Reasons for Procedure

Possible Complications

What to Expect

Call Your Doctor

En Español

Pacemaker Insertion

by Editorial Staff and Contributors

The Pacemaker Implant Procedure

Definition TOP

This is a procedure to insert an artificial pacemaker. A pacemaker is a small, battery-operated device. It helps maintain a normal heartbeat by sending electrical impulses to the heart.

Pacemaker Insertion

Reasons for Procedure TOP

A pacemaker can be inserted when:

The body's natural pacemaker, the sinoatrial (SA) node, is not working properly—this can cause the heart to beat too slowly
There are malfunctions in the atrioventricular (AV) node, which is the part of the heart’s electrical system that sends signals from the SA node to the ventricles—this leads to a slow heartbeat
Heart performance in people with severe symptoms of congestive heart failure and a weakened heart muscle, known as cardiomyopathy, needs to be improved—his is called biventricular pacing, or cardiac resynchronization therapy
Cardiac surgery is being done

Possible Complications TOP

Complications are rare, but no procedure is completely free of risk. If you are planning to have a pacemaker inserted, your doctor will review a list of possible complications, which may include:

Excess bleeding
Infection
Pacemaker malfunction
Inappropriate stimulation of the diaphragm, which is the large muscle between chest and abdominal cavities
Rupture in the heart muscle—rare

Factors that may increase the risk of complications include:

Obesity
History of smoking
History of excess alcohol consumption
Bleeding or blood-clotting irregularities
Regular use of some medications
Chronic disease

Be sure to discuss these risks with your doctor before the procedure.

What to Expect TOP

Prior to Procedure

Before the procedure, your doctor will likely do:

Blood tests
Chest x-rays—to look at the heart's structure
Electrocardiogram (EKG)— to record the heart's activity

In the days leading up to the procedure:

Talk to your doctor about your medications. You may be asked to stop taking some medications up to 1 week before the procedure.
Eat a light meal the night before the procedure. Do not eat or drink anything after midnight.

Anesthesia

Local anesthesia will be used. This means that only the area being operated on is numbed. It is given as an injection.

Description of the Procedure TOP

You will lie flat on a table. Your heart rate, blood pressure, and breathing will be monitored. A small incision will be made beneath your collarbone. The pacemaker will be inserted through this incision. The wires will be threaded through a vein under the collarbone to your heart. Lastly, the incision will be closed with stitches.

Immediately After Procedure TOP

Your heart rate and blood pressure will be monitored.

How Long Will It Take? TOP

About 2 hours

How Much Will It Hurt? TOP

You will have pain after the procedure. You will be given pain medication.

Post-procedure Care TOP

Before you leave the care center, the pacemaker will be programmed to fit your pacing needs. When you return home, do the following to help ensure a smooth recovery:

Avoid strenuous activity, especially involving the upper body, for 4-6 weeks.
Avoid excessive movement of the arm/shoulder on the side of the pacemaker for 2 weeks. This will help you to avoid dislodging the leads. You may be given a sling to wear to help remind you.
Now that you have a pacemaker, you may need to avoid:
- MRI scans
- Heat therapy—often used in physical therapy
- High-voltage or radar machinery such as electric arc welders, high-tension wires, radar installations, or smelting furnaces
- Contact with radio or television transmitters
Do not carry a cell phone in a pocket directly over the device. Keep the phone on the side away from the device. Headphones worn with MP3 players may also cause interference.
Turn off car or boat motors when working on them. They may confuse your device.
Tell your doctors and dentist that you have a pacemaker.
Check with your doctor about the safety of going through airport security detectors with your device.
Be sure to follow your doctor's instructions.

A hard ridge may form on the skin along the incision. This usually recedes as the wound heals.

Call Your Doctor TOP

After arriving home, contact your doctor if any of the following occurs:

Signs of infection, including fever and chills
Redness, swelling, increasing pain, excessive bleeding, or any discharge from the incision site
Pain that you cannot control with the medicines you have been given
Cough, shortness of breath, or chest pain
Heartbeat irregularities
New symptoms

In case of an emergency, call for emergency medical services right away.

RESOURCES:

American Heart Association
http://www.heart.org

Heart Rhythm Society
http://www.hrsonline.org

CANADIAN RESOURCES:

Health Canada
http://www.hc-sc.gc.ca

Heart and Stroke Foundation of Canada
http://www.heartandstroke.com

References:

ACC/AHA Guideline Update for Implantation of Cardiac Pacemakers and Antiarrhythmic Devices. American Heart Association website. Available at:
...(Click grey area to select URL)
Accessed June 13, 2016.

Heart Failure Society of America. HFSA 2006 Comprehensive Heart Failure Practice Guideline. J Card Fail. 2006;12:e1-2.

What is a pacemaker? American Heart Association website. Available at:
...(Click grey area to select URL)
Published 2015. Accessed June 13, 2016.

11/19/2008 DynaMed's Systematic Literature Surveillance
...(Click grey area to select URL)
Lee S, Ransford B, et al. Abstract 662: electromagnetic interference (EMI) of implanted cardiac devices by MP3 player headphones. Circulation. 2008;118:S596.

Last reviewed June 2016 by Michael J. Fucci, DO
Last Updated: 5/11/2013

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