Pacemakers permanent can be surgically placed into the chest (a permanent pacemaker) through a small incision, or they can be worn outside the body (a temporary pacemaker) and attached to the heart through a wire that is threaded through a neck vein. Temporary pacemakers are used only while a person is in the hospital.

What is an implantable pacemaker?

A pacemaker is a small device that is run by a battery. It helps the heart beat in a regular rhythm. Pacemakers can help pace the heart in cases of slow heart rate, fast and slow heart rate, or a blockage in the heart’s electrical system.

A pacemaker can pace the heart’s upper chambers (the atria), the lower chambers (the ventricles), or both. Pacemakers may also be used to stop the heart from triggering impulses or from sending extra impulses.

A Pacemakers is about the size of a matchbox. It is made up of two parts : –

A pulse generator, which includes the battery and several electronic circuits. Wires, called leads, which are attached to the heart wall. Depending on the type of pacemaker you need, there may be one or two leads.

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Will electronic devices affect my pacemaker?

The American Heart Association (AHA) advises that if you have a pacemaker, you should be aware of your surroundings and of any devices that may interfere with it. Here is a list of devices that will not affect or damage pacemakers. Most people do not need to worry about coming into contact with these devices.

• CB radios
• Electric drills
• Electric blankets
• Electric shavers
• Ham radios
• Heating pads
• Metal detectors
• Microwave ovens
• TV transmitters
• TV remote controls
• X-ray machines
• Airport security detectors

Here is a list of devices that will affect pacemakers. Your pacemaker may not work properly if you come into contact with these devices.

• Power-generating equipment
• Welding equipment
• Certain pieces of equipment used by dentists
• Magnetic resonance imaging (MRI) machines
• Radiation machines for treating cancer
• Heavy equipment or motors that have powerful magnets

Who needs a pacemaker?

Typically pacemakers are implanted in patients with a history of bradycardia, or slow heart rhythms.

These can include the following conditions : –

• Sick sinus syndrome (sinus node arrest, tachy-brady syndrome, symptomatic sinus bradycardia)
• Syncope secondary to a bradycardic rhythm
• Atrial fibrillation with a slow ventricular response and bradycardia (due to medications or after AV node junction ablation)
• AV block
• Distal conduction system block
• Heart failure in patients deemed appropriate for cardiac resynchronization therapy (CRT)

The day of the procedure : –

• Please arrive at the hospital “fasting” from the previous midnight
• You may take your morning medications with a small sip of water
• If you have been instructed to have blood drawn, please do not forget (you may be instructed to have this done several days before your procedure)
• Please make sure you have consulted with your physician if you are on coumadin or insulin for diabetes. For most procedures, your coumadin will be discontinued or adjusted several days prior.

What are the risks?

In general, pacemaker insertion is a safe procedure. However, as with any surgical procedure, there is a risk of complications.

The 1-2% risk of complications from permanent pacemaker implantation includes the following : –

• Bleeding, including a hematoma
• Infection
• Damage the artery or veins
• Blood clot
• Tearing the heart muscle
• Stroke, death, or heart attack
• Puncturing the lung requiring a chest tube

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What to expect after the procedure?

• Procedure duration is typically 1-3 hours
• You will have an arm sling for 24 hours
• Overnight hospital stay is generally advised
• You will be instructed to perform daily dry dressing changes at home to the incision site.
• You may be asked to keep the incision site dry for the following week after implantation (you may shower, but need to keep the affected site dry).
• You will need to return to the clinic in 1 week after device implantation
• You can return to normal activities within several days
• Typically driving is discouraged for at least 1 week or longer after the device is implanted

Extreme motion with the involved arm (above the shoulder) should be avoided for 4-6 weeks after device implantation (this includes activities such as swimming and golf); this could result in lead dislodgement