PACEMAKER INSERTION

General Information

DEFINITION--Insertion of a temporary or permanent pacemaker into the chest wall. A pacemaker is an electronic device consisting of an electrode connected to the heart muscle and a regulatory device and power source implanted in the skin. It provides regular, mild electric shocks that stimulate the heart muscle and maintain normal heartbeat.

BODY PARTS INVOLVED--Veins in neck; tissue under the skin below the collarbone; heart.

REASONS FOR SURGERY

• Regulation of heartbeat that has slowed due to heart disease.
• Treatment of heart block.
• Following cardiac surgery to regulate heart rate,

SURGICAL RISK INCREASES WITH

• Adults over 60.
• Stress.
• Obesity.
• Smoking.
• Excess alcohol consumption.
• Use of drugs such as: antihypertensives; muscle relaxants; tranquilizers; sleep inducers; insulin; sedatives; beta-adrenergic blockers; or cortisone.
• Use of mind-altering drugs, including: narcotics; psychedelics; hallucinogens; marijuana; sedatives; hypnotics; or cocaine.

What To Expect

WHO OPERATES--Cardiovascular surgeon, cardiologist (sometimes).

WHERE PERFORMED--Outpatient surgical facility or hospital.

DIAGNOSTIC TESTS

• Before surgery: Blood and urine studies; x-rays of chest; ECG (See Glossary for all).
• During surgery: ECG monitor; fluoroscopy (See Glossary for both).
• After surgery: ECG.

ANESTHESIA--Local anesthesia by injection.

DESCRIPTION OF OPERATION

• Small incisions are made below the collarbone and in the vein under the collarbone. An electrode is passed through the vein into the heart. The implantation site is confirmed.
• The electrode is attached to the power and regulating units. The entire device is inserted under the skin in a pouch created from tissue under the collarbone.
• The skin is closed with suture material, which usually can be removed about 1 week after surgery.

POSSIBLE COMPLICATIONS

• Excessive bleeding.
• Surgical-wound infection.
• Rupture in the heart muscle (rare).
• Pacemaker malfunction.
• Migration of pacing wire.
• Some pacemakers may be affected by radiation from microwave ovens. Ask your doctor.

AVERAGE HOSPITAL STAY--0 to 2 days.

PROBABLE OUTCOME--Expect complete healing without complications. Allow about 2 weeks for recovery from surgery.

Postoperative Care

GENERAL MEASURES

• A hard ridge should form along the incision. As it heals, the ridge will recede gradually.
• Use an electric heating pad, a heat lamp or a warm compress to relieve incisional pain.
• Bathe or shower as usual. You may wash the incision gently with mild unscented soap.

† You may use non--prescription drugs, such as acetaminophen, for minor pain.

† To help recovery and aid your well--

being, resume daily activities, including work, as soon as you are able.

• Avoid vigorous exercise for 2 weeks after surgery. > Resume driving about 1 week after returning home. > Resume sexual relations when able.

DIET---No special diet.

Call Your Doctor If

† Pain, swelling, redness, drainage or bleeding increases in the surgical area.

• You develop signs of infection: headache, muscle aches, dizziness or a general ill feeling and fever.
• You develop recurrent heartbeat irregularities.