What is an implantable pacemaker?

In this surgical procedure, surgeons implant a device called a pacemaker, which regulates heart rate and rhythm.

Why is it done?

It is performed to treat abnormal heart rates or rhythms (arrhythmia), particularly if they have not responded well to drug therapy (medication).

What is done?

There are several ways of implanting the leads of an ICD:

  • Transvenous approach: Transvenous means through a vein. In this method, a small incision is made near your collarbone and the leads are maneuvered through a vein into the heart. The tip of each lead is positioned next to the inside wall of the heart (the endocardium).
  • Thoracotomy: In this approach, your chest is opened and thin oval patches made of rubber and wire mesh are sewn onto the outside of the heart (epicardium). These patches are connected to the leads.
  • Sternotomy: This approach is similar to a thoracotomy in that the chest is opened. The difference is that the incision is made over the breastbone (the sternum) and the leads are advanced into the heart. A sternotomy may be combined with coronary artery bypass surgery or heart valve surgery.
  • Subxiphoid approach: This approach is also similar to a thoracotomy, but the incision is made slightly to the left of the breastbone (sternum).

Once the leads are in place and tested, they will be connected to the ICD unit. The ICD is then placed under the skin, either near the collarbone or somewhere above or at the waistline.

What can you expect?

Before the operation

Usually, the procedure is scheduled ahead of time. A week or so before your operation, you will probably be asked to visit your hospital. Various tests, such as blood and urine tests, an electrocardiogram, and other tests may be performed. Your doctor will explain the risks and benefits of the procedure and you will be asked to sign a consent form.

Before the procedure starts, inform your doctor if you:

  • Have ever had a reaction to any contrast dye, iodine, or any serious allergic reaction (for example, from a bee sting or from eating shellfish).
  • Have asthma.
  • Are allergic to any medication.
  • Have any bleeding problems or are taking blood-thinning medication.
  • Have a history of kidney problems or diabetes.
  • Have body piercings on your chest or abdomen.
  • Have had any recent change in your health.
  • Are, or may be, pregnant.

During the operation

Endocardial lead positioning

  • This is the most common procedure for implanting a pacemaker.
  • You will be awake throughout the procedure.
  • You will be given a sedative to help you relax and local anesthetics in areas that are involved in the procedure (usually the upper chest area).
  • A thin, flexible tube (catheter) will be inserted into a blood vessel and, using a fluoroscope (similar to an X-ray picture to visualize the catheter), threaded into the heart.
  • Once in the heart, the leads will be attached to the inside lining.
  • The leads will be tested to ensure they are working correctly.
  • From time to time, you may be asked to take deep breaths or cough vigorously in order to test the placement of the leads.Once the leads are in the best locations, they will be plugged into the pulse generator.
  • The pulse generator will be slipped into a small pocket made just beneath the skin of your upper chest or your abdomen.
  • You may feel slight pressure while the leads and pulse generator are being inserted into the pocket.

Epicardial lead positioning

  • Because a larger incision is made in the chest, this procedure is usually performed under a general anesthesia and you will be asleep.
  • The exterior surface of the heart is exposed and the leads attached directly to the surface (epicardium) of the heart.
  • The pulse generator is usually placed under the skin in the upper abdomen, but may also be placed in the upper chest area.

After the operation

  • Once surgery is completed, you will be taken to a recovery room.
  • There may be some soreness around the site where the pulse generator was implanted, but it can be managed with pain medication.
  • Depending upon your condition and which procedure you had, you may stay in the hospital anywhere from several hours to a few days.

At home

When you return home, keep an eye on your incisions.

  • Some bruising is normal but contact your doctor if you experience increased pain, redness, swelling, bleeding or other draining from an incision, fever, or chills.
  • Most people are aware of their pacemaker for a short time following its implantation, but this sensation usually decreases with time.
  • It is OK to take a shower, bathe or engage in usual sexual activity.
  • During the initial eight weeks, avoid sudden, jerky movements with your arms, stretching or reaching over your head or touching the pacemaker.
  • After this time, just avoid putting pressure on the chest area over the implant.
Monitoring your pulse

It is important to always carry your pacemaker ID card. You should also be aware of your pacemaker’s maximum and minimum programmed heart rates. Monitor your pulse regularly and report the readings to your healthcare provider at your pacemaker checkup. With the help of a special analyzer your doctor can detect if the batteries are about to run down.

Devices that may interfere with your pacemaker

General household and office appliances or equipment will not interfere with your pacemaker. This includes:

  • microwave ovens
  • televisions
  • radios
  • stereos
  • vacuum cleaners
  • electric blankets
  • hair dryers
  • shavers
  • gardening machinery
  • toasters
  • food processors
  • computers
  • copy machines.

Devices that may pose some risk to pacemaker function are:

  • anti-theft systems (also called EAS systems) at shopping malls
  • metal detectors for security
  • cell phones.

Move through anti-theft systems or metal detectors at a regular pace without any delays. At airports, you can ask for a hand search to avoid the use of hand held metal detectors. It is advisable to hold your cell phone to the opposite ear, farther from the pacemaker implant. Do not keep a turned on cell phone in the shirt pocket.

MP3 player headphones, including the ear bud style, use a magnetic substance and therefore cause interference in pacemaker function. These headphones should be kept at least 1.2 inches away from the pacemaker and should not be placed in the breast pocket or worn by someone resting their head on your chest.

Certain medical procedures can interfere with your pacemaker`s function. These include:

  • magnetic resonance imaging (MRI)
  • extracorporeal shock-wave lithotripsy, a non-invasive treatment procedure for kidney stones.

When MRI must be done, some pacemaker models can be reprogrammed.

Dental drilling also has a tendency to increase the pacing rate.

It is advisable to let a healthcare provider know about your pacemaker before testing with any medical devices.

In addition, radiofrequency ablation procedure for arrhythmias, short-wave/microwave diathermy physical therapy, and therapeutic radiation for cancer and transcutaneous electrical nerve stimulation for pain may all interfere with pulse generation. Your doctor will need to evaluate your pacemaker’s function after these procedures.

X-rays and electroconvulsive therapy (ECT) should not affect your pacemaker.

What is an internal cardioverter defibrillator (ICD)?

An internal cardioverter defibrillator (ICD) is another device that offers a treatment option for people with arrhythmia. Like a pacemaker, it is implanted in the chest (or sometimes in the abdomen). Unlike a pacemaker, which is designed to treat irregular heart rhythms in a consistent manner, an ICD can correct sudden, life-threatening rhythm abnormalities such as cardiac arrest by delivering high-energy impulses or shock (defibrillation). A pacemaker, in contrast, can only deliver low-energy impulses.

Related information

You and your pacemaker (Hamilton Health Sciences)