Permanent Pacemaker
A guide for patient and families
This document outlines:
What is a pacemaker (PPM)?
What to expect before, during and after
What is a Permanent Pacemaker
(PPM)? How does a Pacemaker Work?
A pacemaker is designed to support the heart’s
A pacemaker is a small device that is implanted
natural electrical system. All modern pacemakers
under the skin, typically below the left collarbone.
are so called “demand pacemakers” and only kick
The pacemaker delivers electrical stimuli to treat
in when required. The pacemaker will not override
slow or interrupted heart beats.
the natural heart rhythm if it is present.
The pacemaker comes in 2 parts. Pacemakers can do 2 things, they can pace and
The first is the pacemaker generator that contains sense.
the battery and the ‘brains’ of the system. Pacing – a pacemaker sends an electrical impulse to
The second are the pacemaker leads. These are the heart through a pacing lead when the heart’s
soft, insulated cables, each about the diameter of a own rhythm is too slow or interrupted. The
spaghetti noodle. The leads carry the electrical electrical impulse stimulates a heartbeat.
impulse from the pacemaker generator to the heart Sensing – a pacemaker will sense (monitor) the
and relay information about the heart’s natural hearts natural electrical activity. When the
activity back to the pacemaker generator. pacemaker senses a natural heartbeat, it will not
deliver a pacing pulse.
Insertion of a Pacemaker
Insertion of a Permanent Pacemaker is a very
common procedure at The Royal Melbourne
Hospital. It is performed under local anaesthetic
and medication may be given to make you sleepy
and comfortable. The procedure takes
approximately 1 - 2 hours and is performed in the
cardiac catheter lab.
The staff in the lab will be dressed in hospital
scrubs, hats and masks.
Permanent Pacemaker | Authorised by Mandy Graham EP CNC | Last updated by Carolyn Buick April 2021 (images from medtronic and vectorimages.com) 1
A nurse/doctor will insert an intravenous line (IV),
usually into your left arm. This is needed to
perform a venogram (to look at patency of your
veins) and to administer medications. These include
antibiotics and pain relief.
ECG monitoring will be attached to your chest area
to monitor your heart throughout the procedure.
You will also have a blood pressure cuff on your
arm that will regularly inflate throughout the
procedure.
The area where the pacemaker is going to be
inserted (usually under the left collar bone) will be
prepared with an antiseptic solution that will feel
cold and may sting. You will be covered by a large
sterile drape that will partially cover your face. You
will be able to look out from under the drape to the
What are the risks?
side and a nurse will be with you at all times. Permanent Pacemaker insertion is a common and
You may be given oxygen to breathe by a small low risk procedure at The Royal Melbourne
tube (nasal prongs) that is positioned under your Hospital. However, should a complication arise, it
nose or by a mask (Hudson mask) that covers your will be dealt with at immediately. Although most
face. people undergoing Permanent Pacemaker insertion
do not experience any complications you should be
At the start of the procedure, the doctor will inject aware of the following risks:
local anaesthetic into the area under the collarbone
where the pacemaker is to be inserted. This will Haematoma (large bruise) – this can occur at the
sting momentarily then the area will become Permanent Pacemaker insertion site. This may be
numb. A small incision, approximately five to ten uncomfortable and can take several weeks to settle.
centimetres long, will be made in your upper chest Pneumothorax – During the procedure it is
area, just below your collarbone. One or two leads necessary to the insert the Pacemaker leads into
will be guided through a vein into your heart, and your heart via a small vein under the collar bone.
the leads will be connected to the pacemaker This vein runs very close to the lung and there is a
generator. small chance that a small hole could be
The pacemaker will be inserted beneath your skin, inadvertently made in the lung (Pneumothorax). If
and the incision in your chest will be closed. The this occurs it usually heals by itself. However,
stiches/ sutures are internal and self-dissolving. occasionally a small tube may need to be inserted
into the lung to drain out the air. This can be
A waterproof dressing will be applied to the site. uncomfortable and means spending extra days in
Pacemaker settings will be programmed, and the hospital. You will have a chest x-ray 4 hours after
device will be tested to ensure it is working your pacemaker insertion, to check for a
properly to meet your medical needs. pneumothorax.
Lead dislodgement - Occasionally a lead moves and
this will need to be repositioned. This usually
occurs within the 24 hours after the procedure and
Permanent Pacemaker | Authorised by Mandy Graham EP CNC | Last updated by Carolyn Buick April 2021 (images from medtronic and vectorimages.com) 2
is detected by testing the Pacemaker. Sometimes 3. You will receive a Pre-Admit phone
this can be picked up after your 4-6 week check. call from the arrhythmia nurse,
Infection - There is a small risk that the Pacemaker approximately one week before
can develop an infection. If this happens the your Pre-Admission Clinic
Pacemaker usually needs to be removed for the Telehealth appointment. This is to
infection to clear. Any infection around the get you ready for your upcoming
pacemaker site is treated seriously, so if there are appointments and ask you a few
any concerns, please inform us or ask your doctor questions.
to inform us at The Royal Melbourne Hospital. Questions that you will be asked include:
Cardiac perforation – A very rare complication in • Have you completed a test call of Telehealth?
which one of the leads makes a small hole in the Do you have family/friends/GP to help if
heart causing blood to accumulate around the needed?
heart. If this occurs the problem will be dealt with • Go through your list of
immediately. You might require a small drain to medications and create a
help remove the excess blood. medication plan. Particularly
in relation to blood thinners.
What to expect before the procedure • Are you diabetic? What medications do you
1. You will receive a take for diabetes?
letter/email from the • What is the name of the pathology
booking office lab/company that you had your bloods taken
outlining: with?
