Pacemaker implantation is a relatively simple procedure that improves the quality of life of patients with abnormal heart rhythm.
Your heart has its own internal electrical system that controls the rate and rhythm of your heartbeat. This conduction system consists of groups of cells that act like wires and a generator by initiating and carrying electrical impulses through the heart muscle. These coordinate impulses establish your heart rate and rhythm.
Arrhythmias are problems with the rate or rhythm of the heartbeat. During an arrhythmia, the heart can beat too fast (tachycardia), too slow (bradycardia), or at an irregular rhythm. During an arrhythmia, the heart may not be able to pump the blood to the body properly. This can cause symptoms such as fatigue, shortness of breath or loss of consciousness (syncope).
Pacemakers are used to treat arrhythmias. Each year, more than 200,000 Americans receive a pacemaker. This device uses electrical pulses to prompt the heart to beat at a normal rate. A pacemaker is a small device, about the size of a pocket watch, which is implanted under the skin in the chest, via minor surgery (using local anesthesia). When you receive a pacemaker, it is programmed to match your heart as efficiently as possible (rate-responsive), meaning that it increases or decreases the heart rate according to basal activity.
There are two primary types of pacemakers: a standard pacemaker that triggers the chambers of the heart, and a combination of an internal defibrillator and pacemaker, known as a cardioverter defibrillator or pacemaker defibrillator.
The standard type of pacemaker sends an electrical impulse via special wires. Your doctor will decide what type of pacemaker you need based on your heart condition.
– Single chamber pacemaker: Uses one lead in the upper (atrium) or lower (ventricle) heart chamber.
– Dual chamber pacemaker: Uses one lead in the upper chamber and one lead in the lower chamber of the heart.
– Biventricular pacemaker (cardiac resynchronization theraphy): Uses three leads placed in the right atrium, the right ventricle and the coronary sinus vein (left ventricle).
A second type of pacemaker, the combination of an internal defibrillator and pacemaker, also known as an implantable cardioverter-defibrillator (ICD), sends an electrical impulse to the heart to control the heart’s rate and rhythm, just as a standard pacemaker does. In addition to that function, it can also deliver a shock to stop a lethal rhythm.
A pacemaker implant is generally a very safe procedure. In most cases, the procedure takes place in a pacemaker lab or an operating room. To prevent infection, an antibiotic will be given through an intravenous (IV) line in a vein in your arm or hand. The left or right side of your chest will be shaved and sterile drapes are used to cover you from your neck to your feet. We use local anesthesia and medication to relax you, but you will not be asleep during the procedure. The nurse will connect you to several monitors that allow the surgeon to check your heart rhythm and blood pressure. A large X-ray machine will be positioned above you to guide the procedure on an X-ray screen.
A local anesthesia is given to numb the area. A little incision is made in the chest and the lead(s) inserted through the incision into a vein, and then guided to the heart. The lead tip attaches to the heart muscle and the other end of the lead is attached to the pulse generator. After the leads are in place they are tested to make sure they function properly. Finally, the generator is placed in a pocket created under the skin in the upper chest. The pacemaker implant procedure may last from 1 to 4 hours.
After the procedure:
You will be admitted to hospital and you will stay overnight after the procedure. Usually you will be able to go home the day after the procedure. In your hospital room, a special monitor, called a telemetry monitor, will continually monitor your heart rhythm to ensure that the pacemaker is functioning properly. A chest X-ray will be carried out before you are discharged to check your lungs, as well as the position of the pacemaker and leads. We check the incision too.
You will receive specific instructions about how to care for yourself after the procedure including medication guidelines, wound care, activity guidelines, pacemaker care and a follow-up schedule. You will also receive an ID card that indicates what type of pacemaker and leads you have, the date of implant and the doctor who performed the implant. Carry this card with you at all times in case medical care is needed.