Pacemaker Implant

What are pacemakers?

Pacemakers are devices that are implanted into the body.  These devices monitor the heart’s electrical activity, and when necessary, they generate a small electrical impulse which signals the heart to pump.  The delivery of the electrical impulse is called pacing.  Pacemakers are mostly used to prevent slow heart rates, or bradycardia .  They can also be useful when a person’s heart rate is too slow due to a medication that is important for them.  Pacemakers can also be used to make the bottom chambers of the heart (ventricles) beat at the same time, which can help some people who have heart failure .  Pacemakers do not get rid of atrial fibrillation.  Although, pacemakers may be used to prevent bradycardia caused by medications used to manage atrial fibrillation or to prevent bradycardia caused by AV node Ablation.

What are the basic types of pacemakers?

Your cardiologist or cardiology nurse practitioner will recommend the type of pacemaker that is best for your heart problem and your overall health.  Types of pacemakers include:

1. Standard Pacemakers: These pacemakers have wire(s) called leads that connect to the heart from a generator (contains the battery and pacemaker computer) that is implanted under the skin under the collar bone. Standard pacemakers can pace just the bottom of the heart (Single-Chamber Standard Pacemaker), they can pace both the top and the bottom of the heart (Dual-Chamber Pacemaker).
2. Biventricular Pacemakers are used in certain heart failure patients to pace the bottom chambers of the heart at the same time to help them beat together cooperatively, typically in coordination with the top of the heart. This is called cardiac resynchronization therapy (CRT).
3. Leadless Pacemakers: These are small pacemakers that are placed directly on the inside of the heart muscle and do not have wires. Leadless pacemakers are not visible from the outside of the body.  Because they have no leads (wires), they are less likely to have long-term mechanical problems, and they have a lower chance of infection.

What are the risks of pacemaker implant?

• Infection: There is a chance of getting an infection of the cut in the skin used to put-in the pacemaker. Signs of infection include redness, swelling, warmth, or fluid coming out of the cut. If you see any of these signs, tell your doctor right away.  If bacteria enter the blood stream, standard pacemakers can become chronically infected and require removal.
• Bleeding or Bruising: Sometimes, there might be a little bleeding or bruising around the cut used to put the pacemaker in.
• Allergic Reaction: Rarely, a person might have an allergic reaction to the materials used in the pacemaker or the medicine used during the procedure. If you have any known allergies, tell your doctor about them.
• Damage to Blood Vessels or Nerves: During the procedure, there is a small chance that the blood vessels or nerves near the cut used to put the pacemaker in might get hurt. This could cause pain, numbness, or weakness in that area. If you feel anything unusual, tell your doctor.
• Lung Collapse or Pneumothorax: In rare cases, standard pacemaker placement can cause lung collapse. This can make it hard to breathe or cause chest pain.  In severe cases, a chest tube is needed for a short period of time, but most of the time the lung re-opens on its own.
• Perforation or puncture of the heart: puncturing the heart during pacemaker implant can cause bleeding around the heart. This is serious but very treatable.
• Device-related Complications: Sometimes the device, or its wires, can move or break requiring replacement. Over time, the tissue around the device can become scarred or thickened. This might require adjustments or repositioning of the device.

Remember, these risks are unlikely.  Most people who get a pacemaker have no problems. Your medical provider will talk to you about the risks and take steps to make the procedure as safe as possible. If you have concerns or notice unusual symptoms after your pacemaker is implanted, talk to your cardiology team.  They are here to help you.

Why should I have this procedure with South Denver Cardiology?

Dr. Jehu Mathew, Dr. Ryan Jordan, Dr. Sri Sundaram, Dr. William Choe, Dr. Daniel Alyesh, and Dr. Nicholas Palmeri can implant pacemakers.  They specialize in understanding how these pacemakers work and how to safely place them.  They implant hundreds of pacemakers every year, and our center has consistently maintained a lower rate of complications than the average reported in the literature.

What do I need to do to prepare before the procedure?

