Permanent Cardiac Pacemaker Insertion

What is it?

A pacemaker comprises 2 parts:

• the pacemaker box (also known as the pulse generator) which is a sophisticated piece of equipment with microcomputers and
• a battery, and wire (also called leads).

The pacemaker box, which is inserted into the heart is about the size of a small lighter and is made of inert metal alloy. The battery usually lasts 7 to 10 years, after which the entire pacemaker box is changed. The wires are inserted into the heart via the veins from one of the arms.

Modern pacemakers systems are extremely reliable and after implantation, are unobtrusive and do not affect your activities of daily living. Most patients notice an immediate improvement in their condition and symptoms after insertion of a pacemaker.

Why do you need a Cardiac Pacemaker?

Excessively slow heart rhythms can severely affect the heart's ability to pump blood throughout the body. This may cause symptoms such as fatigue, dizziness, shortness of breath, fainting and in extreme circumstances, death. In such cases, your doctor may recommend a permanent pacemaker to be implanted.

In some patients with heart failure, a special pacemaker may be implanted to improve the heart function. It is known as Cardiac Resynchronization Therapy.

What to expect?

You will need to stay in hospital for 3 to 4 days for the pacemaker implantation. The implant procedure usually lasts about one hour, and is performed under local anaesthesia with sedation.

Before the procedure,

• Some routine blood tests and electrocardiograms may be performed
• You will be required to sign a consent form.
• A small needle is inserted in one of the veins on your hand to facilitate injection of medication.
• You will be asked to fast on the night before the procedure.
• Just before the implantation, you will be given an injection of an antibiotic.

 

During the procedure, The implantation is performed in the Invasive Cardiac Laboratory. After injection of local anaesthetic, a small incision (cut) is made in the upper left chest (if you are right-handed) and a small "pocket" is created under the skin to accommodate the pacemaker box. An insulated lead is then inserted through a vein in the upper chest and, guided by X-ray, is threaded until its tip lies snugly within the heart. The other end of the lead is then connected to the pacemaker. The incision wound is closed with stitches, cleaned and bandaged

Upon returning to the ward,

• You will be given regular antibiotic injections to reduce the risk of infection.
• Please inform the attending nurse if you experience pain at the implant site; painkillers can be prescribed.

The following day,

• You will be sent for a chest X-ray to check the position of the pacemaker and wire, and to look for potential complications.
• The pacemaker will also be checked to programmed buy a technologist.

Most patients can be discharged one or two days after the implantation.

On returning home,

• You can resume most daily activities within a few days (please see "What should you do after the Pacemaker Implantation" below).
• Take care to keep the wound dry. The waterproof dressing should be changed daily for a week to 10 days after which it should have healed.
• The stitches need not be removed as they are absorbable.
• Your doctor will arrange a schedule of periodic checks, and will electronically program the pacemaker's behavior to suit your requirements.

What are the potential risks or complications?

The procedure is extremely safe, with a low risk of complications. Most complications are minor and easily treated, such as pain, bleeding and bruising at the implant site.

An infrequent complication is pneumothorax, a condition where the lung is accidentally punctured during the insertion of the wire, and air leaks into the chest cavity, causing the lung to collapse. This condition is reversible and can be treated with insertion of a chest tube to allow the air to escape and the lung to re-expand.

A rare but serious complication is infection of the implant site, requiring antibiotic therapy and removal of the pacemaker system.

What should you do after the Pacemaker Implantation?

1. You should watch for fever, excessive pain, redness or swelling over the wound. Inform your doctor immediately if you have these symptoms.

2. On the side of the pacemaker, avoid excessive movement of the arm, lifting the arm above your head and lifting more than 5kg load for 2 weeks after implantation.

3. Complete the course of antibiotic medication prescribed on discharge.

4. Remember to inform all your attending doctors that you have a permanent pacemaker. Some important reasons for this include:

a) short-wave diathermy for the treatment of rheumatism, and use of diathermy   close to the pacemaker site during surgery should be avoided;

b) you should avoid magnetic resonance imaging, a medical diagnostic imaging technique.

5. Avoid using mobile handphones on the side of the pacemaker as there is a concern that it may affect the functions of the pacemaker.

6. Ensure that you return for regular check-up at the appointed dates so that you derive the greatest benefits from the pacemaker.

If you have any query regarding these instructions, please contact your doctor.

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