Pacemaker Implantation

A pacemaker is a small device that's placed in the chest below the collar bone with wires going into the heart. It helps bring heart rate to normal in people with a very slow heart rate.

Pacemakers can be temporary or permanent.

Temporary pacemakers are used when slow heart rate is due to short-term heart problem, such as following a heart attack, due to medicine overdose or if serum potassium levels become high. They are also inserted in patients awaiting a permanent pacemaker.

Permanent pacemakers are used to control long-term slow heart rhythm problems.

Who needs a Pacemaker?

Doctors recommend pacemakers for many reasons. The most common reasons are bradycardia (i.e slow heart rate) which is usually seen with old age and if a person develops a heart block. In heart block electrical signal is slowed or disrupted as it moves through the heart. Heart block can happen as a congenital (i.e inborn) defect, result of aging or after a heart attack.

What To Expect During Pacemaker Procedure?

Placing a pacemaker requires minor surgical procedure done in cardiac catheterzation laboratory. Pacemaker is inserted just below the collar bone by making a small cut. It is done under local anaesthesia and you are awake during the procedure.

The two wires of the pacemaker are placed in heart through veins under X- ray guidance of the cath lab and than pacemaker's small metal box is placed through the cut, just under your skin, and is connected to the wires that lead to your heart. The entire procedure takes a few hours. You will stay in the hospital for 2-3 days and receive IV antibiotics. After discharge you have to avoid making the pacemaker site wet. Stiches will be removed after one week.

How Will a Pacemaker affect my lifestyle?

Any electrical device that can generate a strong magnetic field can potentially interfere with the pacemaker. So a patient with permanent pacamaker should be careful:

• Cell phones ( avoid keeping in the shirt pocket and hear from right side as mostly pacemaker is implanted on left side)
• High-tension wires
• Metal detectors
• Electrical generators

Some medical procedures can disrupt your pacemaker. These procedures include:

• Magnetic resonance imaging, or MRI ( not if you have a MRI safe procedure)
• Shock-wave lithotripsy or IVL (to get rid of kidney stones)
• Electrocauterization to stop bleeding during surgery

Your pacemaker can be programmed before these procedures and than they can be safely performed

What is a leadless pacemaker?

A leadless pacemaker is small self-contained device about the size of a large vitamin capsule, that is inserted inside the heart. There is no skin incision and no wires going through the heart. The device is inserted through a small puncture in the groin under X-ray guidance in a cardiac cathetherization laboratory. The advantage is no skin cut, less chances of infection, no wires so no chance of they moving from their place.

Who is a candidate for a leadless pacemaker?

Currently, the device is available only for patients who need single-chamber pacing only.