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Pacemaker Implant

By

Sarah Lewis, PharmD

What is a pacemaker implant?

A pacemaker implant is the surgical placement of a device called an artificial pacemaker. It is a treatment for arrhythmias (abnormal heartbeats). Arrhythmias happen when your heart’s electrical signal causes it to pump too slowly, too quickly, or irregularly. A pacemaker implant uses electrical pulses to help your heart return to a normal heartbeat.

Your heart is basically a pump made up of muscle tissue. It has four chambers, two upper chambers (atria) and two lower chambers (ventricles). Like all pumps, your heart requires a source of energy in order to function. Your heart's pumping energy comes from a built-in electrical conduction system.

In order for you to have a normal heartbeat, your heart's four chambers must work in harmony with one another. A heartbeat is produced when an electrical signal travels through these chambers. Any malfunction in this signal can make your heart beat too quickly, too slowly, or at an uneven rate. This causes an arrhythmia.

A pacemaker implant has risks and potential complications. It is only one method used to treat arrhythmias. Discuss all of your treatment options with your doctor to understand which options are right for you.

Types of pacemaker implants

A pacemaker has two main parts. The first part is the wires with electrodes that connect to your heart. These wires continually monitor your heart rhythm. They send the information to the second part of a pacemaker, the pulse generator. The pulse generator is a small battery-operated computer. It recognizes abnormal heart rhythms and responds by sending electrical pulses back to your heart to correct the rhythm. 

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The types of pacemaker implants include:

  • A biventricular pacemaker has three wires that connect to the right upper chamber (right atrium), the right lower chamber (right ventricle), and the left lower chamber (left ventricle). It coordinates signals between the right atrium and both ventricles. This type of pacemaker is also called a cardiac resynchronization therapy (CRT) device.

  • A dual chamber pacemaker has two wires that connect to an upper chamber and a lower chamber of your heart. It corrects abnormal electrical signals between the two chambers.

  • An external pacemaker stays on the outside of your body to adjust your heart rate and rhythm. It is for temporary or emergency use, such as immediately after a heart attack.

  • A single chamber pacemaker has one wire that connects to either an upper chamber or a lower chamber. It corrects abnormal electrical signals within a chamber. 

Types of pacemaker programming

Your doctor can program your pacemaker implant computer from outside your body. 

The types of pacemaker programming include:

  • Demand programming monitors your heart rhythm and only sends pulses when it detects an abnormal heart rate or your heart misses a beat.

  • Rate-responsive programming also monitors your breathing, body temperature, and other factors. It uses this information to determine your activity level. It then adjusts itself either up or down to match your activity level.

Why is a pacemaker implant performed? 

Your doctor may recommend a pacemaker implant to treat a heart arrhythmia. Your doctor may only consider a pacemaker implant for you if other treatment options with less risk of complications have been ineffective. Ask your doctor about all of your treatment options and consider getting a second opinion before deciding on a pacemaker implant. 

Your doctor may recommend a pacemaker implant to treat:

  • Congenital (present at birth) heart disorders, meaning they are present at birth

  • Heart block, a blockage in your heart’s electrical pathway

  • Heart failure, a condition in which the heart cannot pump enough blood to the body

  • Heart transplant

  • Hypertrophic cardiomyopathy, a complex heart disease characterized by thickened heart muscle and ventricular stiffness

  • Irregular heart beat or skipped heartbeats that occur often 

  • Syncope, unexplained fainting 

  • Too rapid or too slow heart beats, called tachycardia (too rapid) and bradycardia (too slow), that happen too often or at abnormal times

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

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

How do I prepare for my pacemaker implant? 

You are an important member of your own healthcare team. The steps you take before surgery can improve your comfort and outcome.

You can prepare for a pacemaker i