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Pacemaker Implantation

A pacemaker is a small electronic device, which when implanted in your body, can generate electrical impulses to treat a slow heart rhythm.

The impulse generator is encased in a lightweight metal container which is about 2" in length, 1 1/2" in width, 1/8" thick, and 3 oz in weight. The generator consists of a tiny programmable computer, a battery and a connector.

One or two pacing leads are attached to the connector. They are insulated wires which have a small electrode on their tips. The leads are inserted into the right side of your heart, either in the upper chamber (atrium) or in the lower chamber (ventricle). The leads carry signals to and from the heart. When the heart receives a signal, it contracts (beats).

Are all pacemakers alike?
Your doctor can choose among many different types of pacemakers. He will evaluate which impulse triggering system is best for you, and whether you need a single- or dual-chamber pacemaker

Single-chamber pacemakers have one lead which goes into either the atrium or the ventricle. Dual-chamber pacemakers have two leads; one goes into each of the chambers.

Today, most pacemakers can be programmed for more than one triggering system. Some of the impulse triggering systems are : "demand" or "rate-responsive".

If you receive a demand pacemaker, your physician will program the generator to send out impulses if your heart beats below a minimum rate such as 60 beats per minute. A demand pacemaker can be single- or dual-chamber.

Rate-responsive or rate adaptive pacemakers change the rate of your heartbeat depending upon your activity level. So, for example, when you are playing tennis or dancing, the pacemaker will help your heart beat faster. These pacemakers slowly raise or lower your heartbeat from 60 to 140 or more heartbeats per minute. A rate-responsive pacemaker can be single- or dual- chamber.

Why has my doctor ordered a pacemaker for me?
Perhaps you complained about one or more of the symptoms of a slow heartbeat. These symptoms include: drowsiness, shortness of breath, blackouts, dizziness, fatigue, lightheadedness, or confusion.

You might have undergone diagnostic testing such as Electrophysiology Studies, electrocardiograms, echocardiograms, or Holter monitoring, to determine the existence and nature of an abnormal heart rhythm.

Based on the results of these tests, your symptoms, and a physical examination, your doctor has determined that a pacemaker will provide the best course of treatment for you.

What is an abnormal heartbeat?
Your heart has a natural pacemaker called the "SA node" or "sinus node". Normally, the SA node sends out an electrical impulse to the atria which cause them to contract. This starts the heartbeat.

Then the signal travels through another node (the AV node) into the ventricles through pathways called the "His bundle". The signal moves into the ventricles, causing them to contract.

Heartbeat problems can occur at any point along the signal path. An SA node problem can cause a slow heartbeat called "sinus bradycardia". The SA node may cause a heartbeat that alternates between being too fast and too slow. This is called "sick sinus syndrome". Signals may not leave the AV node or His bundles, and thus, never reach the ventricles. This is called, "heart block."

Your doctor will determine the exact nature of your heartbeat problem and select the appropriate pacemaker for you.

How should I prepare for the implantation?
You should not eat or drink anything for at least six hours before the procedure. Discuss your medications with your physician well in advance. He may ask you to stop taking some of them for a few days before the procedure. Refrain from using aspirin for a few days as well. You may take approved medications with small sips of water.

Usually, you will be allowed to choose whether the pacemaker is implanted near your left or right shoulder.. In making your decision, remember which hand you use when you talk on the telephone. Cellular phones must be held on the opposite side of your body from the pacemaker.

What happens before the procedure?
A doctor will explain the potential risks and complications of the procedure. These risks include: bleeding, severe bruising, tearing of a blood vessel, clotting, infection, and puncturing of the lung or heart muscle . These events are rare. Do not hesitate to ask questions and voice your concerns. You will be asked to sign a consent form.

How is a pacemaker implanted?
Although pacemaker implantation may be performed in an operating room, it is not open heart surgery.

Most likely you will be given a mild sedative to help you relax before the procedure. A nurse will shave and clean your chest to prevent infection. During the procedure, you will remain awake, but you will receive a local anesthetic to numb the site of insertion.

The doctor will make an incision just below the collarbone to create a small pocket. He will thread the pacing lead through a vein and into your heart. X-ray monitors will guide. her. If there is a second lead, the doctor will repeat the process.

The pacemaker generator is then connected to the leads, and placed under the skin into the small pocket. The pacemaker is programmed, and the incision is closed.

How long does the procedure take?
The procedure can sometimes take less than an hour, but usually lasts from one to two hours.

