Pacemaker implantation

Pacemaker

A pacemaker, also called an electrical cardiac pacemaker (PM), is a small device that stimulates the heart with electrical impulses to restore or maintain a normal heartbeat. The device is implanted under the skin beneath the collarbone.
Pacemakers have different functions, and your doctor will determine which type is most suitable for you.

  • One or two electrically insulated leads (electrodes) are connected to the pacemaker and attached to the right atrium and right ventricle of the heart.
  • If needed, an additional lead may be placed into a vein on the surface of the left ventricle in patients with heart failure, helping to coordinate the work between the ventricles. This is called a biventricular pacemaker (CRT, Cardiac Resynchronization Therapy).
  • An implantable cardioverter-defibrillator (ICD, Implantable Cardioverter-Defibrillator) has, in addition to pacing, the ability to treat life-threatening arrhythmias. With an ICD, one lead is fixed in the right atrium and another in the ventricle. The ventricular lead includes a defibrillation function that can stop a dangerous arrhythmia with an electric shock.

Preparation for the Procedure

  • On the morning of the procedure, take a shower at home and take your required medications with a small amount of water.
  • Stop taking blood-thinning medications 48 hours before the procedure.
  • Do not eat or drink on the day of the procedure.
  • Upon arriving at the hospital, first check in at the registration desk. From there, you will be directed to the ward.
  • In the ward, a nurse will receive you and place an IV cannula in your arm. You will receive an antibiotic intravenously and then be transported to the operating room.
  • If you have any questions regarding the pacemaker or the procedure, you may ask the staff before or after the procedure.

If you have any allergies, inform the doctor before the procedure.

Pacemaker Implantation

The pacemaker is implanted in the operating room under local anesthesia. You will be awake but will not feel pain.

Before the procedure, ECG leads are attached to monitor your heart rhythm. The area beneath the collarbone (usually the left side) is cleaned and covered with a sterile drape. A 5-cm incision is made, and the leads are inserted into the right atrium and right ventricle through a vein located in that area, under X-ray guidance. Once the doctor confirms that the leads are correctly positioned, they are connected to the pacemaker. A “pocket” is created under the skin to hold the device, and the incision is stitched closed.

You will receive the following items after surgery:

  • a pacemaker information booklet,
  • a pacemaker identification card — a white card containing your personal and device information (carry it with you at all times),
  • in some cases, a home monitoring device that allows your doctor to follow your heart function remotely.

After the Procedure

A dressing is applied to the incision, and in some cases, a small sandbag is used to reduce the risk of bleeding.
Change the dressing at home if it becomes wet or dirty. After one week, you may remove the dressing completely.

You may shower under running water the day after the procedure. After showering, apply a fresh dressing.

Avoid lifting heavy objects and refrain from using the sauna, bath, and swimming pool during the first week.
For the first month, avoid wide-range arm movements (e.g., chopping wood).

Follow-up and Battery Life

You will be scheduled for a follow-up visit with your doctor 3–4 months after the procedure. Subsequent check-ups will take place every one to two years.

Pacemaker battery life is typically 5–12 years, depending on several factors. During doctor visits, the estimated remaining battery life is assessed — therefore, attending follow-up appointments is very important.
When the battery becomes depleted, the pacemaker will be replaced with a new one.

Possible Complications

As with any medical procedure, complications may occur. Pacemaker implantation rarely causes complications, but they may include:

  • bleeding or bruising at the incision site, especially if you use blood-thinning medication;
  • pacemaker infection, which may occur within 12 months after implantation — in such cases, the entire system must be removed;
  • displacement of the leads or detachment from the heart wall — a repeat procedure may be required;
  • damage to the lung during vein puncture, causing pneumothorax. In rare cases, a chest drain is needed, and hospitalization is required.

When to Contact Your Doctor

Contact your doctor if you experience:

  • difficulty breathing,
  • fainting or dizziness,
  • persistent hiccups,
  • redness, prolonged pain, or any change at the incision site.

Life with a Pacemaker

Your quality of life will significantly improve once your heart rhythm is normalized. You may use household appliances and smart devices, exercise, lift moderate weights, travel, perform domestic chores, and work.

Strong magnetic fields, electrical substations, or tools that produce strong vibration may interfere with pacemaker function.

If you need a magnetic resonance imaging (MRI) scan, consult your doctor beforehand.

Prepared by: Department of Cardiac Arrhythmias
2024