What is a pacemaker?
A pacemaker is a small electronic device that helps regulate a slow heartbeat. The
pacemaker is usually implanted in the chest, just below the collarbone. Your doctor
may recommend this device to keep your heartbeat from slowing down to a dangerously
The heart is a pump made up of muscle. The muscle is stimulated by electrical signals.
These signals normally follow a specific circuit within the heart. These signals organize
contractions of the different parts of the heart. This makes it beat at a rate that
keeps blood flowing around the body the way it should. A pacemaker may be needed when
there are problems with the electrical signals in the heart. Your heart may sometimes
beat too slowly, or at an irregular rate.
A pacemaker is made of 3 parts. They include a pulse generator, 1 or more leads, and
an electrode on each lead. A pacemaker signals the heart to beat when the natural
heartbeat is too slow or irregular.
Why might I need a pacemaker?
Your healthcare provider may advise
a pacemaker when your heart beats too slowly and this can't be fixed with other
treatments. A pacemaker will cause a faster heart rate.
Problems with the heart rhythm may
mean your heart is not pumping enough blood to the body. If your heart rate is too
the blood is pumped too slowly. If the heart rate is too fast or too irregular, the
heart chambers are unable to fill up with enough blood to pump out with each beat.
Medicines are often used to slow down these fast heart rhythms. But the medicines
also result in slow heart rates when the rhythm is normal. When the body does not
enough blood, symptoms such as tiredness, dizziness, fainting, or chest pain may
Some examples of problems for which
a pacemaker might be needed include:
Bradycardia.This is when the heart beats too slowly.
syndrome. This is characterized by alternating fast and slow
This occurs when the electrical signal is delayed or blocked as it
travels through the heart muscle. There are several types of heart blocks.
Your healthcare provider may have
other reasons to advise pacemaker insertion.
What are the risks of pacemaker insertion?
Risks of pacemaker insertion
Reaction to the anesthetic or sedatives used during the
Swelling or bruising in the upper chest area where the pacemaker
device is placed
Bleeding from the cut (incision) or
catheter insertion site
Damage to the vessel where the
catheter is put into the heart
Infection of the incision or catheter
Bleeding that can occur from the heart
with blood accumulating in the sac (pericardium) surrounding the heart (pericardial
Lead displacement. This means the
wires of leads of the pacemaker become disconnected or displaced. You may need
another procedure to reposition them.
Mechanical problems with the pacemaker device
Kidney damage from contrast dye used in the placing the
For some people, having to lie still on the procedure table for the length of the
procedure may cause some discomfort or pain.
There may be other risks. This
depends on your specific health condition. Be sure to discuss any concerns with your
healthcare provider before the procedure.
How do I get ready for pacemaker insertion?
Your healthcare provider will explain
the procedure to you. He or she will ask if you have any questions.
You will be asked to sign a consent
form. This gives your permission to do the procedure. Read the form carefully. Ask
questions if anything is not clear.
Tell your healthcare provider if you
are sensitive to or are allergic to any medicines, iodine, latex, tape, or anesthetic
agents (local and general).
You will need to fast (not eat or
drink) for a certain period before the procedure. Your healthcare provider will tell
you how long to fast, usually overnight or at least 8 hours before the
Tell your healthcare provider if you
are pregnant or think you might be, or if you are breastfeeding.
Be sure your healthcare provider knows
about all medicines, vitamins, herbs, and supplements that you are taking. This
includes both prescription and over-the-counter medicines.
Tell your healthcare provider if you
have a history of bleeding disorders or if you are taking any anticoagulant
(blood-thinning) medicines. This includes aspirin, or other medicines that affect
blood clotting. You may need to stop taking some of these medicines before the
Tell your healthcare provider if you have heart valve disease.
You may need to take antibiotics before the procedure.
You may need a blood test before to
the procedure. This is to see how long it takes your blood to clot. You may need
other blood tests and a chest X-ray as well.
You may get a sedative before the
procedure. This is to help you relax. If a sedative is used and you go home right
afterward, plan to have someone to drive you home. You will likely spend at least
night in the hospital after the procedure. This is to watch your heart and make sure
the pacemaker is working the way it should.
