under your collarbone and threaded down the inside of your heart. The physician implanting your device uses fluoroscopy—an x-ray “movie”—to position the leads inside your heart. The leads will be attached to the inner surface of the heart muscle. After the leads are secure, electrical measurements will be performed to ensure that they are in the right place and are properly fixed.

The physician will then create a small pocket or space to fit the pulse generator under the skin of your chest. He or she will plug the lead(s) into the pulse generator and will place it in the pocket. The incisions will be closed and a dressing placed over the operative site to keep it clean. As with most surgical procedures, antibiotics are generally given before and after your pacemaker implantation to decrease the likelihood of infection.

After the Procedure

After the procedure, you may be taken to the recovery room for observation or returned to your hospital room. Once your vital signs are stable, a nurse will help you up, and will check your blood pressure while you are lying in bed, sitting and standing.

Your physician will visit with you in your room while you are recovering to give you specific instructions and answer any questions you may have. He or she may prescribe pain medication if the insertion site is sore. If the procedure was performed on an outpatient basis, you may be allowed to leave after you have completed the recovery process.

Date Last Modified: January 21, 2011

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