DISCLAIMER: All information contained on these pages is intended for Canadian residents only and is NOT intended as specific medical advice for any individual with a medical condition similar to that described herein.
The usual reason for needing a permanent pacemaker is because the heart is beating too slowly to meet the body's needs and the low heart rate is either causing symptoms or putting you at risk of serious injury or harm. The medical term for slow heart beating is "bradycardia". Bradycardia can cause symptoms such as dizziness, fatigue, or fainting spells.
What are the parts of a pacemaker system?
When a person receives a pacemaker, two basic parts are inserted: (1) the pacemaker generator, and (2) one or more pacemaker wires (leads). The pacemaker generator is often called the "pacemaker battery". In reality, a generator contains not only the battery but all the important wiring and circuitry that make the pacemaker work properly. Modern pacemaker generators are like miniature computers. Pacemaker generators send out very small sparks of electricity to make the heart beat but these sparks must be delivered to the heart muscle. To do this, pacemaker leads are inserted through the veins and the tips of the leads are attached to the heart. The other end is then hooked into the generator so that the electrical sparks can be sent down the pacemaker lead and cause the heart to beat.
What is done in preparation for a pacemaker implantation?
The first step in implanting a pacemaker is for doctors to establish that a pacemaker is needed. Once this decision is made and the date booked, you will be notified of the date and time. Pacemaker implantation is a small operation that can be done without general anesthetic in most cases. Some centres in Canada routinely discharge patients home the same day; others prefer to keep patients overnight.
In preparation for the operation, you will be given basic instruction by hospital staff. Usually, you will be asked not to eat or drink anything the morning of the operation. Someone else should drive you to the hospital and take you home afterwards. Certain medications (like blood thinners and diabetic pills) may need to be held in advance of your procedure. You will get specific instructions that are right for you.
What is done in a pacemaker implant procedure?
At the proper time, you will be taken to the procedure room or operating room and transferred from the stretcher to the operating table. The shoulder will be exposed by lowering the hospital gown and nurses or doctors who are wearing masks and gowns will clean the skin near the shoulder with an iodine or alcohol solution. The area will be covered by a sterile drape to keep the area clean during the operation. You will be given drugs through the intravenous to help you relax, sleep and lessen any pain that you may feel during the operation.
The doctor will then inject anesthetic drugs to "numb" or "freeze" the skin where the pacemaker will be implanted. Just like dental freezing, the anesthetic stings or burns as it is injected but works quickly to numb the whole area so that you should feel minimal or no pain during the rest of the operation.
Once the skin area is numb, the doctor will make a 1-2 inch incision in the skin and make a pocket under the skin for the generator. The doctor will also use a needle to find the vein under the collarbone. One or more pacemaker leads will be inserted down the vein and guided by X-rays into the right places in the heart. These leads will be hooked or screwed into the muscle to minimize the chances they will fall out of place. The nursing or technologist staff will then take measurements from the leads to make sure the pacing leads will work well when needed. The doctor will then tie the lead down and plug the other end into the generator. The generator is placed in the pocket and the incision sewn up. The sutures used will dissolve on their own and will not need to be removed. A dressing is placed over the wound to protect it while it is healing and will need to stay in place for a few days. The procedure is now finished.
You will be helped off the table and taken to a recovery area for a brief rest or taken directly to the X-ray department to have a chest X-ray. A nurse, doctor, or technologist will check your pacemaker over and program it to the right settings for you. You will be given a return appointment. Like dental freezing, the numbness over the area where the pacemaker was implanted will gradually wear off after 4-5 hours. Nursing staff will instruct you as to what you may take for the pain before you leave the hospital and instructions regarding medications you may have been taking before your operation.
A pacemaker implant procedure
What are the risks associated with pacemaker implantation?
As with every operation, there are risks associated pacemaker implantation.
During the procedure, there is a small chance that you could have an allergic or other adverse reaction to the medications that are given. Your doctor and nurses will be watching carefully for this and are prepared to deal with this if it happens. The implant procedure itself may be complicated by bleeding, infection, leakage of air from the lung into the chest cavity, dislodgment of the lead(s) or the creation of a hole in the heart. Generally, the risks are low and pacemaker implantation is considered to be a minor procedure.
After implant, there is a chance that the pacemaker components may perform less well than expected. This could lead to a recommendation to replace the pacemaker, lead(s) or both. Some companies also issue advisories about certain devices after implant. If this happens, your doctor will discuss the specific implications for you.
What can I do now that I have a pacemaker?
- For the first several days, do not do anything strenuous with your arms and allow the wound to heal. Avoid lifting your arm over your head for at least several days and try not to allow anything to hit the wound area.
- You may resume normal daily activities as much as you like within limits of pain from the operation site. Ask your doctors about whether you can resume driving because there are usually restrictions about when you may resume driving.
- You may take a bath as soon as you return home but try not to get the dressing wet or rub the area. Taking a shower is possible but keep your back to the shower spray so that the water does not spray onto the dressing directly.
- Take your usual medications as directed by your doctor. If you normally take blood thinner drugs (anticoagulants), please ask for instructions from the hospital doctors and follow those instructions.
How long does a pacemaker last before it needs to be replaced?
A pacemaker generator lasts, on average, 6-8 years but it all depends on how much your body needs the pacemaker to pace the heart. It also depends upon how much electricity is needed to make the heart beat each time. The more you use it and the more electricity required for each spark, the shorter time the device will last.
Why do I need to be seen in the Arrhythmia Device Clinic?
Every person who receives a pacemaker should have a regular checkup at least once a year in Pacemaker Clinic. In the Clinic, the amount of battery power remaining is measured and the functioning of the pacemaker is assessed to make sure that the settings are correct, have not inadvertently been changed and that there are no signs of trouble with the generator or leads. It also allows the staff to ask how you are feeling in order to determine whether the pacemaker settings need to be changed to better meet your needs.
How often should I be checked in the Device Clinic?
Your physician will determine how often you need to be seen in the Device Clinic. If there are any concerns, you may be asked to return to the Clinic sooner or more frequently. If you received a research pacemaker, you may be asked to return more frequently for follow-up checks. Finally, as the battery power starts to get low and time to replacing the generator draws closer, more frequent checks may be needed.
Must my pacemaker follow-up checks all be done at the centre where I was implanted?
It is often possible for pacemaker checks to be done at the Device Clinic closest or most convenient to where you live. You should discuss follow-up with your physician before you go home.