- An intravenous (IV) line will be started in your hand or arm prior to the procedure for injection of medication and to administer IV fluids, if needed.
- You will be placed on your back on the procedure table.
- You will be connected to an electrocardiogram (ECG or EKG) monitor that records the electrical activity of the heart and monitors the heart during the procedure using small, adhesive electrodes. Your vital signs (heart rate, blood pressure, breathing rate, and oxygenation level) will be monitored during the procedure.
- Large electrode pads will be placed on the front and back of the chest.
- You will receive a sedative medication in your IV before the procedure to help you relax. However, you will likely remain awake during the procedure.
- The pacemaker insertion site will be cleansed with antiseptic soap.
- Sterile towels and a sheet will be placed around this area.
- A local anesthetic will be injected into the skin at the insertion site.
- Once the anesthetic has taken effect, the physician will make a small incision at the insertion site.
- A sheath, or introducer, is inserted into a blood vessel, usually under the collarbone. The sheath is a plastic tube through which the pacer lead wire will be inserted into the blood vessel and advanced into the heart.
- It will be very important for you to remain still during the procedure so that the catheter does not move out of place and to prevent damage to the insertion site.
- The lead wire will be inserted through the introducer into the blood vessel. The physician will advance the lead wire through the blood vessel into the heart.
- Once the lead wire is inside the heart, it will be tested to verify proper location and that it works. There may be one, two, or three lead wires inserted, depending on the type of device your physician has chosen for your condition. Fluoroscopy (a special type of x-ray that will be displayed on a TV monitor) may be used to assist in testing the location of the leads.
- The pacemaker generator will be slipped under the skin through the incision (just below the collarbone) after the lead wire is attached to the generator. Generally, the generator will be placed on the non-dominant side.
- The ECG will be observed to ensure that the pacer is working correctly.
- The skin incision will be closed with sutures, adhesive strips, or a special glue.
A Answers (2)
Brigham and Women's Hospital answeredGenerally, pacemaker insertions follow this process:
Intermountain Healthcare answered
This procedure usually takes 1 to 2 hours. You’ll be relaxed but awake. Here’s what will happen:
1. Monitoring and local anesthetic.
- Devices will be attached to keep track of your heart rate, blood pressure, and breathing.
- The doctor will inject numbing medication in the site where the pulse generator will be inserted. The injection usually feels like a pinprick with some burning, and only lasts a few seconds. After that, your chest will be numb and you should feel no pain.
2. Incision. The doctor makes a small incision (cut) in the skin below your collarbone. This makes a “pocket” for the pulse generator.
3. Placing one or more leads. The doctor inserts a needle into a vein in your upper chest, and inserts each lead using the needle. Using x-ray guidance, the lead is threaded through the vein into your heart.
4. Testing the leads. The medical team takes electrical measurements to make sure each lead is in the correct place. Each lead might be slightly moved once or twice, and retested each time, until it is perfectly positioned.
5. Attaching the pulse generator. The pulse generator is connected to the leads and inserted under your skin, into the “pocket” beneath your collarbone.
6. Programming the pacemaker. The pacemaker is then set to the rate your heart needs. The medical team might also adjust other settings. You’ll probably hear them calling numbers to each other as they do this. They might also ask you to take some deep breaths.
7. Closing the incision. Your doctor will close the surgical cut with a few stitches, and you will be moved to recovery.