Contact us
If you have any questions, please contact our arrhythima specialist nurses on:
Phone: 01223 638947
Email: phn-tr.arrhythmia-nurses@nhs.net
Overview
There are several types of implantable devices to control the heart rate (and rhythm). Although the implant procedure is similar, the number of leads inserted will vary depending on the condition being treated.
A standard pacemaker will stop your heart going too slowly.
Pre-procedure
The implant is usually undertaken as a day case which means you will be admitted and discharged on the same day. Occasionally you may be required to stay overnight.
You will continue most of your usual medications, but if you take blood-thing drugs, you will be advised when to stop them before admission.
If you have a mechanical heart valve, warfarin should not be stopped, and you should discuss this with the arrhythmia nurses ahead of admission.
Please shower the night before your procedure. You will also be asked to shower with an antiseptic cleaner on the morning of your procedure, and the area may be clipped.
The implant is carried out in an operating room called a cath lab. There will be a team of people with different roles who will introduce themselves when you arrive. This includes the doctor, a physiologist providing technical support, a radiographer to manage the x-ray equipment and nurses to look after you and assist the doctor.
The implant procedure
You will be asked to lie on your back on a small operating table and attached to ECG electrodes to allow your heart rate to be monitored.
Antibiotics will be administered through a small canula placed in the back of your hand or in your arm. This can also be used to provide additional sedation and/or painkillers if required.
The implant site will be cleaned with a cold anti-septic solution, and you will be covered in a sterile paper drape, leaving your face uncovered.
Local anaesthetic will be injected into the implant site which will sting initially before the area becomes numb. An incision is then made under the collar bone and a ‘pocket’ created under the skin where the pacemaker will be placed.
Lead(s) are then inserted into a vein and fed into the heart and positioned using x-rays. The lead(s) are checked by the physiologist before being connected to the device and placed in the pocket.
The wound is then closed with dissolvable stitches and covered with a dressing.
Post-procedure
You will return to the ward following the procedure, where you will be re-attached to the heart monitor and remain on bed rest for a short period.
You will have a dressing over the wound which can be removed after 4 days. Regular painkillers such as paracetamol may be taken as required.
Approximately two hours after the procedure, a physiologist will check the settings on the device, and you will have a chest x-ray to confirm the position of the leads and exclude a collapsed lung (pneumothorax). If you are staying overnight, these checks may be done the following morning.
You will need someone to stay with you overnight. You will not be able to drive for a period of time after the implant. This is usually a week for a standard licence holder but longer if you have a type 2 licence.
Risks
The risks associated with having a pacemaker implanted are as follows:
- localised bleeding and bruising 1% (1 in 100)
- collapsed lung (pneumothorax) 1% (1 in 100)
- infection 1% (1 in 100)
- lead displacement 1% (1 in 100)
- lead perforation of heart wall 0.5% (1 in 200)
Please note: Implanted medical devices such as pacemakers and defibrillators are occasionally subject to advisories relating to issues with software or hardware.
Although these are rare, they are usually identified after many devices have been implanted, often years later.
It is our responsibility to keep accurate records of all implanted devices and to inform you immediately we are informed of an advisory affecting your system.
No action may be required but occasionally your device may need to be reprogrammed or rarely revised or replaced.
Recovery
Most people recover quickly from having a device implanted and feel well enough to carry on with normal activities after a few days. However, you should avoid heavy lifting or stretching the arm nearer to the pacemaker for one month, to allow the device and leads to settle in.
It is important however to keep the shoulder joint moving to reduce the risk of a frozen shoulder. You may develop some swelling over the device which should reduce gradually over the next few days. If the site becomes very swollen or painful please contact us or, in an urgent situation, contact your GP or out of hours service or attend A&E.
There may be some bruising around the device area, which is normal and should resolve over the next few weeks. If you have any discomfort around the wound, simple painkillers such as paracetamol should be sufficient to resolve this or stronger painkillers are available from chemists.
Follow-up
When the device is checked after the implant you will be given a home monitor to take home, that will communicate wirelessly with your device and allow us remotely to receive information on how it is functioning. We will explain how this works before you go home.
However, you will be asked to attend for your first follow-up about 2-3 months after discharge to check the device and the wound.
Subsequent follow-up will usually be annually and a mixture of in-person and remote. The frequency of follow-up will increase as the battery is getting closer to needing replaced. Please, also see Pacemaker generator change.