• Your Pacemaker Procedure: What to Expect

    If you and your doctor decide that a pacemaker is the right treatment for your condition, your care team will explain how the small, battery-powered device will be implanted under your skin and how it will work to monitor your heart rate and send electrical signals to your heart.

    Before you receive a pacemaker  for a cardiac arrhythmia such as atrial fibrillation, your medical team will make sure you are aware of how the device works as well as any limitations to your normal activities that will be necessary after the procedure. Here we review some general information about pacemaker implantation.

    Testing Before Pacemaker Implantation 

    Before your pacemaker procedure, your doctor and medical team will recommend various tests to confirm that you are likely to benefit from having a pacemaker:

    • Electrocardiogram (EKG or ECG): This quick, painless test measures the heart’s electrical activity and records any disturbances in heart rhythm. Learn more about how an EKG works here.  
    • Stress Test: Sometimes your doctor will recommend that a stress test be performed along with an electrocardiogram to monitor your heart’s electrical activity during physical activity, such as walking on a treadmill or riding an exercise bike. Learn more about stress tests here. 
    • Echocardiogram: This test uses sound waves to create a moving picture of your heart. The information provided by this test can help your doctor see the heart’s chambers, walls, muscles and valves. Learn more about how an echocardiogram works here 
    • Holter Monitoring: Your doctor may recommend that you wear a device for several hours or up to 2 days as you go about your regular routine. The device, called a Holter monitor, records your heart’s rate and rhythm. Learn more about Holter monitoring here. 

    Depending on your overall health and any risk factors, your doctor may recommend other tests as well.

    How a Pacemaker Is Implanted 

    Pacemaker implantation procedures are performed in a hospital and may take several hours. A specially trained cardiologist, called an electrophysiologist, leads a team of health professionals who work in the electrophysiology (EP) lab. You can learn more about electrophysiologists and atrial fibrillation care teams here.  

    Before the procedure, you will be given a sedative to help you relax. The area where the pacemaker is to be inserted will be numbed, so that you will not feel the procedure taking place. Your electrophysiologist will implant tiny wires, known as electrodes or leads, near your collarbone. These electrodes will be guided through the veins to your heart. Once the electrodes have been delivered to the heart, your electrophysiologist will place them inside your heart where they can deliver electrical impulses to the muscles of the upper and/or lower heart chambers. The pacemaker’s battery and the circuits that create the electrical impulses (the pulse generator) will be implanted below your skin, not far from your collarbone.

    Once your pacemaker has been successfully implanted, your medical team will probably recommend that you stay overnight in the hospital. During your hospital stay, your electrophysiologist will program your pacemaker to fit your needs, considering your heart condition and activity level. Several follow-up visits will be scheduled to make sure the device is operating correctly, and to talk with you about how the pacemaker is working for you.

    After Your Pacemaker Implantation Procedure 

    Your electrophysiologist will provide recommendations concerning your activities following implantation of the pacemaker. In general, these recommendations will depend on your overall health, risk factors and activity level. It is likely you will not be allowed to work out strenuously or lift anything heavy until you have received your doctor’s approval. Your doctor will want to see you regularly until he or she is certain the pacemaker is functioning as it should and your body has adjusted to it.

    Wearing a Medical ID Bracelet or Necklace  

    After you receive your pacemaker, your medical team may recommend that you wear a medical ID bracelet or necklace to let emergency personnel and other healthcare providers know that you have a pacemaker. Remember, your pacemaker will be invisible beneath your skin. If you are ever in a position where you cannot speak for yourself, this information will help first-responders and others treat you appropriately.

    Your doctors may also recommend that you keep a printed card noting the type of pacemaker, when it was installed, the condition it treats and all contact information for the doctor. The American Heart Association has developed a downloadable card you can fill out. 

    Monitoring Your Pacemaker 

    You should also have regular check-ups with your medical team so that they can monitor your health and the condition of your pacemaker. Make sure to keep all appointments, as regular monitoring is an essential part of confirming that your pacemaker is functioning correctly, and that your heart is responding as it should.

    Technological advances have made it possible for some medical devices to be monitored using the telephone or the Internet. If this is an option for your pacemaker, your medical team will explain how it works.

    Your Pacemaker’s Battery Life 

    Pacemakers are powered by an internal battery that typically lasts 5 to 10 years. Pacemaker batteries are formulated to give adequate notice before they lose their charge, so you do not need to worry that your pacemaker battery will suddenly die and the pacemaker will stop working.

    You will not feel any symptoms when your pacemaker’s battery needs charging. However, because you will be having regular check-ups with your doctor, he or she will find the low battery in the course of the regular examination.

    When your pacemaker’s battery is running low, your electrophysiologist will replace the pulse generator of the pacemaker. Just as with the original procedure, you will be given a sedative to relax you and the insertion and removal site will be numbed. During the procedure, the doctor may also elect to replace one or more of the leads that deliver electrical impulses to the heart. In general, replacement procedures take less time than initial pacemaker implantation.

    Life with Your Pacemaker 

    No matter how well your pacemaker is working, the most important factor in its continued success is you. A heart-healthy lifestyle will provide your heart with optimal conditions for good health, and will allow the pacemaker to have its maximum beneficial effect. Talk to your doctor about the following:

    As always, you should have good communication with your doctor and your medical team. Ask all of your questions. To help you get started, we have gathered answers to many of the questions that are often asked about pacemakers. To review them, click here. 

    Learn More About Pacemakers  

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