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By Mayo Clinic staff
During the procedure
Surgery to implant the pacemaker is usually performed while you're awake and typically takes about one or two hours. You'll be given a sedative to relax, and the area where your pacemaker is inserted will be numbed.
During surgery, a flexible, insulated wire (lead) is inserted into a major vein under or near your collarbone and guided to your heart with the help of X-ray images. One end of the lead (the electrode) is secured to your heart's right ventricle, while the other end is attached to the pulse generator, which is usually implanted under the skin beneath your collarbone.
In many cases, another lead is secured to your heart's upper right chamber (atrium) to keep your heart pumping in a coordinated manner. This is called a dual chamber pacemaker system because both the right atrium and right ventricle are stimulated in sequence.
After the procedure
You'll usually stay in the hospital for one day after having a pacemaker implanted. Before you leave, your pacemaker is programmed to fit your particular pacing needs. A return visit is often scheduled to make sure your pacemaker's settings are correct.
After that, you'll have your pacemaker checked via telephone every few months. You connect to a phone line with either a transmitter attached to wristbands on each of your arms or a wand placed over the pacemaker. These devices send pacemaker information to your doctor's office. A technician on the other end of the line checks your heart rate and rhythm and evaluates your pacemaker's function and remaining battery life.
After your procedure to implant your pacemaker, your doctor may recommend that you avoid vigorous exercise or heavy lifting for about a month. You may have some aches and pains near the area where your pacemaker was implanted. These pains can be relieved with over-the-counter medicines, such as acetaminophen (Tylenol, others) or ibuprofen (Motrin, Advil, others), but talk to your doctor before taking any pain relievers.
Special precautions
It's unlikely that your pacemaker would stop working properly because of electrical interference. Still, you'll need to take a few precautions:
- Cellular phones. It's safe to talk on a cell phone, but avoid placing your cell phone directly over your pacemaker implantation site when the phone is turned on. Although unlikely, your pacemaker could misinterpret the cell phone signal as a heartbeat and withhold pacing, producing symptoms, such as sudden fatigue.
- Security systems. Passing through an airport metal detector won't interfere with your pacemaker, although the metal in it may sound the alarm. But avoid lingering near or leaning against a metal-detection system. If security personnel insist on using a hand-held metal detector, ask them not to hold the device near your pacemaker any longer than necessary or ask for an alternative form of personal search. To avoid potential problems, carry an ID card stating that you have a pacemaker.
- Medical equipment. If a doctor is considering any medical procedure that involves intensive exposure to electromagnetic energy, tell him or her that you have a pacemaker. Such procedures include magnetic resonance imaging, therapeutic radiation for cancer treatment, and shock wave lithotripsy, which uses shock waves to break up large kidney stones or gallstones. If you're having surgery, a procedure to control bleeding (electrocautery) also can interfere with pacemaker function.
- Power-generating equipment. Stand at least two feet (60 centimeters) from welding equipment, high-voltage transformers or motor-generator systems. If you work around such equipment, your doctor can arrange a test in your workplace to determine whether it affects your pacemaker.
Devices that are unlikely to interfere with your pacemaker include microwave ovens, televisions and remote controls, radios, toasters, electric blankets, electric shavers and electric drills.
- Pacemaker. National Heart, Lung, and Blood Institute. http://www.nhlbi.nih.gov/health/dci/Diseases/pace/pace_all.html. Accessed July 28, 2010.
- Saxon LA, et al. Overview of cardiac pacing in heart failure. http://www.uptodate.com/index. Accessed July 28, 2010.
- Pacemaker (dual chamber) animation. American Heart Association. http://www.americanheart.org/presenter.jhtml?identifier=3057329. Accessed July 28, 2010.
- Hayes DL. Indications for permanent cardiac pacing. http://www.uptodate.com/index. Accessed July 28, 2010.
- Olshansky B. Temporary cardiac pacing. http://www.uptodate.com/index. Accessed July 28, 2010.
- Living with your pacemaker. American Heart Association. http://www.americanheart.org/presenter.jhtml?identifier=24. Accessed July 28, 2010.
- Lampert R, et al. HRS expert consensus statement on the management of cardiovascular implantable electronic devices (CIEDs) in patients nearing end of life or requesting withdrawal of therapy. Heart Rhythm. 2010;In press. Accessed July 13, 2010.
- Bharadwaj P, et al. Ethical considerations of patients with pacemakers. American Family Physician. 2008;78:398.
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