Pacemaker implantation
Pacemaker implantation is the insertion of of a small electronic device that is usually placed in the chest, just below the collarbone to help regulate slow electrical problems with the heart.
Some facts about Pacemaker implantation:
- A pacemaker implantation may be recommended to ensure that the heartbeat does not slow to a dangerously low rate.
- A pacemaker consist of a pulse generator, one or more leads, and an electrode on each lead.
- It signals the heart to beat when the heartbeat is irregular or too slow.
- An electrical impulse is sent through the lead to the electrode if the rate of heart is slower than the programmed limit so that the heart will beat at a faster rate.
- The pacemaker generally monitors the heart rate and will not pace when the heart beats at a rate faster than the programmed limit.
- Modern pacemakers do not compete with natural heartbeats as they are programmed to work on demand only.
- No electrical impulses will be sent to the heart unless natural rate of the heart falls below the pacemaker's lower limit.
- A biventricular pacemaker is a newer type of pacemaker, which is currently used in the treatment of specific types of heart failure.
- Scheduled appointments should be made regularly to ensure the pacemaker is functioning properly after a pacemaker insertion.
Preparation for Pacemaker implantation:
- Your doctor should be notified if you are sensitive to or are allergic to any medications, latex, tape, iodine, or anesthetic agents (local and general).
- Drinking anything including water and eating anything after midnight the night before the implantation is restricted.
- Certain drugs can be taken the morning of your surgery.
- Your doctor should be notified of all medications (prescription and over-the-counter) and herbal or other supplements that you are taking.
- A blood test prior to the procedure may be done to determine how long it takes your blood to clot.
- A sedative may be given prior to the procedure to help you relax.
- You need to stay at least one night in the hospital after the procedure to ensure the pacemaker functions properly and for observation .
- Other specific preparation may be requested based on your medical condition.
Procedure for Pacemaker implantation:
- Pacemaker implantation can be performed on an outpatient basis or as part of your stay in a hospital.
- You need to empty your bladder before the procedure.
- Excessive hair at the incision site may be clipped off.
- An intravenous (IV) line will be given in your hand or arm before the procedure for injection of medication and to administer IV fluids, if needed.
- You will be placed on your back on the procedure table and connected to an electrocardiogram (ECG or EKG) monitor that records the electrical activity of the heart.
- The ECG or EKG monitor also monitors the heart during the procedure using small, adhesive electrodes.
- Your vital signs such as heart rate, blood pressure, breathing rate, and oxygenation level will be monitored during the procedure.
- Large electrode pads will be placed on both front and back of the chest.
- A sheath or introducer, is inserted into a blood vessel, usually under the collarbone after the physician will make a small incision at the insertion site.
- The pacer lead wire will be inserted into the blood vessel and advanced into the heart through this sheath which is a plastic tube.
- The catheter should not move out of place and damage to the insertion site can be prevented by remaining still.
- The lead wire will be inserted through the introducer into the blood vessel and will be advanced into the heart.
- The lead wire will be tested to verify proper location and that it works, once it is inside the heart.
- Depending on the type of device your doctor has chosen for your condition, there may be one, two, or three lead wires inserted.
- Fluoroscopy is 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 which is just below the collarbone, after the lead wire is attached to the generator.
- The generator will be generally placed on the nondominant side
- The ECG will be monitored to ensure that the pacer is working properly.
- The skin incision will be closed with adhesive strips, sutures, or a special glue and a sterile bandage or dressing will be applied.
