What can I expect during a pacemaker insertion procedure?

You will be given an injection to numb the area where the device will be inserted. You will also be sedated for the procedure. Your heart rate, blood pressure, and breathing will be monitored. The doctor will make a small incision beneath your collarbone and insert the pacemaker through this incision. Wires to the heart muscle will be threaded through a vein under the collarbone to your heart. Then the incision will be closed with stitches. The entire procedure lasts about two hours. The stitches are removed in about a week.
Imran K. Niazi, MD
Clinical Cardiac Electrophysiology

Pacemaker insertion is a simple, brief and surprisingly uncomplicated procedure.

You will arrive at the hospital after an overnight fast. After numbing the skin over the chest with local anesthetic, a small pocket is made underneath the collar bone and the pacemaker placed in it. The pacemaker is connected to the heart by one or more wires that are introduced via a vein behind the collar bone. The procedure takes 30 to 45 minutes, and is usually done under twilight sleep.

You may be discharged the same evening or early the next day.

Here's what you can expect during a pacemaker or implantable cardioverter-defibrillators (ICD) procedure:
  1. You'll be given a local anesthetic to block feeling to the upper chest area.
  2. The doctor makes a small incision in your upper chest and separates the tissues to create a small "pocket."
  3. With the visual guidance of x-rays, wires (leads) from the pacemaker or ICD are passed through a small vein in your chest. The wires are then attached in your heart.
  4. The main body of the pacemaker or ICD is placed into the surgical pocket.
  5. The skin is closed with skin adhesive, stitches, or staples.
The whole procedure takes about an hour. Your doctor will often do an electrophysiology (EP) study to make sure the device is working properly.
Generally, pacemaker insertions follow this process:
  1. 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.
  2. You will be placed on your back on the procedure table.
  3. 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.
  4. Large electrode pads will be placed on the front and back of the chest.
  5. 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.
  6. The pacemaker insertion site will be cleansed with antiseptic soap.
  7. Sterile towels and a sheet will be placed around this area.
  8. A local anesthetic will be injected into the skin at the insertion site.
  9. Once the anesthetic has taken effect, the physician will make a small incision at the insertion site.
  10. 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.
  11. 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.
  12. 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.
  13. 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.
  14. 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.
  15. The ECG will be observed to ensure that the pacer is working correctly.
  16. The skin incision will be closed with sutures, adhesive strips, or a special glue.

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