Pacemakers

Understanding Pacemakers

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A pacemaker helps to regulate your heart rhythm. A small device about the size of two stacked silver dollars, a pacemaker is placed under the skin of your chest just below the collarbone. The device runs on batteries and sends out electrical impulses that keep the heart beating at its proper rate. A pacemaker has two parts:

• A pulse generator, which is the battery/timer unit.
• One or more electrodes and wires that carry the electrical impulses to the heart.

The pacemaker is always sensing your heartbeats. It paces your heart only when it has waited a certain amount of time and your heartbeats have not occurred. A pacemaker will keep your heart contracting and pumping blood. It is needed when there is a problem with your heart’s electrical system, which can cause very slow heartbeats or both fast and slow heartbeats.

Some symptoms that may indicate a problem are:

• Dizziness
• Fainting spells
• Shortness of breath
• Blurred vision

Before Pacemaker Insertion

• Do not eat or drink anything for a number of hours before surgery.
• You may be given a Betadine Scrub to shower at home before you are admitted.
• Your upper chest may be shaved.
• Your skin will be numbed.
• You will get medication to relax you but not put you to sleep.

During Pacemaker Insertion

Having a pacemaker implant is not considered major surgery. The procedure takes about about two hours and is done in the cardiac catheterization lab. The surgeon or cardiologist makes a 3- to 4-inch incision in the upper chest area, and a small pocket is made under the skin over a vein. The pacemaker will sit in this pocket. As the surgeon or cardiologist watches progress on a monitor, the wires are guided through a vein into the heart’s chambers The electrode rests directly against the inner wall of the heart. The pulse generator is attached to the wires and placed in the pocket under the skin.

After Pacemaker Insertion

Will the pacemaker hurt?

No. Patients with a pacemaker say that they are not able to feel it when it is working. You will, however, have an incision that will need to heal–just below your shoulder where the pacemaker is inserted. If you are uncomfortable, let your nurse know and you will be given medication to control pain.

Can the pulse generator of my pacemaker be changed?

Most pacemakers can be programmed. This means the doctor can adjust the pacemaker from the outside of the body, without surgery. The lifespan of a pacemaker depends on how much it is being used and how much energy is required to pace the heart.

What can I do when I get home?

Your doctor will give you specific instructions. But here are some general guidelines:

• Do not get water on the incision for at least seven to ten days following surgery.
• Take sponge baths for seven to ten days.
• Your doctor will instruct you on how to care for your incision.
• You will need to make an appointment to have your stitches removed.
• You may have tiny strips of tape placed over the incision instead of stitches; these can be removed if they don’t wear off after a few weeks.
• If your doctor has prescribed antibiotics, take them as directed until they are gone.
• Do not lift more than 5 pounds.
• Do not play tennis or other vigorous activities for a few weeks.
• Avoid contact sports that could result in the pacemaker being hit or crushed.
• Slow, circular arm exercises may help the soreness go away.
• Eat a balanced diet.

Potential Complications

As with any operation, possible complications include bleeding problems or infection. Problems specific to pacemaker implants include the possibility of a wire becoming dislodged after surgery, which would require a return to the catheterization lab to have it repositioned. Another possible complication is collapse of a lung when the wire is passed under the collarbone into the subclavian vein and then into the heart. Talk to you doctor about the risks so you are fully informed.

Call your doctor or seek medical treatment if:

• The incision is red or draining.
• The incision is hot to touch or very tender.
• You have a fever.
• You have any other unusual symptoms