Pacemaker Implantation

Pacemaker Implantation

If you have been advised a cardiac pacemaker implantation it means that your heart rate has been persistently or intermittently slow or the heart rate does not increase with exercise at an expected level for your age or you are on essential medications that can predispose you to significant slowing down of the heart.

Cardiac pacemakers are most commonly implanted cardiac devices. Over the years millions of these devices have been implanted across the world. Pacemaker implantation can be done as a day case procedure, however in most instances patient stays overnight in the hospital for one day.

Pacemakers are implanted to treat slow heart rhythms. A pacemaker helps stabilize heart rhythm and ensures that it does not go too slow. A pacemaker unit consists of a small battery and a lead (a wire that connects battery to the heart).

Pacemakers are generally implanted in a cardiac catheter lab using fluoroscopy (X-rays). Procedure is performed under local anaesthesia which means patient undergoing pacemaker implantation would be conscious during the procedure. A small cut is made in the upper chest and a pocket (usually size equivalent to three finger breadths) under the skin and subcutaneous fat but above the muscle is created to lodge the pacemaker and the lead. Pacing lead is then introduced in to a blood vessel (vein which traverses from the left arm to the heart) under the collar bone. Once introduced in to the blood vessel, pacing lead is gently pushed in to the heart under X-ray guidance. Once lead is in a secure place in the heart the other end is connected to the pacemaker battery (weights around 20-50 grams) which in turn is placed under the skin and over the muscle in the previously created pocket.Pacemaker site is closed using a series of absorbable sutures. The whole of this procedure take around 60 minutes.

Pacemaker implantation are generally a low risk procedure compared to some of the other cardiac procedures. However 1-2 patients in a hundred undergoing this procedure may experience complications including infection, bleeding, abnormal heart rhythms due to cardiac muscle irritation, puncture of lung causing leakage of air, called pneumothorax and puncture of the heart with leakage of blood in to the outer layers compromising cardiac function, also called cardiac tamponade. Most of these complications can be dealt with by the implanting team.

A chest X-ray would be performed four hours post pacemaker insertion to look for anyevidence of complication and to ensure appropriate position of the pacing leads. You would be asked not to lift the arm on the side of the pacemaker implantation, above the shoulder for about four weeks. You would however, be able to walk immediately after pacemaker implantation. You would be discharged home the following day after pacemaker implantation. You will be asked to take it easy for a few days and avoid any form of exertion. You would also be asked to look for any signs of infection including redness, soreness or discharge from the pacemaker site and report promptly to the implanting team. You will be advised to visit clinic one week after discharge to check on the wound and also to make fine adjustments to the pacemaker using a laptop like device called programmer that can wirelessly communicate with your pacemaker.

Following pacemaker insertion you are advised to make regular visits to the clinic initially for 3 months and subsequently once every 6-12 months. Pacemaker is checked for various parameters including remaining battery life, during interrogation using programmer. Most new generation pacemaker batteries last for about 10 years on an average may be less or more in some instances.

When a pacemaker approaches its end of battery life you would be scheduled for a pacemaker box change procedure. This is a minor procedure and similar to pacemaker implantation but much shorter in duration. This is also done under local anaesthesia which means you would be conscious during the procedure. A cut is made at the pacemaker site and dissection is carried out to the level of the pacemaker device. Old pacemaker device would be released from the pacing lead and new pacemaker battery would be connected to the lead. The new battery would now be placed in the pocket and wound closed with series of absorbable sutures. You may be allowed home the same day or the following day in some instances. You would be advised to look for any signs of bleeding or infection at the pacemaker site. You would be followed up in the doctor’s clinic in a similar way after you had your original pacemaker.

After initial few days of rest following pacemaker implantation, you would be able to travel. Following pacemaker implantation you be provided with a pacemaker identification card which you can provide to airport security staff at the time of walk through the metal detector. It is always essential to carry the medical case notes related to your pacemaker implantation at the time of travel as it would be handy should you need any medical intervention whilst you are away from your home city.

You would be advised to take it easy for a few days and avoid any direct pressure over pacemaker area. For the first four weeks you would be advised not to reach out for things with your arm on the side of the pacemaker implantation above the level of your shoulder. You would be able to resume normal activities after initial period of rest for a week or two and same would apply for resumption of sexual activity.

Dr. Venkat D Nagarajan

Dr. Venkat D Nagarajan

FHRS, FRCP Edin, CCT UK (Cardiology), CEPS, ECDS

Department

Cardiac Sciences/Cardiology

Expertise

Electrophysiology (EP) studies and ablation therapy for atrial and ventricular arrhythmia’s including atrial fibrillation and ventricular tachycardia. Implantation of cardiac devices including pacemakers for treatment of slow heart rhythms and advanced cardiac device (defibrillators, cardiac resynchronization therapy devices (CRT) and His bundle pacing) for patients with advanced heart failure.