PACEMAKER INSERTION
What is a pacemaker?
A pacemaker is a sophisticated electronic device that consists of a battery and leads. It sits under the skin, usually on the left side under the clavicle (collar bone) and sends electrical signals to your heart to help it beat normally. Specialised pacemakers e.g. cardiac resynchronisation therapy [CRT] pacemakers) may have an additional lead on the left side of the heart.
The pacemaker monitors the heart’s own electrical system. When it senses the failure of your heart to send an electrical message, the pacemaker will provide the beat. When necessary, it regulates the frequency of the heartbeat (i.e. it sets the heart rate) and coordinates the contraction of the heart muscle, so that the heart beats effectively.
Why do I need to have a pacemaker?
Most pacemakers are designed to correct bradycardias (slow heart beats). Abnormally slow heart rhythms can cause weakness, fatigue, dizziness, loss of consciousness or even death.
Your doctor may also recommend a pacemaker if you are experiencing heart arrhythmias (irregular heartbeats) that are not being treated effectively with medication.
What does a pacemaker insertion involve?
Insertion of a pacemaker is a common procedure. It requires minimally invasive surgery, which is done under local anaesthetic and sedation and takes approximately one hour.
Where do I go to have the procedure?
Pacemaker insertion is performed in the hospital setting at Peninsula Private Hospital. You will be required to remain overnight for monitoring.
What do I need to bring?
Your hospital admission paperwork with a signed consent form, health insurance details and Medicare /DVA card. Bring your usual medications in their original packaging and an overnight bag.
What do I wear?
Wear clothing that is easy to remove as you will be asked to change into a hospital gown prior to the procedure.
Where do I go to have the procedure?
Pacemaker insertion is performed in the hospital setting at Peninsula Private Hospital. You will be required to remain overnight for monitoring.
What do I need to bring?
Your hospital admission paperwork with a signed consent form, health insurance details and Medicare /DVA card. Bring your usual medications in their original packaging and an overnight bag.
What do I wear?
Wear clothing that is easy to remove as you will be asked to change into a hospital gown prior to the procedure.
What happens during the procedure?
You will be given a local anaesthetic to numb your collarbone area as well as intravenous sedation analgesia and antibiotics prior to the procedure.
- A small incision (5 – 8 cm) is made under the clavicle (collarbone) and a “pocket” for the pacemaker battery is fashioned in the tissue under the skin.
- The leads are inserted through a vein near the site of the pocket and advanced into the right side of your heart using x-rays for guidance.
- The leads are attached to the inside of the heart via tiny screws and then connected to the battery.
- The pacemaker battery is tucked inside the pocket, under the skin, and the incision is closed with dissolvable stitches and a waterproof dressing applied to the area.
- The pacemaker is then programmed so that the software inside the device suits your individual needs, it “listens to your heart”.
How long does the procedure take?
The procedure takes approximately one hour.
What are the risks?
Pacemaker insertion is a low-risk procedure.
The most common risk for this procedure is bruising or swelling at the pacemaker site.
Although complications are rare, you should be aware of the following risks:
- Collapsed lung from needle puncture while searching for the vein under your collarbone.
- Dislodgement of the pacemaker leads – this may require a repeat procedure to fix the problem.
- Bleeding at pacemaker site requiring evacuation of clot.
- Infection at the pacemaker site – this is a rare but difficult problem to treat and usually requires pacemaker and lead removal.
- Lead fracture/failure can occur from the wear and tear.
Recovery and follow-up
There will be a visible bulge under the skin where the pacemaker has been inserted.
You will require a chest X-ray and pacemaker check on the day of discharge.
You may feel mild tenderness at the site but this should settle within a few days. You should not drive your car, lift your arm above your head or remove the dressing for 2 weeks after the procedure. There are no stitches to remove.
You may otherwise resume your normal daily activities.
You will be required to return to the clinic in 2 weeks for a wound and pacemaker check.
Periodic pacemaker checks with your cardiologist (usually 6 – 12 monthly) will be necessary, to check on pacemaker function and how dependent you are on the pacemaker.
When the battery gets too low (8-12 years, depending on how often your heart is using the pacemaker), you will need to have a generator/battery change. A generator change is similar to the pacemaker insertion procedure except that the leads will remain in place and you can be discharged on the day of the procedure.
What devices can interfere with pacemakers?
Refer to you pacemaker information booklet.
The following information will help to avoid interference of your pacemaker:
- Home appliances should not cause any concern.
- Devices that generate powerful magnetic fields (e.g. arc welders) can inhibit the function of pacemakers and should not be used.
- Mobile phones should be carried in the opposite side pocket your pacemaker as they can potentially affect its function if in close proximity.
- MRI scanners can interfere with the pacing function. Always confirm if your pacemaker is MRI-safe.
- Radiation therapy for cancers can damage the circuits of a pacemaker and should be shielded from the radiation field. Occasionally, the pacemaker may need to be re-positioned.
Results and follow-up
Follow-up appointments will be made on discharge. A copy of your procedure will be provided to your referring doctor and placed in your medical history.
