Pacemaker Implantation

  • Reference Number: HEY-452/2016
  • Departments: Cardiology

Introduction

This leaflet has been produced to give you general information about pacemaker implantation.  Most of your questions should be answered by this leaflet.  It is not intended to replace the discussion between you and your doctor, but may act as a starting point for discussion.  If after reading it you have any concerns or require further explanation, please discuss this with a member of the healthcare team caring for you.

What is a pacemaker?

A pacemaker is a small device that is placed in the chest or abdomen to help control abnormal heart rhythms. The pacemaker works by sending electrical impulses to stimulate your heart to contract. Most pacemakers are programmed to work just when they are needed (on demand) and some send impulses all of the time (fixed rate). You cannot feel the electrical impulses that the pacemaker delivers. The pacemaker is fitted just below your collar bone and is usually very comfortable. Most pacemaker boxes are approximately 0.5cm (0.2 inches) in thickness and weigh around 20–50 grams depending on the type used. A pacemaker system consists of a pulse generator (the pacemaker box) and one or more electrode leads. Pacemakers with one lead are called single chamber pacemakers, pacemakers with two leads are called dual chamber pacemakers and pacemakers with three leads are called biventricular pacemakers. The type of pacemaker you have implanted depends upon the reason you need to have one fitted. The medical team will discuss with you which is the most suitable type of pacemaker.

Why do I need a pacemaker?

The most common reason for having a pacemaker implanted is that your heart is beating too slowly, either occasionally or all the time. A pacemaker can be helpful for some patients with heart failure who also have an electrical abnormality called left bundle branch block. In this circumstance, the pacemaker is not to speed up the heart but to help it contract (beat) in a more coordinated manner. The medical team caring for you will explain to you the reason you need a pacemaker fitting.

Can there be any complications or risks?

The risks from having a pacemaker implanted are small. Bruising around the operation area (pacemaker insertion site) is common, but please be assured that this usually resolves within a week or so and is nothing to be concerned about. Rarely, infection around the pacemaker can occur; the intravenous antibiotics given prior to the procedure aim to prevent this complication. It is possible for the lining of the lung to be punctured during the procedure, which can result in the lung collapsing (pneumothorax). This occurs in only approximately 1 in a 100 cases and may be treated by inserting a tube into the chest (chest drain) to allow the lung to re-inflate. This does not leave any long term damage or ongoing problems.

How do I prepare for the procedure?

Please read this information leaflet. Share the information it contains with your partner and family (if you wish) so that they can be of help and support. There may be information they need to know, especially if they are taking care of you following this examination.

Pre-admission

You will be required to attend the pre-admission clinic prior to your procedure date. At this appointment, a specialist nurse will confirm your personal details and conduct a nursing and medical assessment. They will also perform a physical examination to ensure you are medically fit for the procedure. Your procedure will be explained and you will have the opportunity to ask any questions. You may then be asked to sign a consent form. Blood samples will be obtained and swabs taken for MRSA (a bacteria responsible for infection) screening and an ECG (heart tracing) will be performed.

Fasting

You may eat a light meal before admission and drink, up to the procedure.

Medication

Some medications have to be stopped before the procedure. The nurse at your pre-admission appointment will tell you if this is necessary for you. It is very important that you bring all of your current medications or a current prescription with you to any appointment.

What happens during the procedure?

You will be asked to put on a hospital gown and you will have a small needle (cannula) placed into a vein in the back of your hand or in your arm. You will be given intravenous antibiotics through the cannula before the procedure to reduce the risk of any infection. A small area around the collar bone will be shaved if necessary. The procedure is performed in the Cardiac Catheterisation Laboratory under a local anaesthetic. You will be awake for the procedure, but the insertion site will be numb.

You will lie on your back in the theatre, your body will be covered with sterile theatre towels and the skin around the neck and shoulder area will be cleaned with a cold antiseptic solution. The area where the pacemaker box is to be fitted will be injected with a local anaesthetic to numb the area so the procedure will not be painful. A small pocket is made under the skin to make room for the pacemaker box. Using the vein lying under the collar bone to gain access to the heart, one or more electrodes are carefully directed to the correct position(s) in the heart chamber(s). X-rays are used to guide the procedure. The lead (or leads) is then connected to the pacemaker box. The pacemaker box is fitted into the pocket made earlier. The skin is then closed, usually with dissolvable stitches or glue. The procedure may take up to one hour, although it can take considerably longer for a pacemaker for heart failure to be implanted.

What happens after the procedure?

When the procedure is over, you will return to the ward area. If your procedure is performed in the morning and there are no problems you may be discharged the same day. If your pacemaker is performed in the afternoon you will need to stay overnight. Before discharge the pacemaker will be tested and a chest X-ray will be performed.

You will be given further advice about returning to your usual activities when you are discharged.

You should not drive yourself home following the procedure. It recommended that you do not drive for at least one week after pacemaker implantation. Specific instructions are available on the DVLA website.

If for any reason you do not attend the pre-admission appointment, or if you have any questions about your medication, or should you require further advice on the issues contained in this leaflet, please do not hesitate to contact:

Cardiac Nurse Practitioners on telephone no (01482) 461647.

Cardiology 5 Day Ward on telephone no (01482) 461518/461517.

General Advice and Consent

Most of your questions should have been answered by this leaflet, but remember that this is only a starting point for discussion with the healthcare team.

Consent to treatment

Before any doctor, nurse or therapist examines or treats you, they must seek your consent or permission. In order to make a decision, you need to have information from health professionals about the treatment or investigation which is being offered to you. You should always ask them more questions if you do not understand or if you want more information.

The information you receive should be about your condition, the alternatives available to you, and whether it carries risks as well as the benefits. What is important is that your consent is genuine or valid. That means:

  • you must be able to give your consent
  • you must be given enough information to enable you to make a decision
  • you must be acting under your own free will and not under the strong influence of another person

Information about you

We collect and use your information to provide you with care and treatment. As part of your care, information about you will be shared between members of a healthcare team, some of whom you may not meet. Your information may also be used to help train staff, to check the quality of our care, to manage and plan the health service, and to help with research. Wherever possible we use anonymous data.

We may pass on relevant information to other health organisations that provide you with care. All information is treated as strictly confidential and is not given to anyone who does not need it. If you have any concerns please ask your doctor, or the person caring for you.

Under the General Data Protection Regulation and the Data Protection Act 2018 we are responsible for maintaining the confidentiality of any information we hold about you. For further information visit the following page: Confidential Information about You.

If you or your carer needs information about your health and wellbeing and about your care and treatment in a different format, such as large print, braille or audio, due to disability, impairment or sensory loss, please advise a member of staff and this can be arranged.