PACEMAKER IMPLANT PROCEDURE

What is a pacemaker?
A pacemaker is a small device that helps control your heartbeat. It uses electrical impulses to keep your
heart beating at a normal rate.

Why do I need a pacemaker?

You may need a pacemaker if you have a heart rate that is too slow (bradycardia) while resting and/or
exercising, unexplained fainting spells (syncope) or heart failure.

How does a pacemaker work?

Your heartbeat is controlled by an electrical system in your heart. As electrical
impulses travel through your heart, the top chambers (atria) and bottom chambers
(ventricles) take turns squeezing and relaxing. When they relax, they fill with blood.
When they squeeze (contract), blood is pushed out to the rest of your body.
The sinoatrial (SA) node, atrioventricular (AV) node, bundle branches and His-
Purkinje network keep the electric impulse moving through your heart. If this pathway is
interrupted, it causes changes to your heart rate and rhythm.
The pacemaker uses wires (leads) to sense your heart’s electrical activity. If needed,
electricity travels through the leads to your heart muscle to keep the electric impulse
moving. Your doctor will adjust your pacemaker settings as needed. The pacemaker only
sends an impulse when your heart tries to drop below the set minimum. Right and Left
Bundle Branches

The pacemaker uses a battery and tiny computer, which are inside the pulse generator.

Pulse
Generator
Types of pacemakers
Your doctor will talk to you about the type of pacemaker that is best for you.
Depending on your medical condition, you will need a:

Right
„ Single chamber pacemaker: Uses one lead in either your heart’s upper
Leads
Atrium chamber (atrium) or lower chamber (ventricle).
Left
Ventricle
Right „ Dual chamber pacemaker: Uses two leads — one in your heart’s upper
Ventricle
chamber (atrium) and one in the lower chamber (ventricle).
„ Biventricular pacemaker: Uses three leads — one in your heart’s upper right
chamber (atrium) and one in each lower chamber (right and left ventricles).

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How is a pacemaker put in place?
The pacemaker is placed in a pocket that is created under your skin. This is usually done using an
endocardial (transvenous) approach. But, your doctor may need to use an epicardial approach instead.
Endocardial approach - most common
„ The pacemaker/pulse generator is placed in your upper chest area, in a pocket
created under your skin.
„ Uses local anesthesia. You will be awake, but the procedure area will be numb,
and you will get medicine to make you drowsy.
„ A small incision is made in your upper chest.
Endocardial approach
„ Your doctor guides the lead(s) into the incision, through a vein that leads to
your heart.
„ The lead tip(s) attach to your heart, and the other end connects to the pulse generator.
Epicardial approach
„ The pacemaker/pulse generator is placed in your abdomen, in a pocket created
under your skin.
„ Uses general anesthesia. You will be asleep.
„ If you need an epicardial approach, your doctor will talk to you about your
surgery. You may have either a traditional or minimally invasive procedure. Epicardial approach
„ Getting Ready for Your Procedure
My procedure is ____________________________ (date) at __________________________ (time)

Medicine

„ Make sure your doctor knows every type of medicine you take. This includes vitamins, supplements and
medicine you buy without a prescription.
„ Ask your doctor if you need to make changes to your medicine routine before your procedure.
„ You may need to stop taking some types of medicine or make other changes.
„ DO NOT make any changes to your medicine routine unless your doctor tells you to.
„ If you take blood thinners (Coumadin, aspirin or other anticoagulant):
„ You may need to stop taking the medicine a few days before your procedure.
„ If you take Coumadin, the results of your INR test must be in a good range before you can have your
procedure.
„ If you have diabetes, ask your nurse how to adjust your insulin/medicine.
Eating and drinking
„ Eat a normal meal the evening before your procedure.
„ DO NOT eat, drink or chew anything after 12 midnight before your procedure. This includes gum,
mints and candy.
„ If you need to take pills, take them with only small sips of water.
„ Do not swallow any water when you brush your teeth.
Clothing, makeup, etc. „ We will apply several sticky patches (electrodes)
on your chest, back and heart. These are used to
„ DO NOT wear makeup or nail polish. record an electrocardiogram (ECG/EKG) and, if
„  ear comfortable clothes to the hospital. You will
W needed, adjust your heart rate/rhythm during the
change into a hospital gown for the procedure. procedure.

