In detail about Permanent Pacemaker Implant - Procedure & Risks

A pacemaker is a device that sends small electrical impulses to the heart muscle to maintain a suitable heart rate or to stimulate the lower chambers of the heart (ventricles). A pacemaker may also be used to treat fainting spells (syncope), congestive heart failure and hypertrophic cardiomyopathy.

Types of pacemakers:

The types of pacemakers are listed below. Your doctor will decide what type of pacemaker you need based on your heart condition. Your doctor also determines the minimum rate (lowest heart rate) to set your pacemaker. When your heart rate drops below the set rate, the pacemaker generates (fires) an impulse that passes through the lead to the heart muscle. This causes the heart muscle to contract, creating a heartbeat.

Leadless Pacemaker - Self-contained device without connecting leads (wires) and generator
Biventricular Pacemaker - also called cardiac resynchronization therapy (CRT)

Why do I need a pacemaker?

You need a pacemaker if your heart is pumping too quickly or slowly. In either case, your body doesn’t get enough blood. This can cause:

• Fatigue


• Fainting or lightheadedness


• Shortness of breath


• Damage to vital organs


• Eventual death

A pacemaker regulates your body’s electrical system, which controls your heart rhythm. With each heartbeat, an electrical impulse travels from the top of your heart to the bottom, signaling your heart’s muscles to contract.

A pacemaker can also track and record your heartbeat. A record can help your doctor better understand your arrhythmia.

Not all pacemakers are permanent. Temporary pacemakers can control certain types of problems. You may need a temporary pacemaker after a heart attack or heart surgery. You may also need one if a medication overdose temporarily slowed your heart.

Your doctor or cardiologist will test you to see if you’re a good candidate for a pacemaker.

What happens before the procedure?

Before the procedure begins, a nurse will help you get ready. You will lie on a bed and the nurse will start an IV (intravenous line) in a vein in your arm or hand. The IV is used to deliver medications and fluids during the procedure.

To prevent infection and to keep the pacemaker insertion site sterile:

• An antibiotic will be given through the IV at the beginning of the procedure.


• The left or right side of your chest will be shaved.


• A special soap will be used to cleanse the area.


• Sterile drapes are used to cover you from your neck to your feet.


• A soft strap will be placed across your waist and arms to prevent your hands from coming in contact with the sterile area.

How is pacemaker surgery performed?

Implanting a pacemaker typically takes one to two hours. You’ll receive a sedative to relax you and a local anesthetic to numb the incision site. You’ll be awake during the procedure.

Your surgeon will make a small incision near your shoulder. They’ll guide a small wire through the incision into a major vein near your collarbone. Then the surgeon will lead the wire through your vein to your heart. An X-ray machine will help guide your surgeon through the process.

Using the wire, your surgeon will attach an electrode to your heart’s right ventricle. The ventricle is the lower chamber of the heart. The other end of the wire attaches to a pulse generator. This contains the battery and electrical circuits.

Typically, your surgeon will implant the generator under your skin near your collarbone.

If you’re getting a biventricular pacemaker, your surgeon will attach a second lead to your heart’s right atrium, and a third lead to the left ventricle. The atrium is the upper chamber of the heart.

At the end, your surgeon will close your incision with stitches.

What should I expect?

In your hospital room, a special monitor, called a telemetry monitor, will continually monitor your heart rhythm. The telemetry monitor consists of a small box connected by wires to your chest with sticky electrode patches. The box displays your heart rhythm on several monitors in the nursing unit. The nurses will be able to observe your heart rate and rhythm.

You will also have a holter monitor, a small recorder attached to your chest with sticky electrode patches. The holter monitor records your heart rhythm for 12 hours to ensure that the pacemaker is functioning properly.

Risks:

Every medical procedure has some risks. Most risks associated with a pacemaker are from the surgical installation. They include:

• An allergic reaction to anesthesia


• Bleeding


• Bruising


• Damaged nerves or blood vessels


• An infection at the site of the incision


• A collapsed lung, which is rare


• A punctured heart, which is also rare

Most complications are temporary. Life-altering complications are rare.