A link to the pre-operative instructions can be found in the “Helpful Resources” links at the bottom of the page.

What happens during the procedure?

Your procedure will be done in an Electrophysiology Lab  at Porter Adventist Hospital, Swedish Medical Center, Littleton Adventist Hospital, Parker Adventist Hospital, or Castle Rock Adventist Hospital.  You will be given medications that make you feel calm, sleepy, and you may sleep through the procedure (conscious sedation).  The procedure usually takes 1-2 hours, and people often go home the same day.

During a pacemaker procedure, here’s what happens:

1. Getting Ready: Before the procedure, you’ll change into a special hospital gown. The doctors will clean the skin area used to put-in the pacemaker.
2. Sedation Medicine: You will be given medicine to make you calm and sleepy during the procedure and the access site will be numbed.
3. Getting access to implant pacemaker:
   1. Standard pacemaker: The doctor will make a small cut in your skin, usually below your collarbone.
   2. Leadless pacemaker: A straw-like piece of equipment called a catheter is threaded into a vessel in the upper leg (groin area) which leads to the inside of the heart.
4. Placing the pacemaker:
   1. Standard pacemaker: from the incision made under the collarbone, tiny wire(s) called lead(s) will be threaded into a blood vessel which leads to the inside of the heart. The tips of the lead(s) are connected to the heart tissue.  The other end of the leads are connected to the generator, the part of the pacemaker that contains the computer and battery.  The generator is about the size of pocket watch.  It is placed just under the skin at the site of the incision.
   2. Leadless pacemaker: the tiny pacemaker is guided through the catheter and connected to the heart tissue.

5. Checking and Programming: After placing the pacemaker, the doctor will test it to make sure it’s working well and the placement is good. They will also program the pacemaker with the right settings for your heart’s needs.
6. Closing-Up:
   1. Standard pacemaker: the incision is closed with stitches that dissolved and surgical glue and/or tiny pieces of tape are left on the surface of the skin to ensure the incision stays closed. In some cases, there may be staples or sutures at the surface of the skin that need to be removed later.   The incision will be covered with a large bandage overnight to keep it clean and put pressure on it.
   2. Leadless pacemaker: the catheter is pulled out of the body and the incision site is closed with a stitch. There will be a small dressing over the incision overnight to keep it clean.

What happens right after the procedure?

You’ll be taken to a special area where you’ll rest while you are monitored by the nursing staff:

1. Monitoring You: The medical team will keep a close eye on you to see how your body is doing after the procedure. They will check your heart rate, blood pressure, and other important vital signs to make sure everything is okay.
2. Taking Care of the Incision: Your incision will be monitored to ensure it is not bleeding.
3. Managing Pain: If you feel any pain or discomfort, nurses will give you medicine or use other ways to help you feel better.
4. Instructions for returning home: You will be given written instructions to take home with you. Before you leave the hospital, be sure to ask any questions about your discharge instructions that you may have.
5. Going Home: Once the staff ensures you’re doing well, you’ll be able to go home. It’s important to have a responsible adult with you to make sure you get home safely. You will likely be discharged the same day as your procedure. Remember that everyone’s recovery is different; you may have specific needs.  In some cases, it’s best to stay the night in the hospital.

How will I feel right after the procedure? 

1. Soreness and Bruising: It is common to experience some soreness and bruising at the incision. Ice and/or Tylenol is typically all that is needed to manage the pain.
2. Relief of Symptoms: many people do not feel any different after a pacemaker. If your heart rhythm was slow enough to cause fatigue, lightheadedness, or shortness of breath, you may notice improvement in these symptoms quickly.

What should I expect during the healing period and beyond?

The post-operative instructions (also called “Discharge” or “DC” Instructions) can be found in the Helpful Resources links below.  These instructions contain all the details about activity restrictions, work, travel, caring for the incision, and follow-up appointment schedule.  If you have further questions about the procedure or post-procedure course, contact the South Denver Cardiology electrophysiology nurses through the patient portal.