Description of the procedure

A pacemaker is a small battery-powered electronic device that is surgically implanted, usually in your chest, to monitor your heart rate. If your heart rate is below a pre-determined point, the pacemaker will send an electrical signal to your heart in order to cause it to beat. This device is used mainly to prevent your heart from beating too slowly.

When should this procedure be performed?

Your doctor will decide when this procedure is required.

Why is this procedure performed?

When the heart no longer beats with a normal rhythm, a doctor may suggest a pacemaker. People who require a pacemaker need it because their heartbeats have become too slow. This reduced heart rate may happen for a number of reasons:

• aging
• damage to the heart muscle from a heart attack
• problems with the heart's electrical system
• use of certain medications (e.g., beta-blockers)

A slow heart rate, also called bradycardia, can have a major impact on a person's daily activities. Household chores, exercise, and other normal activities can lead to dizziness, fainting, and fatigue because of the poor blood and oxygen supply to the body.

Are there any risks and precautions

Bleeding and infection are the main risks associated with this procedure. Although rare, some complications of the procedure include:

• clotting
• damage to the blood vessel and heart muscle
• stroke
• heart attack
• puncture of the lung and collapse

What happens during the procedure?

The procedure is usually performed under local anesthesia by a surgeon or cardiologist.

Through an opening made below the collarbone, insulated wires (also known as leads) are inserted into a large vein and attached to the chambers on the right side of the heart. This is done with the help of an X-ray machine. With one end of the wires attached to the heart, the other ends are connected to the pacemaker. A pocket is made under the skin or under the muscle, in the upper chest, and the pacemaker is placed in this pocket. The opening is then stitched closed.

The procedure typically takes one to two hours.

How should I prepare for this procedure?

Do not eat for 8 hours before the procedure. You may continue to drink clear liquids until 2 hours before the procedure. If your doctor has recommended different times, follow the timing recommended by your doctor.

Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications that you are taking. Also tell them about any medication allergies and medical conditions that you may have.

Ask your doctor or pharmacist whether you need to stop taking any of your medications before the procedure.

Follow any additional instructions from your doctor.

What can I expect after the procedure?

Some people are sent home the same day, but most remain in the hospital for one to two days. While there, the doctors will check the pacemaker using a heart monitor and adjust the settings if necessary.

There are certain precautions you must take to keep your pacemaker working properly. For the first few days, do not raise your arms above your head. If you do, the wire leads that attach to the heart may move and the pacemaker will not work.

Once you leave the hospital, it is important to:

• keep cellular phones away from the pacemaker.
• avoid standing too close to certain mechanical equipment as they may interfere with the electrical signals from the pacemaker (e.g., welding equipment, high-power generators). Discuss what is considered a safe distance with your doctor.
• make sure security personnel at airports or other areas know about the pacemaker, since it may set off these security systems.
• tell your doctors or other health care professionals that you have a pacemaker in order to avoid problems with certain diagnostic equipment (e.g., magnetic resonance imaging [MRI] machines) and other procedures

You should follow-up with your doctor from time to time to check that your pacemaker is working properly. Pacemaker batteries generally last on average 5 to 10 years. Your doctor will change the batteries when it is needed. The leads may be replaced at the same time, if it is needed. Your doctor may be able to check your pacemaker over the telephone if your pacemaker has this feature.

Results

When properly implanted and functioning normally, the pacemaker will prevent your heart from beating too slowly.