Stanford Cardiac Arrhythmia Service

Permanent Pacemakers

Patients may develop slow heart rhythms (See section on slow heart rhythm – bradycardia).   Patients may develop symptoms such as fatigue and decreased exercise tolerance or dizziness or loss of consciousness.   

What does a pacemaker do? The main role of a pacemaker is to prevent the heart rate from getting to be too slow. 

There are a number of categories of patients with indications for pacemaker implantation.

  1. Symptoms documented to be related to slow heart rates
  2. Pauses of 3 seconds while awake
  3. Complete AV block
  4. Mobitz II AV block

How is Implantation Performed?

The procedure is performed in the electrophysiology laboratory. The patient may be given sedation.  The physician will inject a local anesthetic in the upper chest area to numb the skin and tissue which is where the device will be placed.  Access to the vein under the collar bone is obtained and one or more leads (thin wire-like tubes) are advanced to the heart. The leads are connected to the pacemaker and closed up under the skin. 

Risks and Success

There is about a 1% or less risk of stroke, heart attack, death, damage to the heart or lungs requiring surgery, including puncturing the heart but this risk may vary based on the patient’s condition.  There is a risk of bleeding and bruising, damage to the artery, nerves, and veins requiring surgery or transfusions, blood clots and swelling and infection.   There is about a 5% chance of the lead dislodging requiring reoperation.    For about 4 weeks it is important to avoid lifting the arm on the side of the pacemaker above the level of the shoulder to decrease the risk of dislodging the leads.  There is a risk of damage to the lead so repetitive motion on the side of the pacemaker should be avoided long-term.

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