A pacemaker insertion is the implantation of a small electronic device that is usually placed in the chest (just below the collarbone) to help regulate slow electrical problems with the heart. A pacemaker may be recommended to ensure that the heartbeat does not slow to a dangerously low rate. A pacemaker may be performed on an outpatient basis or as part of your stay in a hospital. Procedures may vary depending on your condition and your doctor's practices.
Generally, a pacemaker insertion follows this process:
- You will be asked to remove any jewelry or other objects that may interfere with the procedure.
- You will be asked to remove your clothing and will be given a gown to wear.
- You will be asked to empty your bladder prior to the procedure.
- If there is excessive hair at the incision site, it may be clipped off.
- 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 doctor 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 doctor 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 nondominant side. (If you are right-handed, the device will be placed in your upper left chest. If you are left-handed, the device will be placed in your upper right chest).
- 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 sterile bandage or dressing will be applied.