Based on your medical condition, your
healthcare provider may request other specific preparation.
What happens during pacemaker insertion?
A pacemaker insertion may be done
on an outpatient basis. Or it may be done as part of your hospital stay. The procedure
may vary depending on your health and how your healthcare provider does the
Generally, a pacemaker insertion follows this process:
You will be asked to remove any
jewelry or other objects.
You will be asked to remove your
clothing and will be given a medical gown to wear.
You will be asked to empty your bladder before the procedure.
If there is a lot hair at the incision site, it may be shaved off.
An IV (intravenous) line will be
started in your hand or arm before the procedure. This is to give you medicine and
You will lie on your back on the procedure table.
You will be connected to an
electrocardiogram (ECG) monitor. This records the electrical activity of your heart.
It monitors your heart during the procedure using small, plastic electrodes that
stick to your skin. Your vital signs will also be watched during the procedure. These
include your heart rate, blood pressure, breathing rate, and oxygen level.
You will get a sedative in your IV
before the procedure to help you relax.
The skin at the pacemaker insertion site will be cleaned with antiseptic soap.
Sterile towels and a sheet will be placed around this area.
A local anesthetic will be injected into the skin of the chest at the insertion site.
Once the area is numb, the healthcare
provider will make a small cut (incision) at the insertion site.
A sheath is put into a large blood
vessel. The sheath is also called an introducer. It is usually put under the
collarbone. The sheath is a small plastic tube. The provider will thread the pacer
lead wire or wires through this tube into the blood vessel and advance them into the
It will be very important for you to
stay still during the procedure. This is so that the catheter does not move. This
helps to prevent damage at the insertion site.
The provider will thread the lead wire
through the sheath into the blood vessel. The provider will advance the lead wire
through the blood vessel into the heart. A type of moving X-ray is displayed on a
screen (fluoroscopy) may be used to help check the location of the leads.
Once the lead wire is inside the
heart, it will be tested to be sure it’s in the right location and it works. There
may be 1, 2, or 3 lead wires inserted. This depends on the type of device your
healthcare provider has chosen for your needs.
The lead wire is attached to it to the
pacemaker generator. Then the provider will slip the generator under your skin
through the incision just below the collarbone. The generator is often placed on the
non-dominant side. This means if you are right-handed, the device will be placed in
your upper left chest. If you are left-handed, the device may be placed in your upper
The pacemaker will be checked to be
sure that it is working correctly.
The skin incision will be closed with sutures, adhesive strips, or a special glue.
A sterile bandage or dressing will be applied.
What happens after pacemaker insertion?
In the hospital
After the procedure, you may be
taken to the recovery room or returned to your hospital room. A nurse will watch your
Tell your nurse right away if
you feel chest pain or tightness, trouble breathing, or pain at the insertion
After a period of bed rest, you
may get out of bed with help. The nurse will be with you the first time you get up.
He or she will check your blood pressure while you are lying in bed, sitting, and
standing. Move slowly when getting up from the bed. This is to prevent dizziness.
You will be able to eat or drink
once you are fully awake.
The insertion site may be sore
or painful. You can take pain medicine if needed. Your arm may be placed in a sling
overnight. Your provider will give you specific instructions about activities you
and can’t do. He or she will talk with you about how to keep your arm from moving
after the procedure. You will have a chest X-ray to make sure your lung was not
injured during the procedure, and to check the device position. You may be prescribed
antibiotics. These are to help prevent an infection around your pacemaker or at the
Once your blood pressure, pulse,
and breathing are stable and you are alert, you will be taken to your hospital room.
Or you may be allowed to go home. It’s common to spend at least 1 night in the
hospital after a pacemaker implantation. Make sure to have someone drive you home
when you are discharged.
You should be able to return to
your normal daily routine within a few days. Your healthcare provider will tell you
if you will need to wait. Don't lift or pull anything for a few weeks. You may also
need to limit movement of your arm on the side that the pacemaker was placed.
