What is pacemaker placement?

A pacemaker is a small, battery-powered device. It sends electrical signals to the heart. This keeps the heartbeat steady when you have bradycardia (a slow heart rate). Thin wires, called leads, carry the signals between the pacemaker and the heart.

You will get medicine before the procedure. This helps you relax and helps prevent pain. The doctor will make a cut in the skin just below your collarbone. The cut may be on either side of your chest. The doctor will put the pacemaker leads through the cut. The leads go into a large blood vessel in the upper chest. Then the doctor will guide the leads through the blood vessel into the heart. The doctor will place the pacemaker under the skin of your chest. The doctor will attach the leads to the pacemaker. Then the cut will be closed.

The procedure may take about 1 or 2 hours. You may need to spend the night in the hospital.

Pacemaker batteries may last about 10 years. Your doctor will talk to you about how often you will need to have your pacemaker and battery checked.

You can likely return to many of your normal activities after your procedure. You will need to be careful with certain electric devices. You will be given more information after getting your pacemaker.

If you are worried about having a pacemaker, it may help if you learn about how the pacemaker helps your heart. Talk to your doctor about your questions and concerns.

Activity

• Rest when you feel tired.
• Be active. Walking is a good choice.
• Do not raise your arm (on the side of your body where the pacemaker is located) above shoulder level until your doctor says it's okay. This helps keep the pacemaker and leads in place while you heal. Your doctor may recommend gentle range-of-motion exercises for your shoulder.
• For at least 3 or 4 weeks, or for as long as your doctor says, avoid activities that strain your chest or upper arm muscles. This includes mopping floors or pushing a lawn mower or vacuum. It also includes swinging a golf club or tennis racquet or swimming.
• You may need to take about 1 to 2 weeks off from work. It depends on the type of work you do and how you feel.
• Ask your doctor when you can drive again.
• Ask your doctor when it is okay for you to have sex.

Diet

• You can eat your normal diet. If your stomach is upset, try bland, low-fat foods like plain rice, broiled chicken, toast, and yogurt.

Medicines

• Your doctor will tell you if and when you can restart your medicines. The doctor will also give you instructions about taking any new medicines.
• If you stopped taking aspirin or some other blood thinner, your doctor will tell you when to start taking it again.
• Be safe with medicines. Read and follow all instructions on the label.
  • If the doctor gave you a prescription medicine for pain, take it as prescribed.
  • If you are not taking a prescription pain medicine, ask your doctor if you can take an over-the-counter medicine.
  • Do not take aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve), or other nonsteroidal anti-inflammatory drugs (NSAIDs) unless your doctor says it is okay.

Incision care

• If you have strips of tape on the incision, leave the tape on for a week or until it falls off.
• You may shower 24 to 48 hours after surgery. Pat the incision dry. Don't swim or take a bath for the first 2 weeks or until your doctor tells you it is okay.
• You will have a dressing over the incision. A dressing helps the incision heal and protects it. Your doctor will tell you how to take care of this.

Other instructions

• Keep a medical ID card with you at all times that says you have a pacemaker. The card should include the manufacturer and model information.
• Wear medical alert jewelry stating that you have a pacemaker. You can buy this at most drugstores.
• Tell all of your doctors, dentists, and other health professionals that you have a pacemaker before you have any test, procedure, or surgery.
• Ask your doctor for a list of electric devices that you might need to keep a short distance from your pacemaker.
• Check your pulse as directed by your doctor.
• Have your pacemaker checked as often as your doctor recommends. In some cases, this may be done from your home. Your doctor will give you instructions about how to do this.

Procedures can be stressful. This information will help you understand what you can expect. And it will help you safely prepare for your procedure.

Preparing for the procedure

• Be sure you have someone to take you home. Anesthesia and pain medicine will make it unsafe for you to drive or get home on your own.
• Understand exactly what procedure is planned, along with the risks, benefits, and other options.
• If you take a medicine that prevents blood clots, your doctor may tell you to stop taking it before your procedure. Or your doctor may tell you to keep taking it. (These medicines include aspirin and other blood thinners.) Make sure that you understand exactly what your doctor wants you to do.
• Tell your doctor ALL the medicines, vitamins, supplements, and herbal remedies you take. Some may increase the risk of problems during your procedure. Your doctor will tell you if you should stop taking any of them before the procedure and how soon to do it.
• Make sure your doctor and the hospital have a copy of your advance directive. If you don’t have one, you may want to prepare one. It lets others know your health care wishes. It’s a good thing to have before any type of surgery or procedure.

There are several risks to getting a pacemaker. But risks vary for each person. And risks vary based on the type of pacemaker you get. Your doctor can help you understand your risk.

