Pacemaker Surgery: What to Expect

If you have been recommended pacemaker surgery, you may be wondering what to expect. Please continue reading to get the answers to all your questions.

What is a pacemaker?

A pacemaker or cardiac pacing device is a small device that is implanted (placed) in the chest. A pacemaker sends electrical signals to the heart chambers to control the heartbeat. When it detects a slow heartbeat, the pacemaker stimulates the heart to beat faster by sending electrical pulses.

If you have heart rhythm disorders or heart failure causing a slow heartbeat, your healthcare provider may have recommended you have a pacemaker implanted. This can be a temporary pacemaker, for example, after heart surgery or a heart attack. However, sometimes, pacemaker implantation is permanent.

A pacemaker consists of two parts: a pulse generator that has pacemaker batteries and electrical circuitry to generate electrical impulses. In addition, most pacemakers have three pacemaker leads or electrodes that go from the pulse generator to the chambers of the heart. Some pacemakers are leadless and are implanted directly into the heart muscle.

Depending on your condition, the device can be a single-chamber pacemaker, dual-chamber pacemaker, or biventricular pacemaker. These devices differ in whether the leads are connected to the right ventricle, the right atrium, and the right ventricle, or the right and left ventricles (lower chambers) of the heart.

Is getting a pacemaker a major surgery?

In most cases, pacemaker surgery is not a major surgery. It is a minor surgical procedure that is done in a pacemaker clinic or outpatient surgical center.

What preparation is needed before pacemaker implantation?

Before the surgery, your medical team will perform tests, discuss the type of pacemaker with you depending on your heart problems, explain the benefits and risks of the procedure, and have you sign a consent form. If you take blood thinners to lower the risk of blood clots, your doctor may ask you to discontinue the medication for a few days around the time of your pacemaker surgery. If you are having general anesthesia, your doctor may ask you to stop eating and drinking the night before.

What type of anesthesia is used for pacemaker surgery?

The procedure is usually done using local anesthesia to numb the pacemaker site in your upper chest wall. You remain awake throughout. In some cases, general anesthesia may be necessary, in which case you will be asleep during the pacemaker surgery.

What happens during the procedure?

You will change into a hospital gown. They will hook you up to a monitor with sticky electrode patches on your chest to keep an eye on your heart rhythm. After numbing the implantation site, the surgeon will make a small incision (cut) and place the pacemaker under the skin in your upper chest near your collarbone on the left side. The tips of the leads will be attached to the pulse generator and guided through a blood vessel to the heart. The surgeon will obtain X-ray images to check the position of the pacemaker before you leave the hospital. The entire procedure takes 30-60 minutes to complete.

How many days do you stay in the hospital after a pacemaker?

Pacemaker surgery is typically done on an outpatient basis. You can go home the same day after a few hours of observation. You will need someone to drive you home, however. Some patients may need to stay in the hospital overnight.

Is pacemaker placement painful?

The local anesthetic will numb the pacemaker site during the procedure, and you will not feel any pain. However, there can be some mild discomfort and bruising after the procedure. You can take pain medication to control it.

How to care for the wound after pacemaker placement?

Keep your wound clean and dry. Avoid wearing clothes that rub against the wound. Women may need to wear a bra with wider straps. Depending on the type of stitches used, you may need to go back for a follow-up appointment after 7-10 days to have the stitches removed.

How long is bed rest after having a pacemaker implanted?

You will be able to go back to routine activities of daily living after one week. Ask your doctor when you can return to work, as this will depend on the nature of your job.

When can I drive and have sex after a pacemaker?

You can start driving again after one week, provided you have not had a recent heart attack or heart surgery or felt symptoms such as lightheadedness or fainting.

You can have sex after one week or as soon as you feel up to it. Avoid placing pressure on the chest area for the first 4-6 weeks.

How long does it take to recover from a pacemaker surgery?

The usual recovery time after pacemaker surgery is 4-6 weeks. During the recovery period, you should avoid strenuous workouts, heavy lifting, and reaching up for things from high shelves. However, it is important to stay mobile to lower your risk of a blood clot in the legs. It is also important to move your arms and shoulders to prevent a frozen shoulder (a physical therapist can show you safe exercises to do after pacemaker placement).

After 4-6 weeks, you should be able to return to an active lifestyle, including routine physical activity and sports. However, your doctor may advise you to avoid very energetic activities and contact sports.

What are the risks of pacemaker surgery?

Risks associated with pacemaker placement include infection, bleeding, an allergic reaction to the local anesthetic used during the procedure, and in very rare cases, a collapsed lung. Follow your doctor’s wound care instructions carefully to prevent infection. Keep all your appointments to have your pacemaker checked periodically.

What is the follow-up care after pacemaker implantation?

Your doctor will likely call you for a follow-up appointment after 4-6 weeks. After this, you may be asked to come in every 3, 6, or 12 months depending on your medical needs and heart rate control. Your cardiologist or cardiac technician can make small adjustments in your pacemaker to control your heartbeat better.

The battery life of a pacemaker is 6-10 years, so you will not need to have it replaced for a long time.

Your doctor will ask you to carry a medical ID card for emergencies telling people you have a pacemaker.

After pacemaker implantation, you should seek immediate medical care if you develop shortness of breath, chest pain, severe or prolonged weakness, fainting, dizziness, prolonged hiccups, high fever, or swelling or redness of the pacemaker site or the arm on the side where the pacemaker was placed.

What precautions should I take after a pacemaker?

Strong electromagnetic fields can interfere with the functioning of a pacemaker. Make it a habit to use your cell phone in the other ear and keep it at least 6 inches away from your pacemaker. Most household appliances are safe, but stay at least 6 inches away from hair dryers and microwave ovens and at least 2 feet from induction hobs.

Do not stand too close to anti-theft scanners in stores. Move quickly through airport security systems. Inform the security personnel that you have a pacemaker so that they don’t place hand-held metal detectors directly over your pacemaker.

If your heart beats faster when you stand close to an appliance, your heartbeat should normalize when you move away from it.

Tell all your healthcare providers that you have a pacemaker implanted. Some medical procedures, such as MRI scans, lithotripsy for kidney stones, or using a TENS unit, may not be safe for you.

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