Surgeries
Pacemaker Surgery

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Your heart has an electrical system that controls how fast or slow it beats. The natural pacemaker sends electrical impulses from the top of the heart (the atria), towards the bottom of the heart (the ventricles). When electrical signals reach these chambers, the heart contracts and then relaxes. The heart pumps blood to al parts of the body. This pumping makes waves of pressure that are felt as our pulse.

When the electrical signal is intermittent or slow, you may need an artificial pacemaker. You may have had one of the following symptoms:

• Dizziness – when the heart rate drops, even for a few seconds, you may feel dizzy or faint. You may fall down;
• Blackouts or fainting spells;
• Blurred vision;
• Shortness of breath; and
• Chest pain

The heartbeat is usually 50 to 110 beats per minute. However, it may be as low as 30 to 40 beats per minute if you have a condition called “heart block”. There are different types of heart block.

• Complete heart block – your natural pacemaker cannot send impulses between the atria and ventricles.
• Intermittent heart block – your natural pacemaker works some of the time.
• Sick sinus syndrome – sometimes the natural pacemaker is too slow or races uncontrollably and dizziness or fainting may result.

Electronic Pacemakers

An electronic pacemaker is made up of two parts.

• Pulse Generator – contains the circuitry and battery that generate the electrical signal. The battery can last from 6 to 15 years, depending on the type of pacemaker and how much you use it.
• Leads – the wires that carry the electrical signal from the pulse generator to the heart. An electrode is located at the end of the lead. Through this, the pacemaker monitors (senses) the heart’s electrical activity and sends out electrical impulses (paces) only when needed.

Types of Electronic Pacemakers

• A “single chamber pacemaker” can stimulate either the atria or ventricles.
• A “dual chamber pacemaker” can stimulate both the atria and ventricles.
• A “rate responsive pacemaker” uses special sensors that detect a need to increase and decrease your heart rate where necessary.

Before Pacemaker Surgery

A doctor will come to see you before your surgery to explain the procedure and have you sign a form that gives the surgeon permission to do the surgery. If your heart rate is too slow, you may be on a monitor called “telemetry”. This allows the nurses and doctors to watch your heart rate all the time until the electronic pacemaker is implanted. The anaesthetist (the doctor who monitors you and gives you your medications during the surgery) will want you to fast for a while before your surgery.

The Surgery

You will receive a local anesthetic to freeze the area where the pacemaker will be inserted. You will be awake but relaxed. The surgery will last 30 to 60 minutes. The anaesthetist and operating room nurses will be there to attend to your needs. The anaesthetist will start an intravenous in a vein to give you antibiotic and other medications to relax you. In the operating room your heartbeat will be monitored along with your blood pressure. When your pacemaker is inserted you probably won’t feel any pain, but you may feel a pressure sensation. A few tests will be performed to ensure the pacemaker is functioning appropriately.

After your surgery you will be taken to the recovery room. The nurses will check your dressing over your pacemaker site, your intravenous and take you back to your room as soon as you are ready.

Your incision will be three to four inches long, probably on the left side of your chest (if you are right-handed), just below the collar bone. If you are left-handed, inform your nurse or doctor and the pacemaker can be placed on your right side. The stitches will dissolve as the incision heals. You will not need to come back to the hospital to get them removed.

After Surgery

 You may still have an intravenous when you come back to your room. After you have eaten and taken fluids, your intravenous will be removed. The doctor may monitor your rate on “telemetry” for a few hours. This is to check that your pacemaker is working properly. After the freezing wears off, you may feel some discomfort where the pacemaker was inserted. Your nurse can give you medicine to help relieve the pain.

You will have a small dressing over your incision. This dressing will be removed the morning after the surgery. It is normal to see some swelling or a bruise around the incision site. This will go away in about one week.

Before leaving the hospital you will have your pacemaker checked at the pacemaker clinic. If you have any questions, or would like your family to go with you to the pacemaker clinic, please tell your nurse.

For 10 to 14 days after the surgery you should not lift your arm above your head on the side where the pacemaker was implanted (normal movement is okay). This will help keep the pacemaker wire in good position.

It is normal to occasionally feel weak and tired for the first month after surgery. Before leaving the hospital you will usually get a temporary pacemaker ID card. This card has your name on it and the type of pacemaker and leads that you have. You will get a permanent card to replace the temporary card in the mail. You will also receive an appointment notice from the pacemaker clinic six to eight weeks after discharge.

Be sure to ask for an application form to get a medic alert bracelet. This alerts others that you have a pacemaker.

At Home After Surgery

Once you are home, you can shower or bath. Do not direct the showerhead directly on the incision until it is completely healed. You can continue with all of your previous activities (housework, gardening, etc.) when you feel ready.

Remember to tell any new doctor, dentist or therapist that you have a pacemaker. Some tests or medicine may interfere with your pacemaker. Have your pacemaker ID card available to show them if they want to see it.

Points to Remember

• You will come back to the pacemaker clinic once or twice a year for a routine visit to ensure your pacemaker is functioning appropriately. It is important to keep these appointments even if you feel well. If you have problems between visits, speak with your family doctor.
• Counting your pulse is a good way to check that your pacemaker is working properly. Your doctor will set your pacemaker to beat at a certain number of beats per minute. By putting your fingertips on a point on the inside of your wrist, or over an artery in your neck, you can feel your pulse. The number of pulse beats per minute is the same as the number of heartbeats. Count your pulse and keep a record of any symptoms such as shortness of breath, racing heart beat (palpitations) etc. Don’t be alarmed if your pulse rate is higher than the pacemaker’s set rate. The pacemaker is there for a back up so your heart rate doesn’t beat too slowly. If your heart rate increases dramatically (above 120 beats per minute) please call or see your family doctor, especially if it is associated with shortness of breath or chest pain.
• If you wish to participate in active contact sports, try and avoid contact to the pacemaker.
• You can wear protective pads under straps, suspenders or seat belts.
• If you work with heavy equipment, arc welders or ignition systems, you should talk to the pacemaker clinic staff about the potential for problems. If you feel light headed or dizzy when near to, or when using an electrical device with large electromagnetic fields, move away and symptoms should subside.
• The metal detector used in airports may go off because of the metal in your pacemaker. Make sure to tell airport security staff you have a pacemaker. The metal detector will not affect your pacemaker. Have your pacemaker ID card available.
• You may have a microwave oven in your home. No special precautions are necessary, as microwaves are well insulated and will not interfere with the functioning of your pacemaker.
• You may operate any of the electrical devices in your home. These include shavers, and electric kitchen appliances. They will not affect how your pacemaker works.
• If it unlikely that cell phones will affect your pacemaker, but use the following guidelines. If your pacemaker is on the left side, use the right side to talk, and vice versa. Do not carry your cell phone in your breast pocket over your pacemaker site.

Problems to Watch For

• Fever
• Soreness
• Drainage
• Redness

Tell your family doctor if you notice any of these signs of infection.

• Sudden shortness of breath or dizziness.

A slow heart rate (less than your minimum programmed rate), or an extremely fast heart rate (greater than 120 or your upper programmed rate), can mean your pacemaker or heart’s electrical system is not functioning properly. Call your family doctor or go the nearest emergency room.