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Permanent Pacemakers

What Is A Pacemaker?

Your doctor has recommended a pacemaker because there are signs that your heart is not beating fast enough or there is a problem with the normal electrical signal which causes your heart to beat. A permanent pacemaker consists of a generator and leads which are usually implanted into the upper chest through a small incision. The generator is a metal case containing the power source and a timer that regulates how often the pacemaker sends out electrical signals. The generator life is usually 7 to 10 years. The leads allow the pacemaker to monitor your heart rhythm and to send out electrical signals to make your heart beat when needed.

Diagnosis

The normal electrical signal starts at the top of the heart in an area called the sinus node located in the right atrium. The signal then travels through the AV node into the lower chambers of the heart. As the signal reaches the bottom of the heart, the heart contracts resulting in a heartbeat. The normal heartbeat is 60 to 100 beats per minute at rest and varies with activity. Some problems that may require the use of a pacemaker include:

• Failure of the SA node to send out adequate electrical signals resulting in a slow heart rate.

• A block in or below the AV node which prevents the impulse from reaching the lower chambers of the heart.

• Abnormal heart rhythms that are not controlled by medications.

Placement of the Permanent Pacemaker

The pacemaker is usually implanted in the upper chest and the leads are threaded through a vein into the heart. The generator is attached to the leads and placed under your skin. The leads must touch the heart so the electrical signals can be carried back and forth between the heart and the generator. In some cases, you may need a temporary pacemaker. A temporary pacemaker is placed outside of the body and is removed once the permanent pacemaker is implanted.

Before Pacemaker Insertion

Your cardiologist will tell you about the risks and benefits of the pacemaker insertion. This is a good time to ask questions and to share any feelings or concerns you may have. The day of the procedure you will be asked to sign a consent form. Before your procedure you will have blood tests, an electrocardiogram (EKG) and a chest x-ray. If you are a female between the ages of 10 and 55 and have not had a hysterectomy, your blood tests will include a pregnancy test.

Please note the following:

• Be sure to get pre-certification from your insurance company.

• If you are diabetic or taking coumadin, please check with your cardiologist for special instructions.

• If you are allergic to any of the following, please inform the nurses or cardiologist immediately.

• iodine

• shellfish

• latex

• tape

• medication

• food

• Take your medications on your regular schedule unless told differently by your cardiologist. Bring a list of all the medications you are currently taking.

• Usually, the meal before the pacemaker procedure is withheld. You may have sips of water to swallow your medications. If the pacemaker procedure is scheduled for later in the day, you may have a liquid breakfast.

You will be given a hospital gown to wear. The room will be cool, so you may wish to wear socks. You will be able to wear your glasses and hearing aids. Please leave your jewelry at home. You will be asked to remove your dentures. An IV will be started. During the procedure, your family may wait in the waiting area in Cardiology Services. They will be told when your procedure is completed and will be allowed to see you when you are in the recovery area.

During Pacemaker Insertion

You will be taken to the Cardiac Catheterization Lab (Cath Lab) by cart and moved onto the x-ray table.

The table has a large camera above it and television screens close by. The surgical team will include the cardiologist, nurses and technicians. They will be wearing masks, gowns and gloves. After being positioned on the x-ray table, you will be connected to a variety of monitors and covered with sterile sheets.

• You may be given a medication through your IV before the procedure to help you relax. This medication may make you drowsy.

• The insertion area on the upper chest will be shaved and cleansed to help prevent infection.

• A local anesthetic will be given to numb the insertion area.

• Your cardiologist will make a small incision about 1-3 inches in length for the insertion of the pacemaker.

• The leads will be threaded through a vein into the heart and connected to the generator.

• The generator will be positioned just under the skin.

• Your cardiologist will test the pacemaker and program it for your specific needs.

• The incision will then be closed with stitches and may be covered with steri-strips.

After Pacemaker Insertion

• The procedure will take 1-2 hours.

• Your cardiologist will talk with your family immediately after the procedure.

• Once you are in the recovery area or in your room, your family may visit. If your room is on PCCU (Progressive Cardiac Care Unit), the visiting hours are 11a.m. to 8 p.m. with a limit of 2 visitors at a time. Children under 12 are not permitted on PCCU.

