Permanent Pacemaker Insertion

What is it?

Pacemakers are commonly used to treat patients’ whose heart beats too slowly, but can also be used to regulate an abnormally high heart rate, or to treat severe heart failure. A pacemaker is a small batter operated device that helps your heart beat normally. The pacemaker resets the heart rate to an appropriate pace, ensuring adequate blood and oxygen are delivered to the brain and other parts of the body.

How does it work?

A pacemaker contains a powerful batter, electronic circuits and computer memory that together generate electronic signals. The signals, or pacing pulses, are carried along thin, insulated wires, or leads. The signals cause the heart muscle to begin the contractions that
cause a heartbeat.

The pacemaker is programmed to stimulate the heart at a pre-determined rate, and settings can be adjusted at any time. Routine evaluation, sometimes even via telephone, ensures the pacemaker is working properly and monitors battery life, which generally runs from five to ten years.

What to expect?

A permanent pacemaker insertion is considered minor surgery, and can be done on an inpatient or an outpatient basis. The procedure may be performed in an electrophysiology laboratory, operating room, or outpatient surgical facility. 

The patient is given a local anesthetic, and the insertion site is cleaned and shaven. In most cases, the pacemaker is inserted beneath
the skin on the front of the chest under the clavicle (collarbone).  The physician will incise the chest wall just below the clavicle to create a small pocket, into which the pacemaker is placed. Wires attached to the pacemaker (pacemaker leads) are then passed through a vein in the upper chest and directed to the right atrium or right ventricle. The leads, which are used to stimulate the contractions of the heart, are then attached to the inner surface of the heart chamber using small screws or tines. Following insertion, the skin is closed with sutures or staples.

A hospital stay of 1 to 2 days may be required for the physician to confirm that the patient’s condition is stable and the pacemaker functioning. The physician may also perform one or more tests.  An x-ray, ECG, and echocardiogram help make sure the pacemaker
and leads are in the proper location and working correctly.