• Procedure date • Ensure you are aware that if you are
a woman under the age of 55yrs, a
• Pre-admission appointment via telehealth date standard pregnancy test will be
• Pathology request form with instructions included in the blood tests.
• Telehealth patient information • Discuss Allergies
• COVID patient advice • Discuss driving (No driving for 2 weeks after
your procedure, this might be longer if you have
• Procedure information suffered a cardiac arrest)
• ‘Accommodation information’ if you live greater • Who will be your support person to drive you
than 100kms away from the hospital. home?
• Do you have any cuts/wounds/infections?
2. Please ring 9342 8583 to contact the ‘cardiology • COVID-19 screening questions
booking office’ to officially accept the dates you
have been given. • Answer any questions you may have.
4. Telehealth Pre-admission clinic (PAC)
appointment, you will log on to Telehealth
Permanent Pacemaker | Authorised by Mandy Graham EP CNC | Last updated by Carolyn Buick April 2021 (images from medtronic and vectorimages.com) 3
https://www.thermh.org.au/telehealth at your • Nurse will usually send you an e-mail to confirm
nominated date and time. what was discussed.
Please call the telehealth team on 03 93428670 if
you have any problems with telehealth. What to expect day of procedure
1. Home:
• Please pack a small bag as
there is limited amount of
space at the bedside.
• Toiletries and slippers.
• Change of clothes for the next day.
Morning procedure (7am admission) will often
go home same day, afternoon procedure (10am
admission) will often go home by 10am the next
During the telehealth call, you will spend some time day.
with the resident doctor then some time with the
PAC nurse. • You should bring some small entertainment to
pass the time, please bring headphones for
Doctor will go through: electronic devices.
• Consent • Ensure you have followed instructions to shave
• Medication chest area and wash with chlorhexidine wash.
• Past medical history • 7am admission to fast from midnight – No food,
• Details of the procedure No drinks
• 10am admission to fast from 7am – No food, No
• Discuss blood results drinks
• Please take the correct medications at home
Nurse will go through: with a sip of water.
• What to expect pre & post procedure This should be strictly as per your medication plan
• Where to arrive on the day of procedure that was set in the pre-admission clinic
appointment.
• Fasting instructions
• Your height and weight
2. Hospital:
• Preparation of site i.e. shave and chlorhexidine
wash Once you have arrived at Royal Melbourne
Hospital, you should make your way to 2 south
• Medication plan east pre admission. You will meet the ward
• Transport details and support person clerk on arrival.
• Discharge Planning – ensuring you have correct • Then Nurse will take you through to the ward
medication and support. where you will get into a hospital gown and fill out
relevant paper work to get you ready for your
procedure.
Permanent Pacemaker | Authorised by Mandy Graham EP CNC | Last updated by Carolyn Buick April 2021 (images from medtronic and vectorimages.com) 4
• Avoid lifting your elbow higher than your
3. Cath Lab for procedure shoulder.
• For the first 2 weeks avoid heavy lifting.
• Then you will be taken round to the Cath lab for • You should begin gentle arm and shoulder
your procedure. movements as early as possible after the
• ECG monitoring electrodes (ECG stickers) will be implant. This may cause some discomfort,
attached to your chest area. however it will help to keep this area flexible.
Sports such as tennis, golf, boating, swimming
and fishing should not be played until your
What to expect – After the procedure wound has healed, usually about one month
• After the procedure you will be moved back to post implant. If you participate in hunting or
the ward. shooting sports, the rifle should be rested on
• You will have a chest X-ray and a device check the opposite shoulder to that of your device.
• Before discharge, you will need to eat, drink, • The first pacemaker check is 4 -6 weeks after
toilet and have IV cannula removed. Once safe implant. This is where you can discuss returning
for discharge, family will be called to pick you to exercise regimes.
up.
• This is a day procedure, so you should be in
hospital for 4 - 6 hours. However if you are
having your procedure done in the afternoon, it Limitations
is likely you will stay overnight. MRI tests cannot be performed routinely on
• You will be sent home with a remote monitor patients with pacemakers. Please seek the advice
which you will plug under your bed. This will be of your cardiologist should this test be required.
explained to you by the physiologist who will do
your device check before discharge. Industrial ARC welding equipment will interfere
with the function of the pacemaker so this should
be avoided.
What to expect – When I get home Supermarket store and airport security devices are
• You cannot drive for minimum 2 weeks after safe to pass through, however the pacemaker may
the procedure, as per the TAC guidelines. trigger an alarm, so ensure you have your
• You may have some mild bruising/discomfort in pacemaker card with you at all times.
the area of the pacemaker for a few days.
Avoid use of magnets or magnetic blankets as these
• Ice packs and paracetamol can be used to
will interfere with the function of your pacemaker.
control the pain.
• Please leave the sterile dressing on the
pacemaker site for 10 - 14 days. The dressing is
waterproof so you can shower with it on.
• Carefully remove the dressing after 10 - 14
days. Wound should be healed. Please see your
GP if it is not healed or there are signs of an
infection.
Signs of infection include redness,
swelling, pus/discharge, fever, hot,
pain.
Permanent Pacemaker | Authorised by Mandy Graham EP CNC | Last updated by Carolyn Buick April 2021 (images from medtronic and vectorimages.com) 5
Finally,
For animations/videos of the pacemaker insertion
and further learning, please visit our website:
www.melbourneheartrhythm.com.au
If there are any questions about your
procedure please contact:
Mandy Graham, Arrhythmia Nurse
Consultant via
The Cardiology Department 93427133
The information contained in this brochure is for educational purposes only and is not intended as a substitute for consultation with a doctor or health care professional.
Permanent Pacemaker | Authorised by Mandy Graham EP CNC | Last updated by Carolyn Buick April 2021 (images from medtronic and vectorimages.com) 6
