Definition: A pacemaker is a small, battery-operated device that senses when your heart is beating irregularly or too slowly. It sends a signal to your heart that keeps your heart beating above a programmed rate.
Cardiac pacemaker implantation; Artificial pacemaker; Permanent pacemaker; Internal pacemaker; Cardiac resynchronization therapy; CRT; Biventricular pacemaker
Newer pacemakers weigh as little as 1 ounce. A pacemaker usually has 2 parts:
- The generator contains the battery and the computer to control the heartbeat.
- The leads are wires that connect the heart to the generator and carry the electrical signals to the heart.
A pacemaker can usually sense if the heartbeat is above a certain rate. When it is above that rate, the pacemaker will stop sending signals to the heart. The pacemaker can also sense when the heartbeat slows down too much. It will automatically kick in and start pacing the heartbeat again.
A pacemaker must be implanted under the skin. This procedure usually takes about 1 hour. You will be given a sedative to help you relax. You will be awake during the procedure.
Following use of a local anesthesia, a small incision (cut) is made, usually on the left side of the chest below your collarbone. The pacemaker generator is then placed under the skin at this location.
Using live x-rays to see the area, the doctor puts the leads through the incision, into a vein, and then into the heart. The leads are connected to the generator. The skin is closed with stitches. Most patients go home within 1 day of the procedure.
Two other kinds of pacemakers - transcutaneous and transvenous pacemakers - are used only in medical emergencies. They are not permanent pacemakers.
Why the Procedure Is Performed
Pacemakers may be used for people who have heart problems that cause their heart to beat too slowly. A slow heartbeat is called bradycardia. Two common problems that cause a slow heartbeat are sinus node disease and heart block.
When your heart beats too slowly, your body and brain may not get enough oxygen. Symptoms may be lightheadedness, tiredness, fainting spells, and shortness of breath.
Some, pacemakers can be used to stop a heart rate that is too fast (tachycardia) or that is irregular.
Other types of pacemakers can be used in severe heart failure. These are called biventricular pacemakers. They match up the beating of both sides of the heart.
Most biventricular pacemakers implanted today can also work as implantable cardio-defibrillators (ICD), which restore a normal heartbeat.
Possible complications of pacemaker surgery are:
- Abnormal heart rhythms
- Bleeding from the pacemaker site.
- Punctured lung. This is rare.
- Puncture of the heart, which can lead to bleeding around the heart. This is rare.
Before the Procedure
Always tell your doctor or nurse what drugs you are taking, even drugs or herbs you bought without a prescription.
The day before your surgery:
- Shower and shampoo well.
- You may be asked to wash your whole body below your neck with a special soap.
On the day of the surgery:
- You may be asked not to drink or eat anything after midnight the night before your procedure. This includes chewing gum and breath mints. Rinse your mouth with water if it feels dry, but be careful not to swallow.
- Take your drugs your doctor told you to take with a small sip of water.
Your doctor or nurse will tell you when to arrive at the hospital.
After the Procedure
You will probably be able to go home after 1 day. You should be able to return to your normal activity level quickly.
Talk with your doctor about how much you can use the arm on the side of your body where the pacemaker was placed. You may be advised not to lift anything heavier than 10 - 15 pounds and to avoid a lot of pushing, pulling, or twisting your arm for 2 - 3 weeks. You may also be told not to raise your arm above your shoulder for 6 weeks.
When you leave the hospital, you will be given a card to keep in your wallet. This card lists the details of your pacemaker and has contact information for emergencies. You should always carry this wallet card with you
Implantable Cardioverter Defibrillator (ICD)
The ICD is implanted in the catheterization laboratory. Sedation is given through an intravenous line and sometimes the cardiologist will choose to have anesthesia put you to sleep during the procedure; if not, the nurses will provide sedation. The chest wall is numbed with a local anesthetic. A wire is threaded into a vein that leads to the heart and one, two, or three wires will be implanted. These wires are connected to a generator, which is implanted under the skin to the upper chest wall. The device is tested during the procedure and then the incision is closed with suture/staples. You will be taken to the recovery room and once you are awake you will be taken to a room where you will be monitored overnight.
- Why you are having this procedure (symptoms/indications): ICDs are offered to patient who have documented lethal arrhythmias or of those who are high risk for the development of arrhythmias. Some ICDs can possibly improve symptoms of shortness of breath.
- Prep for the procedure: Nothing to eat or drink after midnight. Notify nursing staff of all allergies and current medications.
- Risks: Infection, bleeding, pneumothorax (collapsed lung), swelling at site, bruising, reaction to medication given for sedation, and blood vessel or nerve damage, and perforation of wall of heart that could result in destruction of tamponade, and death.
- Post procedure instructions/limitations: You will wear a sling and need to wear this for three to four weeks. It is important not to lift your arm above shoulder height. It is best to take sponge baths for the first couple weeks so the dressing will remain dry. No driving for three to four weeks. Resume your medications as your cardiologist instructs. The patient will not have to perform any dressing changes.