The most common reason to recommend a pacemaker is to treat slow or irregular heart beating. This can result from disturbances of the in-built electrical system of the heart. Usually the heart beats between 50-100 beats per minute. When the heart beats slower than this, symptoms such as dizziness, fatigue, shortness of breath or fainting can occur.
The slow heart beating may result from reduced function of your own internal pacemaker called the sinus node (known as sinus node dysfunction) or reduced communication between the upper and lower chambers of your heart (known as AV block or ‘heart block’).
At times slow heart beating can be the result of medications administered to treat fast heat beating. This is known as tachy-brady syndrome.
Procedures
Pacemaker Implantation
Why has my cardiologist recommended a pacemaker?
If you have one of these problems a pacemaker is recommended to regulate the heart beating, restore a normal heart rate, and relieve symptoms.
A pacemaker is a cardiac device that helps maintain your heartbeat in its normal range.
What is a pacemaker?
A cardiac pacemaker is a small device composed of a small battery and some sophisticated electronics that is implanted under your skin to regulate the heart beat. The pacemaker is attached to pacing leads that are inserted into your heart via the vein under the collar bone. The battery of a pacemaker usually lasts at least 10 years.
What should I expect during a pacemaker implantation?
You will meet a number of members of the cath lab team, and you will be asked to move from your hospital bed to the Xray table.
Once the required checks have been completed, and you have been connected to the ECG monitor, the nurses will prepare the skin of your chest with antiseptic and apply surgical drapes to keep the area clean and ‘sterile’.
- insert an IV cannula into a vein in the forearm on the same side as the intended pacemaker implant.
- Give you some antibiotics and a sedative to help you feel relaxed.
- Inject local anaesthetic into skin and subcutaneous tissues of the upper chest at the implant site. There may be some minor discomfort at this stage until the skin becomes ‘numb’.
- Make a small incision just below your collar bone.
- Xray screening will be used to guide insertion of the leads into the heart.
- Insert the pacemaker device into the space created under the skin. You may feel some pushing at times; it should not feel painful. Please let the team know if you are in pain.
- Once in the correct location, the leads are secured in place to the chest muscle with small sutures.
- The leads are then attached to the pacemaker and the wound closed in layers with sutures.
- Skin glue or special skin tapes (known as ‘steri-strips’) will be applied to the top layer of the skin.
- A small dressing may be applied over the wound for protection, and to keep it dry.
You should expect the procedure to take about an hour.
How should I prepare for a pacemaker implantation?
At Western Cardiology most of our procedures take place at St John of God Subiaco Hospital, Subiaco.
The procedure takes place in a specially designed cardiac procedure room (‘the cath lab’). If you are taking ‘blood thinners’ or diabetic medications you will be provided with individualised instructions as to whether and when these need to be withheld. Please make sure you are clear on these instructions.
Your cardiologist or one of the hospital doctors will ask you to sign a consent form. Please feel free to ask any questions that you may have during this process.
Before the day of the procedure, please register with St John of God Subiaco Hospital admissions at www.sjog.org.au/myadmission and complete the online Admissions Form and follow their instructions. If you require any assistance please call 1300 863 566
What are the risks associated with a pacemaker implant?
Pacemaker implantation is generally a straight forward and safe procedure.
Most patients can be discharged the following day.
Although your cardiologist has a good deal of experience, all procedures do involve a small chance of risk.
Common:
- Mild soreness/discomfort
- Redness and swelling for the first few days
- Bruising
Less Common
- A large bruise at the site known as a haematoma. Many patients requiring a pacemaker take blood thinners, and this increases the risk of swelling. A haematoma will usually settle with conservative management over a couple of weeks.
- Lead dislodgement – the pacing leads attach to the heart muscle via a very small screw that can break away from the beating muscle, usually during the first 24 hours. Your doctor will know if this occurs. This will occur in approximately 1 in 30-40 cases and may require a repeat procedure to reposition the lead.
Uncommon
- Infection – this is perhaps the most feared complication, fortunately uncommon. Infection occurs in approximately 1 in 100 cases.
- Pneumothorax – a small needle puncture of the vein under the collar bone is required to insert the leads into the heart. Rarely the needle can injure the nearby lung resulting in an air leak into the chest. This occurs in less than 1 in 200. When this occurs a small drain may be required to allow the lung to re-expand.
- Cardiac perforation: less than 1 in 200 patients.
Your individual risks will be discussed with you by your cardiologist before the procedure. Other members of the hospital team may also provide information.
Aftercare requirements
Following your pacemaker insertion, you will be transferred back to the CCU or ward for overnight observation and monitoring.
When the anaesthetic wears off, there may be some discomfort, however this is usually mild, requiring simple analgesia for comfort.
There will be some temporary bruising.
A pacemaker technician will check your pacemaker to make sure that the leads are stable the following morning and your will be reviewed by your cardiologist.
Most patients can be discharged after these checks have been completed.
For the first few weeks some activity restrictions are recommended to ensure that the wound heals, and the leads remain in stable position.
These include:
- Non driving period of at least 2 weeks.
- Avoid lifting your arm above shoulder height for 2 weeks.
- No heavy lifting for 6 weeks (more than 5kg).
- No vigorous physical activity for 6 weeks.
It is advisable to move the shoulder joint periodically to avoid stiffness and gentle activity is encouraged after the first couple of days (for example walking).
If ‘steri-strips’ have been applied to your wound site, keep the wound dry for the first 5 days. You will be provided with dressings to cover for showering.
If dermabond (glue) has been used, you can shower as normal from day 2. Do not scrub the wound however.
Follow up
Your cardiologist will make arrangements for follow up at Western Cardiology, approximately 4 weeks after the procedure with testing of the pacemaker.
If there are any concerns about the pacemaker site please contact:
Western Cardiology 9346 9300
or
SJOG Subiaco CCU 0411 707 017 or 9382 6496
Remote monitoring
Remote monitoring is a service offered to Western Cardiology patients with implanted cardiac devices (pacemakers, CRT, ICD and loop recorders).
If you opt-in to our remote monitoring service (recommended), you will be provided with a monitor that can check your pacemaker daily and communicate any issues that arise directly with your cardiologist.
The information is sent securely via the internet, to our monitoring team. This will enable many aspects of the follow up care of your pacemaker to occur from the comfort of your own home.
The monitor is usually placed in your bedroom or any room of your house that you would typically spend time in each day.
Remote monitoring has been extensively studied across the world and is now considered the standard of care for patients with implanted cardiac devices.
You will be asked to sign a patient consent form to participate in this service.
There is a small annual fee for this service, however there is a medicare subsidy, reducing the personal cost to you.
If you have any queries please feel free to ask your cardiologist or the pacemaker technician prior to discharge.