What will I feel after the surgery?
You may feel slight discomfort at the site of the incision. Ask the nurse for pain medication.

During your stay, your heart signals will be monitored, and your vital signs will be checked regularly. During this time, you should move your arm, but do not raise it above your head.

How long will I stay in the hospital?
The length of stay varies from hospital to hospital, and often depends upon the type of pacemaker and your general health. Occasionally, you will have to remain in the hospital for two nights. Most often you will have to stay for only one night following the implantation.

A growing number of physicians perform initial pacemaker implantation as an outpatient procedure with no overnight stay.

What happens before I leave the hospital?
Before your discharge, the pacemaker will be programmed to its final settings.

What problems can occur after insertion?
Although problems after insertion are rare, you should watch for indications that your pacemaker is not performing properly. Call your doctor if you have any of these symptoms:: dizziness, lightheadedness, lack of energy, fainting, chest pain, tenderness, redness, prolonged hiccoughing, difficulty in breathing, or swelling of the legs, ankles, arms or wrists.

How will having a pacemaker change my life?
There are very few limitations following pacemaker implantation. You may use common household appliances such as televisions, computers, and hair dryers. Microwave ovens pose no problem. Electrical equipment should be kept in good repair to avoid the possibility of an electric shock.

You should take your pulse rate for one full minute each day and call your doctor if the pulse rate is below the set amount of your pacemaker.

Exercise moderately every day. Your doctor can recommend the best exercise program for you.

You will receive an identification card for your wallet which has information about your pacemaker and emergency instructions.

At the airport, you should not walk through the metal detector because your pacemaker may set off an alarm. Don't let anyone place a hand-held screening wand near your pacemaker because the repetitive motions of the wand may temporarily interfere with the proper operation of your implant. Present your identification card and request a hand search.

Avoid the following:

  • smelting or induction furnaces or arc welders
  • junk yards that use large magnets
  • electronic equipment that may present a strong magnetic field
  • stereo speakers that are held in close proximity to the device.
  • large generators or power plants
  • CB or HAM radio antennae
  • large or defective electronic motors
  • amusement park attractions and rides where magnets are used.
  • auto engines with poorly shielded ignitions
  • working on car engines while they are running
  • putting a cellular phone in your breast pocket (even when it is turned off)
  • hand-held wands at bingo games
  • tight clothing over your pacemaker

Make sure your doctor does not schedule you for a Magnetic Resonance Imaging test (MRI). You must avoid contact with the machines that perform this test.

It's a good idea to wear an ID bracelet or necklace which has information about your heart rhythms and your pacemaker.

Tell your other doctors and dentist about your pacemaker. Keep ambulance or paramedic numbers close to the telephone.

Consult your physician before buying over-the-counter medications. and before taking a trip, vacation or moving.

Eventually, you will be able to lead an active lifestyle and may be able to do things you couldn't do before.

Your doctor will still want to see you regularly to examine you and check your pacemaker. Many doctors also use pacemaker clinics to monitor their patients. These visits will reveal any potential problems.

When May I Resume Activities?
During the healing process, you should refrain from lifting heavy objects and engaging in contact sports. Don't let anything hit or rub against your pacemaker.

There will be a few changes in your life; some of them will be temporary. For example, your doctor will ask you not to drive your car for awhile.

Expect a slow recovery. You may be aware of the pacemaker in the beginning, but you will adjust to it.

You will gradually resume your normal lifestyle. This will include returning to your job, traveling, exercise, sexual activity, pursuing hobbies and recreational activities.

Will I have follow-up visits with my doctor?
Initially, you will have regularly scheduled medical visits with your doctor or with a clinician at a pacemaker clinic to monitor your pacemaker and make changes to the pacing parameters, if necessary.

During these visits, you may undergo electrocardiogram (ECG) testing. The pacemaker battery will be checked.

You may have a magnet check to monitor and adjust the pacing parameters of your device. The clinician will place a magnetic wand over your body where your pacemaker is implanted. He can make program changes to the tiny computer inside the pacemaker. You will not feel anything.

If you received a rate-responsive pacemaker, you will briefly engage in informal exercise, during which the rate-responsive parameters will be adjusted to your needs.

Eventually, long term follow-up and monitoring will be performed trans-telephonically. You will be able to transmit information about the functioning of your pacemaker and your heart rhythms through a small device and your telephone. A clinic will receive this information in the form of a monitoring strip. Trained personnel at the clinic will review the monitoring strip and relay their findings back to you and your physician. If adjustments are required, you will be contacted to arrange a clinic visit.


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