Pacemaker Implantation

The information on this page is for patients who are having an artifical pacemaker fitted because they have excessively slow heart rhythms. It explains what it is for, what is involved with having an implant and any risks there may be.


What is a pacemaker?
The heart has its own pacemaker called the sinus node, which produces electrical impulses. These keep the heart beating in a regular pattern throughout life.


What is an artificial pacemaker?
It is a small electronic pulse generator (smaller than a match box) connected to one or two wire leads, that stimulates the heart to beat in a regular pattern. it is powered by a battery and is implanted under the skin

How does it work?
There are many different models of pacemakers. A typical one conists of two parts, the batteries that power it and the electronic part that controls the heart beat. The whole thing weighs only 20-50 grams (1-2 ounces) and is about 4cm x 8mm (1 1/2" x 1/4"). It is attached to one or more wire leads that transmit the electrical impulse to the heart.

Who needs artificial pacemaker?
There are several reasons why a person may need a pacemaker. the usual reasons are
a) a heart beat that is very slow or pauses intermittently cuasing blackouts, falls or dizzy spells.
b) A catheter ablation that results in either deliberate or accidental damage to the heart's natural electrical system.

How is it implanted?
Nearly all pacemakers are implanted under local anaesthetic by the transvenous method (using a vein). You will be given an appointment or come into hospital for a daycase procedure but you may need to stay overnight. If you are on warfarin you should stop taking it a few days before, as well as checking with your doctor.

Preparation on arrival
A doctor will explain the implantation to you and ask you to sign a consent form to confirm that you understand the procedure and agree to go ahead with it. You will be lying on a table which can be moved around. Mounted above is an x-ray machine. You will have an injection of local anaesthetic (which numbs the area) and may also be given a sedative to make you feel relaxed and sleepy.
The pacemaker is implanted just under the skin in a 'pocket' below your left collar bone. If you are left-handed the right side may be used instead. You will feel pressure as it is inserted. The doctor feeds the wire/s through a vein using x-ray guidance. They are then attached to the pacemaker. Stitches are usually inserted just under the skin to hold the pocket edges together. The scar is about 2" long and if the stitches are not dissolvable they will need to be removed a week later. The procedure usually takes about an hour.

After the implantation
A technician will programme the pacemaker before you go home. This is not painful but you may be aware of your heart beating slower or slightly faster than normal during programming. You will also have a chest x-ray and an ECG to check that the leads are in the right position. You can take painkillers such as paracetamol if you need them. You may be on a short course of antibiotics now or just before the procedure.

Going home
You may stay in hospital overnight or go home on the same day. Please make sure that you arrange a friend or relative to collect you and take you home. Your shoulder may feel uncomfortable for a week or so and you may have some swelling and bruising but this will return to normal in 2-3 weeks. You will be able to feel the pacemaker (and sometimes the wires beneath the skin) but do not worry, they wont pop out. You should be able to return to your normal activities in a week or so, avoid rigorous arm movements for a few weeks.
You must attend the pacemaker clinic for regular check-ups. These may be 3 - 12 monthly intervals depending on the type of pacemaker, for the rest of your life.

You must not drive for the first week after your implant. You must tell the driving Vehicles Licensing Authority (DVLA) that you have a pacemaker (Useful website links). If you have an HGV/PVC license you must not drive for 3 months after your implant.
A pacemaker registration card will be given to you following your implant, please carry it with you and show it to any doctor or dentist who may treat you.
Important - if you notice redness, swelling or a discharge at the site of your implant (signs of infection) please tell your GP immediately as infection can spread.

What are the risks of implantation?
There is a small risk of puncture of the lung (between 1% - 2%) as the vein used for the wire runs close to it. Sometimes no treatment is needed, and sometimes the escaped air has to be removed using a needle or small drain.
There is also a small risk of the wire slipping out of place (between 1% - 4%) if this happens it must be repositioned under x-ray guidance.
The risk of infection (1%) is potentially serious; it can be treated with antibiotics but if this fails then the whole pacemaker system may need to be removed and replaced.

If you have any further questions please contact the Arrhythmia Nurse Specialist on 01273 696955 Ext 4071.