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During the procedure
Surgery to implant the pacemaker is usually performed while you're awake and typically takes a few hours. You'll be given a sedative to relax, and the area where your pacemaker is inserted will be numbed.
During surgery, one or more flexible, insulated wires (leads or electrodes) are 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 each wire is secured to the appropriate position in your heart, while the other end is attached to the pulse generator, which is usually implanted under the skin beneath your collarbone.
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, most pacemakers can be checked remotely using wireless technology. Using your cellphone or radiofrequency signals, your pacemaker transmits and receives information between you and your doctor's office, where your doctor can access the data — including your heart rate and rhythm, how your pacemaker is functioning, and remaining battery life. Remote transmissions can be made at scheduled intervals or at unscheduled times if your pacemaker sends an alert, or you can send a transmission if you have a concern. Remote technology means fewer trips to the doctor's office, but you'll still need to be seen by your doctor in person for scheduled checkups.
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 IB, 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:
- Cellphones. It's safe to talk on a cellphone, 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 cellphone 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 2 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.
- Tracy CM, et al. 2012 ACCF/AHA/HRS focused update of the 2008 guidelines for device-based therapy of cardiac rhythm abnormalities — A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. The Journal of Thoracic and Cardiovascular Surgery. 2012;144:e27.
- What is a pacemaker? National Heart, Lung, and Blood Institute. http://www.nhlbi.nih.gov/health/health-topics/topics/pace/. Accessed Jan. 29, 2013.
- What is a pacemaker? American Heart Association. http://www.heart.org/idc/groups/heart-public/@wcm/@hcm/documents/downloadable/ucm_300451.pdf. Accessed Jan. 29, 2013.
- How the healthy heart works. American Heart Association. http://www.heart.org/HEARTORG/Conditions/CongenitalHeartDefects/AboutCongenitalHeartDefects/How-the-Healthy-Heart-Works_UCM_307016_Article.jsp. Accessed Jan. 26, 2013.
- Fuster V, ed., et al. Hurst's The Heart. 13th ed. New York, N.Y.: The McGraw-Hill Companies; 2011. http://www.accessmedicine.com/resourceTOC.aspx?resourceID=5. Accessed Jan. 28, 2013.
- Goldberger AL, et al. Clinical Electrocardiography: A simplified approach. 8th ed. Philadelphia, Pa.: Elsevier Saunders; 2013. http://www.mdconsult.com/books/page.do?eid=4-u1.0-B978-0-323-08786-5..C2010-0-67269-5&isbn=978-0-323-08786-5&uniqId=402077730-3#4-u1.0-B978-0-323-08786-5..C2010-0-67269-5--TOP. Accessed Jan. 29, 2013.
- Saxon LA, et al. Overview of cardiac pacing in heart failure. http://www.uptodate.com/home. Accessed Jan. 29, 2013.
- McKean SC, et al. Principles and Practice of Hospital Medicine. New York, N.Y: The McGraw-Hill Companies; 2012. http://www.accessmedicine.com/resourceTOC.aspx?resourceID=749. Accessed Jan. 25, 2013.
- 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. 2010;7:1008.
- Grogan M (expert opinion). Mayo Clinic, Rochester, Minn. March 17, 2013.
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