Permanent Pacemaker

What is it?

A pacemaker is a device used to supplement the electrical activity of the heart in patients whose heart is not conducting correctly, i.e their heart rate is beating too slowly, “bradycardia”. It generally does not provide benefit when the heart beats too quickly.

A Biventricular Pacemaker is a pacemaker that paces on both sides of the heart. In selected cases, resynchronising the heart in this fashion can improve cardiac function.

The pacemaker consists of two components, the generator, or battery, and the leads or wires. The generator is about the size of two stacked 50c coins and is implanted under the skin beneath your collarbone.  This is connected to the leads or wires which rest inside your heart. The wire is very soft and flexible and can withstand the twisting and bending caused by body movements.

Preparation

Fasting is required for 6 hours prior to the admission time. Blood thinning medication may need to be stopped a few days before the procedure; however the cardiologist will advise on this. The patient can expect to be in hospital for 1-2 nights.

Procedure

• On admission to the hospital you will have an ECG and may have bloods taken
• Your chest will be shaved and painted with an antiseptic solution called Betadine. The procedure will take about half to one hour
• You will be given some light sedation via an intravenous line to help you relax and feel comfortable during the procedure. You will be awake but drowsy
• The doctor will give some local anaesthetic to numb the area just below your collar bone where the pacemaker will be inserted
• When the area is numb the doctor will then make a small cut (approx. 4-7cm long) to insert the pacemaker
• The leads are then guided through a vein into your heart and then connected to the generator or battery
• The skin is sewn together and a small dressing is placed over the wound site
• The stitches (if not dissolvable) will be removed in approximately 7 days
• The dressing is usually removed the day after the procedure
• If you require a shower while the dressing is still intact it will be covered with plastic to prevent it getting wet

Your recovery

On your return to the cardiac care unit you will have your heart rhythm and blood pressure monitored. You will also have another ECG and chest X-ray. The wound site will be observed for swelling and bleeding. Pain relief for wound discomfort will be given if required.

You will be discharged when your cardiologist is happy with your progress, usually 1-3 days post operatively.

You will receive an information booklet after your procedure detailing information about living with a pacemaker.

Following discharge

• If you have a temperature please let the hospital / cardiologist know asap
• If you are unsure about your medication please contact your doctor
• Whilst the site is healing, avoid wearing tight clothing that could rub and cause you discomfort over the wound site
• Let the hospital know immediately if your wound becomes red or swollen or starts to ooze
• You can shower/bath as normal, but you must keep your wound dry. You will be advised if you need removal of sutures
• A follow up appointment will more than likely be organised for 2-4 weeks later in the consulting rooms

If you are a patient undergoing this procedure and you have any further queries, please raise them with your cardiologist.

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