Why insert a pacemaker

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. These tests can ensure that a pacemaker is the right choice for you. Your doctor will give you complete instructions on how to prepare. Implanting a pacemaker typically takes one to two hours. Your surgeon will make a small incision near your shoulder. 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.

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.

The atrium is the upper chamber of the heart. Every medical procedure has some risks. Most risks associated with a pacemaker are from the surgical installation. They include:. You may go home that evening, or you could stay in the hospital overnight.

Your doctor can reprogram the device as needed at follow-up appointments. Over the next month, you should avoid rigorous exercise and heavy lifting. You may also need to take over-the-counter medications for any discomfort. Ask your doctors what pain relievers are safest for you. It allows your doctor to receive information from your pacemaker without the need for an office visit.

Modern pacemakers are not as sensitive to electrical devices as the old ones, but certain devices could cause interference with your pacemaker. For example, you should avoid:. Although the risk is low, people should keep these devices at least six inches away from implanted medical devices.

This especially applies to pacemakers and cardiac defibrillators. It may be necessary for you to stop some of these medications prior to the procedure. Your doctor may request a blood test prior to the procedure to determine how long it takes your blood to clot. Other blood tests may be done as well. You may receive a sedative prior to the procedure to help you relax. If a sedative is given and there is a possibility that you may be discharged, you will need someone to drive you home.

You will likely spend at least one night in the hospital after the procedure for observation and to ensure the pacemaker functions properly. A pacemaker may be performed on an outpatient basis or as part of your stay in a hospital. Procedures may vary depending on your condition and your doctor's practices. You will be asked to remove any jewelry or other objects that may interfere with the procedure. An intravenous IV line will be started in your hand or arm prior to the procedure for injection of medication and to administer IV fluids, if needed.

You will be connected to an electrocardiogram ECG or EKG monitor that records the electrical activity of the heart and monitors the heart during the procedure using small, adhesive electrodes. Your vital signs heart rate, blood pressure, breathing rate, and oxygenation level will be monitored during the procedure.

You will receive a sedative medication in your IV before the procedure to help you relax. However, you will likely remain awake during the procedure. Once the anesthetic has taken effect, the physician will make a small incision at the insertion site. A sheath, or introducer, is inserted into a blood vessel, usually under the collarbone.

The sheath is a plastic tube through which the pacer lead wire will be inserted into the blood vessel and advanced into the heart. It will be very important for you to remain still during the procedure so that the catheter does not move out of place and to prevent damage to the insertion site.

The lead wire will be inserted through the introducer into the blood vessel. The doctor will advance the lead wire through the blood vessel into the heart. Once the lead wire is inside the heart, it will be tested to verify proper location and that it works. There may be one, two, or three lead wires inserted, depending on the type of device your doctor has chosen for your condition.

Fluoroscopy, a special type of X-ray that will be displayed on a TV monitor , may be used to assist in testing the location of the leads. The pacemaker generator will be slipped under the skin through the incision just below the collarbone after the lead wire is attached to the generator. Generally, the generator will be placed on the nondominant side. If you are right-handed, the device will be placed in your upper left chest. If you are left-handed, the device will be placed in your upper right chest.

After the procedure, you may be taken to the recovery room for observation or returned to your hospital room. A nurse will monitor your vital signs. You should immediately inform your nurse if you feel any chest pain or tightness, or any other pain at the incision site. After the period of bed rest has been completed, you may get out of bed with assistance. The nurse will assist you the first time you get up, and will check your blood pressure while you are lying in bed, sitting, and standing.

You should move slowly when getting up from the bed to avoid any dizziness from the period of bedrest. Your doctor will visit with you in your room while you are recovering. The doctor will give you specific instructions and answer any questions you may have. Once your blood pressure, pulse, and breathing are stable and you are alert, you will be taken to your hospital room or discharged home.

If the procedure is performed on an outpatient basis, you may be allowed to leave after you have completed the recovery process. However, it is common to spend at least one night in the hospital after pacemaker implantation for observation. You should be able to return to your daily routine within a few days.

Your doctor will tell you if you will need to take more time in returning to your normal activities. You should not do any lifting or pulling on anything for a few weeks. You may be instructed to limit movement of the arm on the side that the pacemaker was placed, based on your doctor's preferences. You will most likely be able to resume your usual diet, unless your doctor instructs you differently. It will be important to keep the insertion site clean and dry. You will be given instructions about bathing and showering.

Ask your doctor when you will be able to return to work. The nature of your occupation, your overall health status, and your progress will determine how soon you may return to work. Increased pain, redness, swelling, or bleeding or other drainage from the insertion site. Your doctor may give you additional or alternate instructions after the procedure, depending on your particular situation.

