Pacemaker Surgery

Pacemaker Implantation May be Inpatient or OutpatientPacemaker surgery or the procedure to implant a pacemaker varies depending on a lot of things, such as, the type of device you are getting, whether it is a brand-new system or you are getting a battery change-out for a previously implanted system, your general health, and the local facilities. Pacemaker implantation is what is called “minimally invasive surgery” because only a small incision is made. In many cases, you will not be given general anesthesia and you will only be required to stay overnight in the hospital. Sometimes pacemakers are implanted as outpatient procedures (that is, you go home after the surgery without staying in the hospital) but that is not as common as an overnight stay.

Before the surgery, you will be prepped. The pacemaker is implanted in your upper chest. This region will be shaved (if necessary) and coated with a special medicine to make the area sterile. You will have an IV line and be given medicine to relax you, but you will be aware of your surroundings. In fact, at times the surgical team may actually talk to you. You will be given a shot of local anesthetic to numb the implant area.

In the operating room (or EP lab or cath lab, depending on the clinic or hospital), you will be draped, that is, the surgical nurses will arrange sheets in such a way that you are unable to see what is going on. You will be able to see and hear people around you.

One thing nobody ever warns pacemaker patients about is this: operating rooms are loud. Surgical teams make a racket. It is not unusual for the surgical team to play music in the background. Furthermore, they tend not to whisper to each other, but may even shout at each other across the room. Surgery is very important so if the surgeon asks a question, his or her team makes sure the answer is loud and clear. Plus, during the procedure, there are times when different people have to read out information or check on things–and it can get noisy. Do not let this throw you. It’s perfectly normal.

The surgeon or a nurse will ask you when the chest area is numb. At that point, a small incision is made and the doctor will shape a small “pocket” into which the pacemaker can be placed. You may feel pressure, but you should not feel any pain. If you do feel pain, tell a nurse or the doctor. The doctor will irrigate the pocket with antibiotics to prevent infection.

The doctor will then find a good vein, make a small incision, and carefully insert a wire or lead into the vein. He or she will maneuver the lead down the vein and into the heart. To do this, he or she will use something called a fluoroscope, a sort of video version of an X-ray machine. The fluoroscope is a big device and most doctors operate it using a foot pedal. It can be noisy, too. The fluoroscope will be used as the doctor guides the lead through the vein and into the heart. This is probably the most time-consuming part of the whole procedure, and you should not feel anything. Once in the heart, the doctor will affix the lead in place and then run some tests. During the tests, you may hear folks shouting numbers. It is not unusual for the doctor to remove the lead from one spot and test a couple of other spots to get the best numbers–he or she wants to find the spot in the heart that is going to be most responsive to pacing.

Your pacemaker may have one, two, or three leads. The more leads, the longer the procedure will take.

Once the lead(s) are affixed, the doctor will plug the lead(s) into the top of the pulse generator and slip it into the pocket in your upper chest. The device will be tested some more. When the doctor is satisfied that it is working properly, the pocket is sewn up with sutures. This will leave a scar that will likely fade over time.

You will then be brought to a recovery area. If you are staying overnight in the hospital, you will be brought to a ward. You may be hooked up to an ECG and other monitors, but this is perfectly normal.

Many things can affect how long the procedure will take–how many leads are required, the type of system you have, how quickly the doctor can get optimal values for the lead, how small or twisty your veins are, and your general health. A regular pacemaker can be implanted in about 45 minutes to an hour but more complex systems (such as the three-lead cardiac resynchronization device system) can take an hour or two.

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