Permanent Pacemaker

A pacemaker is a small metal device put inside your body to help regulate your heartbeat. The pacemaker sends out impulses to keep your heart beating at a programmed rate to meet your body’s needs.

Your pacemaker has two parts:

• A generator (battery)

• Leads are wires that carry the electrical impulses to the heart. You will have one to three leads.

Why do I need a pacemaker?

You need a pacemaker if your heartbeat is too slow or your electrical system of your heart isn't working properly. When the electrical system of the heart is working normally, your heart sends an impulse from the SA node in the heart’s upper chamber (atrium) through the AV node (an area between the hearts upper and lower chambers). The impulse spreads to the lower chambers (ventricles) to cause the heartbeat. When the electrical system of your heart is not working properly, you may have:

• Very slow heartbeat

• Slow and fast heartbeat

• Dizziness

• Fainting spells

• Shortness of breath

Another type of pacemaker has an added features of “biventricular pacing” or “cardiac resynchronization.” This pacemaker is used to treat heart failure. In many people with heart failure, the left and right ventricles pump at different times. The ventricles are no longer pumping together as they should. This reduces the heart’s efficiency as a pump and allows blood to “slosh” around inside it. This action wastes the heart’s precious energy and may cause heart failure to worsen. Biventricular pacing is set to stimulate (pace) both heart ventricles to pump together by placing a lead on the right and left ventricle. This improves blood flow to the lungs and rest of the body. A smooth pumping action causes less wear and tear on the heart muscle.

How is a pacemaker inserted?

• You will be given warm blankets and a sterile drape will cover your body in the EP (Electrophysiology) lab.

• You may receive relaxation and pain medications through your IV.

• Your skin is numbed with medicine where the incision is made. The incision is about two to three inches long.

• The doctor places a small lead (wire) into a vein usually near your collarbone. The wire is moved through the blood vessel into the heart where it is positioned.

• The doctor will place one to three wires in your heart.

• The lead(s) are attached to the pacemaker.

• The pacemaker is placed under the skin below your collarbone.

• The procedure takes about one to three hours.

What happens right after the pacemaker is inserted?

• After your pacemaker is inserted, you will return to your hospital room. The nurses will check your pulse and blood pressure often until you are fully awake.

• The nurses will assist you with activities. You must limit use of the arm on the side of the generator for one month. This is to ensure that the leads which attach to the generator and to your heart are not moved.

• You may have some incision pain. Your nurse will give you an ice pack and/or pain medication to relieve the discomfort. Tell your nurse how you feel and if you are having any pain.

• You will be able to eat and drink once you are awake.

• You will be on bedrest for one hour.

Home care guidelines

• There will be a bandage over the pacemaker insertion site. Do NOT remove this bandage. The doctor will remove it at your follow-up appointment. The bandage is waterproof and can be worn in the shower.

• If the edges of the bandage become unsealed, reseal by placing your hand over the edges for warmth.

• Do not put any ointments, creams or lotions on your incision.

• Wear loose clothing to prevent irritating the incision.

• You may use an ice pack on the incision for 24 hours after you leave the hospital if your incision remains swollen and tender.

• To avoid nausea, follow a light diet for the first 24 hours after your procedure and take pain medication with food if these have been given to you by your doctor.

• Your doctor may send you home with an arm immobilizer. 

Exercise guidelines
Exercise should be done gently at first while you recover from surgery. Gradually you can become more active.

Exercise to include early on:

• Shoulder rolls and shrugs: Move your shoulder up and down, forward and backward.

• Small arm circles: Lean forward, let your arm hang loosely, swing clockwise, then counterclockwise.

• Walking arm up wall: Stand facing a wall with your feet apart. Slightly bend your elbow and place your fingers on the wall at shoulder level. “Walk” your fingers up the wall.

• Do not lift the elbow on the pacemaker side higher than the shoulder (except when doing “walking arm up wall” exercise).

• Do the exercises four times a day, six to seven repetitions of each exercise.

Activity for the first month

• Do not lift more than 10 pounds for 30 days, unless your doctor instructs you differently.

• Do not bike, bowl, play tennis or golf.

• You may sleep on the side where the device was placed if it does not hurt to do so.

• You may return to work in two to three days after the procedure unless otherwise instructed by your doctor.

• Do not drive for 7 days.

After the first month there are no activity restrictions, except you must avoid contact sports forever.

Replacing the battery and leads
Pacemaker batteries usually last for four to seven years before they need to be replaced.  Because the battery is sealed inside the generator, replacing a battery requires replacing the entire generator. The leads will be tested at the same time. If a new lead is needed, the procedure will be like your original implantation. If no leads are changed there is no restriction in activity.

Precautions

• It is OK to be near electrical devices such as a microwave, hairdryer, toaster, computer, electric blanket, power tools and small stereo speakers.

• Talk on your cell phone or cordless phone on the side away from the pacemaker. Do not carry the cell phone in your shirt pocket.

• Stay away from magnetic fields, such as large electrical transformers, electric welding, electrocautery and chain saws.

• Call your doctor to discuss options if an MRI is needed.

• If you have other concerns about interference with your pacemaker, ask for more information or contact your cardiologist’s office.

• If you have any surgery in the future, tell the surgeon that you have a pacemaker.

• If you require a dental exam or procedure within six months after your pacemaker implant, please contact your dentist for antibiotic therapy.

Call your cardiologist immediately if you have signs of infection which are:

• Redness, swelling or warmth at the incision site

• Drainage from the incision site

• A fever over 100° F

• Increased pain or nausea

It is extremely important that infection be diagnosed early because the pacing wires go directly to your heart. If you have diabetes, carefully monitor your blood sugar. High blood sugar increases your risk of infection.

If you experience bleeding from the site, place a heavy object such as a 5# bag or sugar/flour or a heavy book over the site, and contact your doctor.

Pacemaker follow-up

• You will receive a home monitoring device that will be given to you while in the hospital or shipped to your home usually within one month after discharge from the hospital. This monitor will be used for your follow-up care of your pacemaker.

• Your pacemaker will need checked about every three months to confirm proper functioning. You will receive a letter after your hospital dismissal with instructions for a follow-up evaluation.

• You will receive a pacemaker identification card from the company within six to eight weeks. It will contain the type, model number and date you received your device. Always carry this card with you.

To contact Bryan Heart, call (402) 483-3333 or toll free 1-866-895-5611.