Who performs a pacemaker implant?

The following specialists can perform a pacemaker implant in a hospital:

  • Cardiac surgeons specialize in the surgical treatment of conditions of the heart and its blood vessels. Cardiac surgeons may also be known as cardiothoracic surgeons.
  • Interventional cardiologists specialize in diagnosing and treating conditions and diseases of the heart and blood vessels using nonsurgical, catheter-based procedures and specialized imaging techniques.
  • Thoracic surgeons specialize in the surgical treatment of diseases of the chest, including the blood vessels, heart, lungs and esophagus. Thoracic surgeons may also be known as cardiothoracic surgeons.

How is a pacemaker implant performed?

Your pacemaker implant will be performed in a hospital. A pacemaker implant takes about an hour and generally includes these steps:

  1. You will dress in a patient gown and lie on a procedure table.
  2. Your team will insert an IV to provide fluids and medications.
  3. You will receive medication (a moderate sedative) to relax you and make you drowsy. You may fall asleep.
  4. A team member will prepare an area of your chest or abdomen (belly). This includes shaving if needed, cleaning, and covering with a surgical drape. This is the area where your surgeon will place your pacemaker.
  5. Your surgeon will numb the area with an injection of local anesthetic. You will not feel anything in the area where your surgeon places the pacemaker.
  6. After the area is numb, your surgeon will thread the wires of your pacemaker through a vein to your heart using real-time x-ray guidance. 
  7. Once the wires are in place, your surgeon will make a cut in either your chest (endocardial approach) or your abdomen (epicardial approach) and place the pulse generator. An endocardial approach is most common for adults, while an epicardial approach is more common for children. If your surgeon is using an epicardial approach, you will receive general anesthesia.
  8. Your surgeon will test the pulse generator once everything is in place and connected. You may feel your heart speed up or slow down during the testing. Tell your doctor about any sensations you feel.

Will I feel pain?

Your comfort and relaxation is important to both you and your care team. You may feel a pinch or prick when the IV is inserted and stinging when the local anesthetic is injected. You may also feel pressure when your surgeon makes the cut to place your pacemaker. 

During the pacemaker testing, you may feel your heart slow down or speed up. Tell your doctor about any sensations you feel during the testing. You will have sufficient sedative medications so that you stay comfortable. Tell your care team if you are uncomfortable in any way.

What are the risks and potential complications of a pacemaker implant?  

Any surgical procedure involves risks and potential complications. Complications may become serious and life threatening in some cases. Complications can develop during the procedure or your recovery.  

General risks of surgery 

The general risks of surgery include:

  • Adverse reaction or problems related to sedation or medications, such as an allergic reaction and problems with breathing 
  • Bleeding, which can lead to shock
  • Infection and septicemia, which is the spread of a local infection to the blood

Potential complications of a pacemaker implant

Complications of a pacemaker implant include:

  • Blood clot or air bubbles in the vein
  • Collapsed lung
  • Heart or nerve damage
  • Pacemaker malfunction requiring your doctor to reprogram it or replace it
  • Punctured heart or lung
  • Tearing an artery or vein

Reducing your risk of complications

You can reduce the risk of certain complications by following your treatment plan and:

  • Avoiding close or prolonged exposure to electrical devices or devices that have a strong magnetic field. Your doctor will give you specific instructions about these devices.
  • Following activity, dietary and lifestyle restrictions and recommendations before surgery and during recovery
  • Notifying your doctor immediately of any concerns, such as bleeding, fever, increase in pain, or wound redness, swelling or drainage 
  • Taking your medications exactly as directed 
  • Telling all members of your care team if you have any allergies