„ DO NOT wear any jewelry (including wedding „ We will keep track of your blood pressure (with
rings and watch). a blood pressure cuff) and oxygen level (with a
small clip on your finger).
„ DO NOT bring any valuables to the hospital.

How long does the procedure take?

What should I bring to the hospital?
The procedure takes 2 to 5 hours.
„ Make sure you arrange to have someone drive
you home from the hospital. Many patients go
home the same day, but you may need to spend Will I feel pain?
the night in the hospital.
„ You should not feel any pain during the procedure.
„ Bring a one-day supply of the medicine you take. Please tell your doctor right away if you feel pain
This is in case your procedure is delayed and you or have any symptoms.
need to take them. Do not take anything unless
„ You will feel some burning/pinching when you get
your healthcare provider tells you to.
the anesthesia. The area will quickly become
„ If you plan to spend the night in the hospital, numb.
pack a small bag with toiletries and other things
„ You may feel a pulling sensation as your doctor
you need for your comfort. Please leave the bag
makes the pocket for the pacemaker in the tissue
with the person who comes with you to the
under your skin.
hospital.

During the Procedure How are the leads tested?

„ Your doctor will test the leads after they are in
Where is the procedure performed? place. This is called pacing.
Unless you are having surgery, your pacemaker „ Pacing involves sending electricity through the
implant procedure will be done in a procedure room in leads to your heart.
the Pacemaker Lab.
„ Your heart will contract, and you may feel your
heart beat faster.
What can I expect?
„ Your doctor will connect the leads to the
„ We will give you an IV in your arm or hand to give
pacemaker/pulse generator after they are tested.
you fluids and medicine. This includes an
antibiotic to prevent infection and medicine to
make you drowsy. After the Procedure
„ We will clean and remove any hair from the
procedure area, then cover you with sterile paper
How will I feel?
sheets (drapes) from your neck to your feet. „ You may feel discomfort at the pacemaker
implant site during the first 48 hours after the
„ You will have a soft strap across your waist and
procedure.
arms to keep your hands from touching the sterile
area. „ Your doctor will tell you which medicine you can
take for pain relief.
„ You will lie on a table with a large X-Ray machine
above you, and a screen to the side. Your doctor „ Tell a member of your healthcare team if you
uses these to guide the lead(s) into place. have a lot of pain or if it does not go away.
Tests and Monitoring
„ You will have a chest X-ray to check your lungs and the position of the pacemaker and lead(s).
„ We will keep track of your heart rate and rhythm with a telemetry monitor. This is a small box with wires
that connect to electrodes on your chest.

Device Clinic
Before you go home, you will go to the Device Clinic to have your pacemaker programmed to the settings
determined by your doctor.
„ You will sit in a reclining chair while your pacemaker is programmed.
„ Wires will be connected from a computer to electrodes on your chest.
„ A nurse will use a programmer device over your pacemaker to change the settings.
„ You may feel your heartbeat get faster or slower. This is normal, but please tell your nurse how you feel.
„ If you have a biventricular pacemaker, you may have an echocardiogram (echo).
„ Your doctor will review the results, and if there are no changes needed, you will be able to go home.

Follow-Up and Discharge Instructions

„ Ask your doctor if you need to take the same medicine you did before your procedure.
„ We will talk to you about incision care, activity guidelines and follow-up appointments.
„ We will give you a temporary ID card that lists the type of pacemaker and leads you have, the date of
implant and your doctor’s name. Carry this card with you at all times in case you need medical care.
You will get a permanent card from the pacemaker company within three months.
„ Please let us know if you have any questions or concerns before you go home.

Questions or Symptoms after you go Home?

Call your doctor’s office: ______________________________________________

If you have an emergency, call 911

or have someone drive you to the nearest emergency department.

This information is not intended to replace the medical [Link]/heart

advice of your healthcare provider. Please consult your
healthcare provider for advice about a specific © 2000-2022 Cleveland Clinic. All rights reserved. Rev. 3/22
medical condition or treatment.
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