What is it?

A pacemaker is a device used to supplement the electrical activity of the heart in patients whose heart is not conducting correctly, i.e. their heart is beating too slowly, “bradycardia”. It generally does not provide benefit when the heart beats too quickly.

A Biventricular Pacemaker is a pacemaker that paces on both sides of the heart. In selected cases, resynchronising the heart in this fashion can improve cardiac function.

The pacemaker consists of two components, the generator, or battery, and the leads or wires. The generator is about the size of two stacked 50 cent coins and is implanted under the skin beneath your collarbone. This is connected to the leads or wires which rest inside your heart. The wire is very soft and flexible and can withstand the twisting and bending caused by body movements.

Preparation

Fasting is required for 6 hours prior to the admission time. Blood thinning medication may need to be stopped a few days before the procedure; however, the cardiologist will advise on this. The patient can expect to be in hospital for 1-2 nights.

Procedure

On admission to the hospital you will have an ECG and may have bloods taken.

Your chest will be shaved and painted with an antiseptic solution called Betadine. The procedure will take about half to one hour.

You will be given some light sedation via an intravenous line to help you relax and feel comfortable during the procedure. You will be awake but drowsy.

The doctor will give some local anaesthetic to numb the area just below your collar bone where the pacemaker will be inserted.

When the area is numb the doctor will then make a small cut (approx. 4-7cm long) to insert the pacemaker.

The leads are then guided through a vein into your heart and then connected to the generator or battery.

The skin is sewn together and a small dressing is placed over the wound site.

The stitches (if not dissolvable) will be removed in approximately 7 days.

The dressing is usually removed the day after the procedure.

If you require a shower while the dressing is still intact it will be covered with plastic to prevent it getting wet.

Your recovery

On your return to the cardiac care unit you will have your heart rhythm and blood pressure monitored. You will also have another ECG and chest X-ray. The wound site will be observed for swelling and bleeding. Pain relief for wound discomfort will be given if required.

You will be discharged when your cardiologist is happy with your progress, usually 1-3 days’ post operatively.

You will receive an information booklet after your procedure detailing information about living with a pacemaker.

How do I live with my Pacemaker?

Check your pulse and keep a record of it the way your doctor tells you.

Your doctor will check your pacemaker every three to six months. The battery in your pacemaker should last five to eight years or longer. When the battery runs down, you will need surgery to replace it.

Take your medicine the way your doctor tells you.

Tell your doctor if you have trouble breathing, if you gain weight or get puffy legs or ankles, or if you faint, black out or get dizzy.

Follow all doctor’s instruction and keep your appointments.

Tell your doctors and your dentist that you have a pacemaker. Certain types of medical equipment may affect how a pacemaker works.

Tell airport security that you have a pacemaker.

Maintain awareness

Your doctor may recommend that you take and record your pulse often to gauge your heart rate. This allows both of you to compare your heart rate to your acceptable range to determine if your pacemaker is working effectively.

When taking your pulse at home, follow your doctor’s instructions about when to get in touch. In general, there’s no reason to contact your doctor unless:

Your heart is beating faster than 100 beats per minute.

Your heart rate suddenly drops below the accepted rate.

Your heart rate increases dramatically.

Your pulse is rapid and irregular (above 120 beats per minute) and your pacemaker is programmed for a fast-slow type of heartbeat.

You notice a sudden slowing of your heart rate.

Don’t worry if your heart is beating close to or within the intended heart rate, but has an occasional irregularity. It likely just means that your heart’s natural pacemaker is competing with the signals emitted by the artificial pacemaker. This occurs infrequently, but it’s normal.

Following discharge