The following precautions should always be considered. Discuss the following in detail with your doctor, or call the company that made your device:. Always carry an ID card that states you have a pacemaker. In addition, you may want to wear a medical identification bracelet indicating that you have a pacemaker.

Let screeners know you have a pacemaker before going through airport security detectors. In general airport detectors are safe for pacemakers, but the small amount of metal in the pacemaker and leads may set off the alarm.

The lead wire is attached to the pacemaker generator. Then the provider will slip the generator under your skin through the incision just below the collarbone. The generator is often placed on the non-dominant side. This means if you are right-handed, the device will be placed in your upper left chest. If you are left-handed, the device may be placed in your upper right chest. The skin incision will be closed with stitches, adhesive strips, or a special glue.

After the procedure, you may be taken to the recovery room or returned to your hospital room. A nurse will watch your vital signs. Tell your nurse right away if you feel chest pain or tightness, trouble breathing, or pain at the insertion site. After a period of bed rest, you may get out of bed with help. The nurse will be with you the first time you get up. They will check your blood pressure while you are lying in bed, sitting, and standing.

Move slowly when getting up from the bed. This is to prevent dizziness. The insertion site may be sore or painful. You can take pain medicine if needed. Your arm may be placed in a sling overnight.

They will talk with you about how to keep your arm from moving after the procedure. You will have a chest X-ray to make sure your lung was not injured during the procedure, and to check the device position.

You may be prescribed antibiotics. These are to help prevent an infection around your pacemaker or at the incision site. Once your blood pressure, pulse, and breathing are stable and you are alert, you will be taken to your hospital room.

Or you may be allowed to go home. This is to monitor your heartbeat and make sure your pacemaker is working well. Make sure to have someone drive you home when you are discharged. You should be able to return to your normal daily routine within a few days. Your healthcare provider will tell you if you will need to wait.

Don't lift or pull anything for a few weeks. You may also need to limit movement of your arm on the side that the pacemaker was placed. You will most likely be able to go back to your usual diet, unless your healthcare provider tells you differently. Keep the insertion site clean and dry.

You will be told when and how to bathe or shower safely. Ask your healthcare provider when you will be able to return to work. The nature of your work, your overall health, and your progress after surgery will determine how soon you may go back to work. Increased pain, redness, swelling, or bleeding or other drainage from the insertion site. Chest pain or pressure, nausea or vomiting, profuse sweating, dizziness, lightheadedness, fainting, or lack of energy.

After a pacemaker insertion, you will need to keep regular appointments to ensure the pacemaker is working the way it should. The healthcare provider uses a special computer, called a programmer, to review the pacemaker's activity and adjust the settings when needed.

A remote monitor may also be used to allow the pacemaker to be checked at your home via the internet or telephone.

Your healthcare provider may give you other instructions after the procedure, depending on your particular situation. Always consider the following precautions. Discuss these in detail with your healthcare provider, or call the company that made your device:. Always carry an ID card that states you have a pacemaker. You may want to wear a medical ID bracelet or necklace saying that you have a pacemaker.

Let security screeners know you have a pacemaker before going through security detectors at the airport or court house. In general, airport detectors are safe for pacemakers, but the small amount of metal in the pacemaker and leads may set off the alarm.

If you are selected for additional screening by hand-held detector devices, tell the screeners that the detector wand should not be held over your pacemaker for more than a few seconds.

This is because the detector wand contains magnets that may affect the function or programming of your pacemaker. Most modern pacemakers are safe in an MRI machine. Check with your healthcare provider before having an MRI scan. Don't go near large magnetic fields such as power generation sites and industrial sites such as automobile junkyards that use large magnets. Don't use short-wave or microwave diathermy that uses high-frequency, high-intensity signals.

This may be used in physical therapy to treat muscles. The signals can interfere with or damage your pacemaker. Turn off large motors, such as cars or boats, when working close to them. This is because they may create a magnetic field. Don't go near high-voltage or radar machinery, such as radio or television transmitters, electric arc welders, high-tension wires, radar installations, or smelting furnaces. If you need a surgery in the future, tell the surgeon that you have a pacemaker well before the operation.

Ask your cardiologist if you need to do anything before, during, or after the surgery. Ask about the safety of the electrocautery device often used during surgery to control bleeding. This may interfere with the pacemaker. In some cases, the pacemaker's programming will be temporarily changed with a magnet during the surgery.

This is done to lessen the risk of interference from the electrocautery. During any physical or sports activity, protect yourself from trauma to the pacemaker.