How do I prepare to have a pacemaker implanted?
Tell your healthcare provider all the medications you are currently taking. If you take a blood thinner, such as aspirin, warfarin (Coumadin), or clopidogrel (Plavix) you may be asked to stop taking it or to reduce your dosage before the procedure. You are not allowed to eat or drink after midnight the night before surgery.
What does implanting a pacemaker entail?
You will be awake during the procedure, but you will be given a sedative to help you relax and local anesthesia to numb the pain of the surgery. The sedative will be given through an intravenous (IV) line. You may feel the needle prick when the IV line is inserted into your arm. The surgical site near the left breast will be shaved if necessary and an antibacterial solution will be applied to the chest.
You will be hooked up to an electrocardiogram ( ECG) so that your heart rate and blood pressure can be monitored. For this, small sticky patches with wires attached will be taped to your body.
The surgeon will make a small incision into your skin. A tube called a catheter will be inserted into one of your veins, usually the large vein under your collarbone(the subclavian vein). Then the surgeon will insert the pacemaker wires into your heart through the vein. Once in place, the wires are tested to make sure that they work and are in the correct spot. This is known as " pacing" and it causes the heart to contract. You may feel like your heart is racing or beating faster. It's important to tell your doctor or nurse any symptoms you feel, especially if you feel pain. Through the same incision, the surgeon creates a small pocket that the pacemaker generator will be inserted into. Next, the pacemaker is attached to the lead wires and inserted into the pocket, and the incision is closed. An X-ray will be taken after insertion to confirm correct placement of the pacemaker. Your doctor will use a magnetic wand called a “programmer” to make the final pacemaker settings. The procedure takes about 1 to 2 hours.
What happens after the procedure?
You will rest in bed until the sedative has worn off completely. When you are fully awake, you will be allowed to eat and drink. The incision site may be sore and you can take pain medication if needed.
Depending on your age and overall health, a short hospital stay may be recommended. Your physician will give you instructions regarding what level of activity is appropriate for you after the procedure.
You may be instructed not to bathe or shower for at least 5 days. During this time, it will probably be all right for you to sponge bath, but you should not get the bandages wet. After 5 days or so, you can wash normally with soap and water, but be careful not to apply any unusual pressure to the site of catheter insertion.
Complete recovery from the procedure can take about 3 to 6 weeks. During that time, the wires will firmly take hold where they were placed. You should avoid contact sports, heavy lifting or pulling, or raising the arm on the side of the pacemaker above your head until your physician says it is all right for you to do so. You should be able to resume sexual activity once your incision has healed, unless your physician instructs you otherwise. Ask your physician when you can return to work, because the nature of your job, your health status, and your progress will determine how soon you can return. You will probably not be allowed to drive for 1 week after pacemaker implantation.
Once healed, usually only a small bump is seen over the spot where the pacemaker was placed.
How often will the pacemaker need to be checked?
You will need to follow up with your cardiologist at regular intervals in order to monitor the device. This is done noninvasively, meaning it does not require surgery. After getting a pacemaker, you will probably see your physician twice within the first 6 months, and then again every 6 to 12 months, to see how the pacemaker is working and to check the life of the battery.1 You may also have monthly monitoring over the telephone, known as transtelephonic monitoring. Signals from the pacemaker get converted into sound waves, which are sent over the phone, and received by a monitoring station at the other end of the phone, where they are reconverted back into the original signals so that your physician can interpret them. This cannot be done using cordless phones or cell phones, however, because of electronic interference.
The average pacemaker battery lasts about 5 to 8 years.4 You do not need to worry about your pacemaker battery running out unexpectedly. When the battery is running low, the elective replacement indicator (ERI) is activated, and your physician can detect this activation during a routine office visit. Once the ERI is activated the pacemaker will continue to work for 6 months, during which time you can schedule a replacement procedure.
Are there any special concerns for living with a pacemaker?
You will receive an identification card after your procedure that contains your name and other information, as well as the serial number and model of your pacemaker. You should keep this card with you at all times because you'll need this information if there are problems with the device, or if you are in an accident or need to avoid certain magnetic devices.
The following are some common concerns of people with pacemakers:
- Airport security checks. You can pass through airport security metal detectors normally, but a handheld wand detector should not be held near the pacemaker4
- MRIs and X-rays. You should avoid MRIs, but X-rays are safe. In general, you should avoid strong electromagnetic fields (like those generated by an MRI)
- Magnets. You should avoid holding strong magnetic items (like stereo speakers) near your pacemaker. Small magnets, like refrigerator magnets, are safe because they produce very weak electromagnetic fields. As a general rule, if you are unsure about whether an item is safe to hold near your pacemaker, maintain a distance of 6 inches between yourself and the item
- Microwaves. Although people with very old pacemakers could not use microwave ovens, this is not true with today's models. All household appliances are safe to use with a pacemaker4
- Cell phones. You should hold cell phones at least 6 inches from the pacemaker, even when the phone is off. Don't keep your phone in clothing pockets near the pacemaker, and use the ear opposite the pacemaker when using your cell phone4
- Slot machines. You may be advised to avoid slot machines or to stay about 12 inches away from them
- Roller coasters. Some newer roller coasters are also controlled by large magnets; you should not ride these types or any roller coasters with shoulder harnesses
Talk to your healthcare provider about any other precautions that may be necessary.
What are the risks of pacemaker implantation?
Serious complications are rare, but can include severe bruising and bleeding, infection, blood clots, or an electrode dislodging from the heart. Some people can develop pacemaker syndrome, in which the pacemaker is no longer synchronized with the heart's own rhythm and attempts to pump blood through a closed valve. Symptoms of pacemaker syndrome are dizziness and fatigue. If you have a pacemaker and you experience any of these symptoms, contact your healthcare provider.
In very rare cases (about 2%), the wires of the pacemakers, called leads, need to be removed, usually due to infection, damage to the lead, or interference with blood flow in the heart. Women have a higher risk of complications during this surgery (called pacemaker lead extraction), though this may be because women are often older than men when they receive a pacemaker.7, 8 New leads are sometimes placed during this procedure. In some cases, such as when you have an infection, the leads will be implanted at a later date because the infection must be cleared up before new leads can be implanted.
