When is a Pacemaker Selected?

When your heart rate is unreliable or too slow due to a malfunction in your SA node, AV node or normal conduction pathway, your physician may recommend a pacemaker. A pacemaker initiates heartbeats when it senses that your own rate is too slow.

The implanted pacemaker has two parts, a "pulse generator" and a "lead system." The pulse generator is approximately the size of a silver dollar and usually placed beneath the skin on the right or left side of the upper chest. It is comprised of small batteries and miniature electronic circuits sealed in a titanium case. The lead system is an insulated flexible wire, which is connected to the pulse generator and passed through a vein in the neck or shoulder into the right side of the heart. Depending on your particular needs, you may have one or two leads placed into your heart.

The lead carries signals from the heart muscle to the pulse generator when you have a normal heartbeat. When your heart misses a beat, the missed heartbeat is "sensed" by the pulse generator. This then initiates an electrical impulse from the pulse generator through the lead to your heart muscle. This electrical impulse will stimulate a heartbeat and keep your heart rate from becoming too slow.

How is the Pacemaker Implanted?

The implantation of a pacemaker is a minor surgical procedure performed in the cardiac catheterization laboratory. Your physician will discuss the pacemaker implantation with you prior to the procedure. Once you and your physician have discussed the procedure and your questions have heen answered, you will he required to sign an informed consent form.

Please do not eat or drink for eight hours prior to the procedure. Please consult with us several days before your procedure to determine whether or not you should discontinue any of your usual medications. You will need to lie flat on a table for the duration of the implantation. Your upper chest will be scrubbed and shaved (if needed) and you will be covered with sterile sheets. You will receive some sedation intravenously to help you relax during the procedure.

The physician will give you a local anesthetic at the site of the pacemaker implantation, usually the right or left side of the upper chest. After the area is numb, the leads will be guided through your vein and into the heart's right-side chambers using fluoroscopy (x-ray monitors). Once the lead has been positioned, the physician will make a two to three inch incision in the skin, creating a small "pacemaker pocket." The leads will be connected to the pulse generator, which is then placed into the pocket. The skin will he sutured together over the pacemaker and a dressing will be placed over the incision. The entire pacemaker implantation usually lasts approximately two hours.

What Happens After the Procedure?

You will remain in the hospital for 12 to 24 hours after the procedure, on a unit that monitors your heart rhythm. A nurse will be checking your blood pressure, pulse and incision. During that time, you will be instructed not to move the arm on the side of the pacemaker implant. This gives the lead time to stabilize in your vein and heart. The incision around the pacemaker will be sore for a few days following the implantation, and we will give you medication to make you more comfortable.

What Happens After I Leave the Hospital?

You must remember several things in caring for yourself after you leave the hospital. Sometimes antibiotics are prescribed and may he taken for several days. Check your temperature twice throughout the day to determine if it is elevated (possibly indicating infection). Change the dressing over the pacemaker daily, but do not take off the steri-strips that are on the incision. Inspect the incision for redness, swelling or drainage and replace the dressing with a clean, dry bandage. Do not cleanse or rub the incision with anything. If you develop redness, swelling, drainage, increased wound tenderness or an elevated temperature, please notify us immediately (650-723-7111).

After the third day, you may shower and allow the incision to get wet, hut do not scrub the area, and keep the force of the water from spraying directly on the incision. The steri-strips will start to loosen and usually come off seven to 10 days after surgery.

You should have a follow-up appointment with your physician within seven to 10 days of surgery. Do not lift or move the arm on the side of the pacemaker above your head for two weeks- Once you see your physician he or she will assist you with guidelines for increasing your activity. It may take rime to build up your strength, but you should increase your activity.

Will My Day-to-Day Life Change?

Know the rate at which your pacemaker has been set by your doctor. Your pulse may be faster than the preset rate, but it should never be slower than this rate. A nurse will help you practice taking your pulse before you leave the hospital.

You will receive a pacemaker identification (ID) card while you are in the hospital, or in the mail after you go home. You should carry this ID at all times. Most electrical and mechanical devices will not interfere with your pacemaker. In general, you may use any appliance or go anywhere except into areas where strong electrical interference may exist. Always tell any doctor or dentist who treats you that you have a pacemaker.

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