Pacemaker

A pacemaker is a small device that is implanted under the skin of the chest to help regulate the heartbeat. It works by sending electrical impulses to the heart to prompt it to beat at a steady pace.

This is often necessary when there is a slow heart beat, or when the heart rate does not increase with exercise. Typical symptoms might include fatigue, dizziness, or fainting.

Procedure

A pacemaker is made up of a small generator (about 3-4cm long, and 7mm thick), and one or more pacemaker leads. Each lead is a thin wire that runs from the generator to the heart.

The procedure is performed in hospital under sedation. After antibiotic medication is given to help prevent infection, a small incision is made below the collar bone. A ‘pocket’ is then made under the skin to house the generator. One or 2 leads are passed into the nearby vein - called the subclavian vein - and then into the heart where they are attached to the inner lining of the heart by small screws. Finally, the wound is closed with absorbable sutures and a dressing placed over the incision.

Once the pacemaker is implanted it is programmed to suit the specific needs of the individual. This can include setting the rate at which the pacemaker sends impulses to the heart, and the sensitivity of the pacemaker rate to the activity level of the patient.

Single or Dual Lead Pacemaker?

A single lead pacemaker is most often used when the upper chambers of the heart (the atria) are in atrial fibrillation. In this case, only a single lead is required in the ventricle.

A dual lead pacemaker is employed when the heart is in rhythm, but either the upper chambers (the atria) run too slowly or else there is an electrical block between the upper and lower chambers (ventricles). The two leads work together to maintain synchronous contraction of the heart.

Post-procedure Care

After the pacemaker is inserted a chest Xray is performed to confirm correct positioning of the pacemaker leads. There is a one night stay in hospital. The following morning, a final check is made of the pacemaker to confirm normal function.

On discharge from the hospital a remote monitor is given which monitors the pacemaker function when at home. In some cases, an application may be used with an iPhone or Android phone, to monitor the paceamaker.

A 1 month review appointment will be made to see the doctor who implanted the pacemaker.

Wound Care

The wound dressing is water-proof to allow showering in the days after the procedure. However, the wound should not be submerged under water.

About 3-5 days after the pacemaker a GP will remove the wound dressing and inspect the wound for infection.

Follow up

Typically you will be seen in the clinic once a year; the remainder of the time, the device will be monitored remotely (either through a monitor device or an application on your phone).

Risks of Pacemaker Insertion

As pacemaker insertion is an invasive procedure, the following risks are possible:

In 1-2% of cases:

• bleeding or haematoma (collection of blood) under the skin
• pneumothorax (that is, air around the lung requiring drainage)
• pericardial effusion (that is, fluid around the heart requiring drainage)
• infection at the wound site requiring pacemaker removal
• lead dislodgement requiring re-operation and repositioning of the pacemaker lead

The risk of very serious complication including: stroke, heart attack, or emergency surgery is 1/1000. The pacemaker battery will last between 8 and 15 years depending on how often it has to pace the heart.