• Your heart rhythm will be monitored continuously.

• Some discomfort after the procedure is common. Ask your nurse for pain medication when needed and let the nurse know if you do not feel relief.

• It is very important that you limit the movement of your arm on the side the pacemaker was implanted for the first 24 hours. The first night, do not lie on your side that the pacemaker was inserted.

• Before going home, your cardiologist may adjust or change your pacemaker program to best fit your needs. A copy of your pacemaker program will be given to you to keep with you at all times.

• After you get home, call your cardiologist with any questions or problems.

At Home After Pacemaker Insertion

Look at your incision before you leave the hospital. Check it daily at home to watch for any changes.

Call your cardiologist’s office to report any of the following:

• drainage

• redness

• swelling

• unusual warmth at the site

• extreme tenderness

• fever greater than 1000 F

Do not wear tight or restrictive clothing that puts pressure on the incision or pacemaker. Women may wear their bras depending on comfort.

Wait 7 to 10 days before taking a shower to allow your incision to heal. In the meantime, you may take a daily sponge bath.

If your incision is not draining and appears to be healing well, you may use lotion around the incision area to ease the dryness and itching.

The steri-strips will start to loosen and may fall off on their own. Your cardiologist will remove the remaining strips when you come into the office for your pacemaker check.

Follow-Up Care

You will see your cardiologist 1 to 2 weeks after your pacemaker is inserted. During regular check ups, you will be connected to a heart monitor and pacemaker programmer. Changes in your program will be made as necessary. Carry your most current identification card and the most current pacemaker program with you at all times.

Activity Guidelines 

• You should limit use of your arm and shoulder where the pacemaker was placed for the first 1 to 3 months. You should NOT do any heavy pushing, pulling, or raising your arm above your shoulder until told otherwise by your cardiologist.

• Do not drive until advised by your cardiologist. This is usually 1 to 4 weeks.

• You may do light housework such as washing dishes and cooking. Avoid vacuuming, lifting laundry, overhead cleaning, and activities that require frequent reaching.

• Ask your cardiologist before doing any sport activities such as golf, bowling, hunting, fishing or weight lifting.

Pacemaker Precautions

• Avoid being near areas with high voltage, magnetic force fields, or radiation because these can cause pacemaker malfunction. These areas may include high tension wires, power plants, large industrial magnets and arc welding machines. Symptoms of pacemaker malfunction are dizziness, lightheadedness or changes in heart rhythm. If symptoms occur, back up 10 feet and check your pulse.

• Pacemakers inserted today are not affected by microwave ovens. Pacemakers have built-in safety mechanisms protecting them from this electrical interference.

• When you go to an airport, always carry your pacemaker card with you. Because the pacemaker contains metal, it may trigger an airport metal detector. Explain to the airport attendant that you have a pacemaker so that special arrangements can be made for a security check. The metal detector itself will NOT harm the pacemaker.

• Do not have an MRI (Magnetic Resonance Imaging) test because it can damage your pacemaker.

Call your cardiologist if you have:

• severe pain at your pacemaker site

• frequent or constant hiccups

• twitching of your abdominal muscles

• shortness of breath

• dizziness, lightheadedness or blackouts

• signs of infection: drainage, redness, swelling, unusual warmth, extreme tenderness

When To Call

• Severe pain at your pacemaker site.

• Frequent or constant hiccups.

• Twitching of your abdominal muscles.

• Shortness of breath.

• Dizziness, lightheadedness or blackouts.

• Signs of infection: drainage, redness, swelling, unusual warmth, extreme tenderness, fever.

Pacemakers online
 

American Heart Association

The American Heart Association web page is an excellent source on many cardiac care issues.  They will walk you through warning signs, disease and conditions, healthy lifestyles and feature the heart and stroke encyclopedia.

Follow this link to the American Heart Association


WebMD


Each year, millions of people are treated with Medtronic products that help them regain health and improve their quality of life. This link is for patients and their families and friends who already have or will soon receive a pacemaker, similar device, or therapy.

You will learn about your device and therapy and how they may affect your health and lifestyle.


Follow this link to WebMD