You will most likely be able to
go back to your usual diet, unless your healthcare provider tells you
Keep the insertion site clean
and dry. You will be told how to bathe or shower safely.
Your healthcare provider will
give you specific instructions about driving.
Ask your healthcare provider
when you will be able to return to work. The nature of your work, your overall
health, and your progress after surgery will determine how soon you may go back to
Call 911 if you have severe chest pain or trouble
Contact your healthcare provider
right away if you have any of the following:
Fever of 100.4°F (38°C) or higher,
or as advised by your healthcare provider
Increased pain, redness, swelling,
or bleeding or other drainage from the insertion site
Chest pain or pressure, nausea or
vomiting, profuse sweating, dizziness, lightheadedness, fainting, or lack of
Rapid or pounding heartbeat
Swelling in the arms or hands on
the side of the incision
Hiccups that will not stop
Muscle twitching in your belly
Shortness of breath
After a pacemaker insertion, you
will need to keep regular appointments to ensure the pacemaker is working the way
should. The healthcare provider uses a special computer, called a programmer, to
review the pacemaker's activity and adjust the settings when needed. A remote monitor
may also be used to allow the pacemaker to be checked at your home via the internet
Your healthcare provider may
give you other instructions after the procedure, depending on your particular
Things to keep in mind
Always consider the following
precautions. Discuss these in detail with your healthcare provider, or call the
company that made your device:
Always carry an ID card that states
you have a pacemaker. You may want to wear a medical ID bracelet or necklace
saying that you have a pacemaker.
Let security screeners know you
have a pacemaker before going through security detectors at the airport or court
house. In general airport detectors are safe for pacemakers, but the small amount
of metal in the pacemaker and leads may set off the alarm. If you are selected for
additional screening by hand-held detector devices, tell the screeners that the
detector wand should not be held over your pacemaker for more than a few seconds.
This is because the detector wand contains magnets that may affect the function or
programming of your pacemaker.
Most modern pacemakers are safe in
an MRI machine. Check with your healthcare provider before having an MRI scan.
Don't go near large magnetic fields
such as power generation sites and industrial sites such as automobile junkyards
that use large magnets.
Don't use short-wave or microwave
diathermy that uses high-frequency, high-intensity signals. This may be used in
physical therapy to treat muscles. The signals can interfere with or damage your
Turn off large motors, such as cars
or boats, when working close to them. This is because they may create a magnetic
Don't go near high-voltage or radar
machinery, such as radio or television transmitters, electric arc welders,
high-tension wires, radar installations, or smelting furnaces.
If you need a surgery in the
future, tell the surgeon that you have a pacemaker well before the operation. Ask
your cardiologist if you need to do anything before, during, or after the surgery.
Ask about the safety of the electrocautery device often used during surgery to
control bleeding. This may interfere with the pacemaker. In some cases, the
pacemaker's programming will be temporarily changed with a magnet during the
surgery. This is done to lessen the risk of interference from the
During any physical or sports
activity, protect yourself from trauma to the pacemaker. A blow to the chest near
the pacemaker can affect its function. If you are hit in that area, see your
healthcare provider to make sure your pacemaker is working the way it should
Cell phones in the U.S. with less
than 3 watts of output don't seem to affect pacemakers or the pulse generator. But
to be safe, keep cell phones at least 6 inches away from your pacemaker. Don't
carry a cell phone in your breast pocket over your pacemaker.
Talk with your healthcare provider
if you feel ill after any activity, or if you have questions about starting a new
Always contact your healthcare
provider if you have any questions about using any equipment near your pacemaker.
Your healthcare provider may give you a list of other devices and procedures to
Before you agree to the test or the procedure make sure you know:
The name of the test or procedure
The reason you are having the test or procedure
What results to expect and what they mean
The risks and benefits of the test or procedure
What the possible side effects or complications are
When and where you are to have the test or procedure
Who will do the test or procedure and what that person’s qualifications are
What would happen if you did not have the test or procedure
Any alternative tests or procedures to think about
When and how will you get the results
Who to call after the test or procedure if you have questions or problems
How much will you have to pay for the test or procedure