You will see your doctor regularly to check your pacemaker and make sure you don't have any problems.

During and soon after the procedure

Problems can happen during or soon after the procedure to implant a pacemaker. Examples of problems include the following:

• Pain, bleeding, or bruising may happen soon after the procedure.
• Blood clots may form in your arms, which cause a lot of swelling.
• A lung could collapse (pneumothorax). This happens if air builds up in the space between the lung and the chest wall. This problem may happen about 1 to 2 times out of a 100.
• A tear in the heart could happen. Or a person might need emergency medicine or surgery.

After the procedure

Problems can also happen months or years after the pacemaker is implanted. These problems are related to the device or the leads. Most people do not have long-term issues with their pacemakers.

Problems include:

• Infection in your chest near the pacemaker. An infection might happen about 1 to 5 times out of 100. This means that about 95 to 99 times out of 100 there is no infection.
• Device problems that need another procedure to fix them. For example, this might happen if a pacemaker lead breaks or a lead moves out of place.

You can drive if you have a pacemaker and you don't have any symptoms such as fainting. But right after you get a pacemaker, your doctor may ask you not to drive for at least a week after the device is implanted. This gives you time to heal.

You may stay overnight in the hospital after having a pacemaker implanted and go home the next day. But sometimes, the surgery is done as an outpatient procedure, which means you do not need to stay overnight in the hospital.

You may be able to go back to work or your usual routine 1 to 2 weeks after surgery. But for at least a few weeks after the surgery, you should avoid vigorous physical activity that involves your upper body.

You'll need to use certain electric devices with caution. Some devices have a strong electromagnetic field. This field can keep your pacemaker from working right for a short time. These devices include things in your home, garage, or workplace. Check with your doctor about what you need to avoid and what you need to keep a short distance away from your pacemaker. Many household and office electronics don't affect your pacemaker.

Your doctor will check your pacemaker regularly. Your doctor may adjust it, if needed. In between checkups at your doctor's office, you may send information from your pacemaker to your doctor. Your doctor will give you instructions on how to do this.

Permanent pacemakers are powered by batteries. The batteries may last about 10 years. If the battery gets low, you will need to decide whether to have another surgery to replace the pacemaker.

Pacemaker placement is surgery to put a pacemaker in your chest. This surgery may be done if you have bradycardia (a slow heart rate). Your doctor made a cut (incision) in your chest. The doctor put the pacemaker leads through the cut, into a large blood vessel, then into the heart. The doctor put the pacemaker under the skin of your chest and attached the leads to it.

Your chest may be sore where the doctor made the cut. You also may have a bruise and mild swelling. These symptoms usually get better in 1 to 2 weeks. You may feel a hard ridge along the incision. This usually gets softer in the months after surgery. You may be able to see or feel the outline of the pacemaker under your skin.

You may be able to go back to work or your usual routine 1 to 2 weeks after surgery. But for at least a few weeks after the surgery, you will avoid vigorous physical activity that involves your upper body.

Pacemaker batteries may last about 10 years. If the battery gets low, you will need to decide whether to have another surgery to replace the pacemaker.

You'll need to take steps to safely use electric devices. Some of these devices can stop your pacemaker from working right for a short time. Check with your doctor about what to avoid and what to keep a short distance away from your pacemaker. For example, you will need to stay away from things with strong magnetic and electrical fields. An example is an MRI machine (unless your pacemaker is safe for an MRI). You can use a cell phone and other wireless devices, but keep them at least 6 inches away from your pacemaker. Many household and office electronics don't affect a pacemaker.

You will get medicine before the procedure. It helps you relax and helps prevent pain.

The doctor makes a cut in the skin just below your collarbone. The cut may be on either side of your chest. The doctor will put the pacemaker leads through the cut.

The leads go into a large blood vessel in the upper chest. Then the doctor will guide the leads through the blood vessel into the heart. The leads are placed in one or two of the chambers in the heart.

The doctor will place the pacemaker under the skin of your chest. The doctor will attach the leads to the pacemaker. Then the cut will be closed.

• Follow the instructions exactly about when to stop eating and drinking. If you don't, your procedure may be canceled. If your doctor told you to take your medicines on the day of the procedure, take them with only a sip of water.
• Follow your doctor's instructions about when to bathe or shower before your procedure. Do not apply lotions, perfumes, deodorants, or nail polish.
• Take off all jewelry and piercings. And take out contact lenses, if you wear them.

At the hospital or surgery center

• Bring a picture ID.
• You will be kept comfortable and safe by your anesthesia provider. You may get medicine that relaxes you or puts you in a light sleep. The area being worked on will be numb.
• The procedure may take about 1 or 2 hours.