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Pacemaker Implantation

A pacemaker is an electrically charged device implanted under the skin to continuously monitor the heart rhythm and prevents it from beating too slowly. Pacemakers have two parts:

1. The pulse generator that contains the battery and the electronics that control your heartbeat.

2. The other part is one or more small wires which send electrical signals to the heart.

Pacemakers can treat two types of irregular heart rhythms (arrhythmias):

• Tachycardia (too fast heartbeat)

• Bradycardia (too slow heartbeat)

Patients who have severe heart failure may need a special type of pacemaker called a biventricular pacemaker or biven that makes the two sides of the heart beat in sync. This is known as cardiac resynchronization therapy (CRT).

Patient will undergo several tests before receiving a pacemaker such as echocardiogram, electrocardiogram, Hotler monitoring, stress tests to check heart rate while exercising. Doctor may suggest the right pacemaker based on the conditions and severity of the heart problem.

Before performing the surgery doctor may give a complete instruction to patient to prepare him or her for the surgery that may include:

• Don’t drink or eat anything after midnight the night before the surgery.

• Medications

• Tests

• Shower, shampoo, lotion to reduce the chances of developing any infection.

Pacemaker implantation surgery is performed mostly with conscious sedation using local anesthesia to numb the area of any incision along with additional IV medication to keep the patient relaxed in the arm at the same side as the pacemaker. Diabetic patient should talk to the cardiologist about their food and medication intake at the time of the procedure to preserve their blood sugar level. Blood thinning medications and some other medications may need to be ceased prior to the procedure. Surgery is done in a room with special x-ray equipment.

Surgeon will make a small incision near the patient’s shoulder and insert one or more flexible, insulated wires (electrodes) into a major vein near collarbone and guided to the heart with the help of X-ray images. With the help of wire, surgeon will attach an electrode to the patient’s right ventricle of the heart. The other end of the wire attaches to a pulse generator which contains the battery and electrical circuits. If the patient is required a biventricular pacemaker then surgeon will attach a second lead to the heart’s right atrium (upper chamber of the heart). Surgeon will then close the incision with sutures and apply a dressing to the skin over the wound. Generally new pacemaker implants require one night’s stay in hospital and the pacemaker is checked by a technician the next day prior to discharge. Simple generator replacements may be done as a day case.

There can be some risk or complications associated with pacemaker implantation:

1. Reaction to anesthesia

2. Abnormal bleeding

3. Bruising

4. Damaged nerves

5. Damaged blood vessels

6. Infection

7. A collapsed lung or punctured heart (in rare cases)

Patient should avoid heavy exercise and lifting and need to take over the counter medications for any discomfort as suggested by the doctor. Some pacemakers can cause interference with electrical devices, so patient should avoid keeping mobile or music player in the pocket near the pacemaker, should avoid standing for too long near the electrical appliances that emit radio waves like microwave, exposures to metal detectors for longer time, high voltage transformers.

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