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Heart Disease and Pacemakers

How Are Pacemakers Implanted?

Pacemakers are implanted two ways:

  • Endocardial approach. This is the most common technique used.
    • This procedure is performed in a pacemaker or electrophysiology lab.
    • A local anesthetic (pain-relieving medication) is given to numb the area. An incision is made in the chest where the leads and pacemaker are inserted.
    • The lead(s) is inserted through the incision and into a vein, then guided to the heart with the aid of the fluoroscopy machine.
    • The lead tip attaches to the heart muscle, while the other end of the lead (attached to the pulse generator) is placed in a pocket created under the skin in the upper chest.
  • Epicardial approach. This technique is more commonly used in children.
    • This procedure is performed by a surgeon in a surgical suite. General anesthesia is given to put you to sleep.
    • The surgeon attaches the lead tip to the heart muscle, while the other end of the lead (attached to the pulse generator) is placed in a pocket created under the skin in the abdomen.
    • Although recovery with the epicardial approach is longer than that of the other approach, minimally invasive techniques have enabled shorter hospital stays and quicker recovery times.

The doctor will determine which pacemaker implant method is best for you.

What Happens During Pacemaker Implantation?

The endocardial pacemaker takes about 1-2 hours to implant. Here is an overview of the procedure:

  • You will lie on a bed and the nurse will start an intravenous line (IV) into your arm or hand. This is so you may receive medications and fluids during the procedure. You will be given a medication through your IV to relax you and make you drowsy, but it will not put you to sleep.
  • The nurse will connect you to several monitors. The monitors allow the doctor and nurse to check your heart rhythm, blood pressure, and other measurements during the pacemaker implant.
  • The left or right side of your chest will be shaved and cleansed with a special soap. Sterile drapes are used to cover you from your neck to your feet. A strap will be placed across your waist and arms to prevent your hands from coming in contact with the sterile field.
  • The doctor will numb your skin by injecting a local numbing medication. You will feel a pinching or burning feeling at first. Then, it will become numb. Once this occurs, an incision will be made to insert the pacemaker and leads. You may feel a pulling as the doctor makes a pocket in the tissue under your skin for the pacemaker. You should not feel pain. If you do, tell your nurse.
  • After the pocket is made, the doctor will insert the leads into a vein and guide them into position using the fluoroscopy machine.
  • After the leads are in place, their function is tested to make sure they can increase your heart rate. This is called "pacing" and involves delivering small amounts of energy through the leads into the heart muscle. This causes the heart to contract. When your heart rate increases, you may feel your heart is racing or beating faster. It is very important to tell your doctor or nurse any symptoms you feel. Any pain should be reported immediately.
  • After the leads are tested the doctor will connect them to your pacemaker. Your doctor will determine the rate of your pacemaker and other settings. The final pacemaker settings are done after the implant using a special device called a "programmer."

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