Other Names: Cardiac pacemaker implantation; Permanent pacemaker; Temporary pacemaker, Internal pacemaker; Heart pacemaker 

Description/Test Basics/Reasons for the test: A pacemaker is a small, battery-operated device placed under the skin near your heart. A pacemaker monitors your heart rate and senses when your heart is beating too slowly (bradychardia), irregularly (arrhythmia) or too fast (tachycardia). Pacemakers are implanted in people with chronic conditions that cause these abnormal heart rates. Based on the type of abnormal heart rate, the pacemaker will send an electrical impulse or signal to your heart to beat at the correct pace. Pacemaker’s can be implanted on a temporary or permanent basis.

There are many underlying causes that can cause an abnormal heart beat, or arrhythmia. Normal aging, heart failure, prior heart attack, genetic conditions, congenital conditions and some medications (such as beta-blockers) are just some of the situations that can cause your heart to beat irregularly.

Sinus node disease and heart block are two heart problems that can cause bradychardia, or a slowing of your heart rate. If your heart beats too slowly, or too quickly, not enough blood flows through your body. This can lead to, among other symptoms, shortness of breath, fatigue, confusion and even fainting spells. By correcting the abnormal heart beat, pacemakers relieve most, if not all of these symptoms, greatly improving your quality of life. Most pacemakers produced today even have sensors that monitor your breathing rate or body motion and can increase your heart rate when, for example, to meet your body’s demands for greater amounts of oxygenated blood. 

Test preparation/pre-test guidelines: You will be asked to not eat anything after midnight the night before the test. You will need little preparation other than to inform the physician about all medications taken within the past month. Your physician may also order and EKG, Holter Monitor, Echocardiogram and/or stress test before the procedure.

Test process/How the test is done: A pacemaker consists of two parts:

  • The pulse generator is a small metal container that houses the battery and the electrical circuitry that sends electrical pulses to control your heartbeat.
  • The leads are flexible, insulated wires that connect the heart to the generator and deliver the electrical pulses to the heart.

Temporary pacemaker placement differs from permanent pacemaker placement. Temporary pacemaker insertion is usually done at the bedside while a patient is in the hospital. A temporary pacemaker is an external device. You will be given a sedative to relax as well as a local anesthetic at the insertion site. The insertion site will be cleaned and shaved. The insertion site will be a vein in either your neck or groin. A metal tipped catheter will be inserted into the vein at the insertion site and guided to the heart. The metal tips will attach to the inside of the heart and deliver electrical signals to the heart.

Permanent pacemaker implantation is considered minor surgery. It is done on an inpatient or outpatient basis. Your pacemaker implantation will take place in either the cardiac catheterization laboratory or electrophysiology laboratory at the hospital. You'll be given a sedative to relax, and the area where your pacemaker is inserted will be numbed will be numbed with a local anesthetic. The insertion site will be cleaned and shaved. You will be awake during the procedure. This procedure usually takes 1-2 hours.
A small incision (cut) is made, usually on the left side of the chest below your clavicle (collarbone). Your physician will incise the chest wall at this location to create a small pocket; the pacemaker generator is placed beneath the skin at this location, in front of the chest and underneath your collarbone. Using live x-rays to see the area, the doctor passes the pacemaker leads through the incision, into a vein, and then into the heart. The leads are secured to the inside of the heart using small screws or tines. The other end of the pacemaker leads are connected to the generator. The skin is closed with sutures, stitches or staples. Most patients go home within 1 day of the procedure.

Post-test guidelines: You'll usually stay in the hospital for one day after having a pacemaker implanted. An overnight hospital stay may be required for your physician to confirm that you’re in stable condition and pacemaker is functioning normally. Before leaving the hospital your pacemaker will be programmed to fit your heart’s needs.

You will be advised not to manipulate the pacemaker in any way. You will also be advised to avoid strenuous exercise or heavy lifting for at least one month. If you have any aches or pains around the incision site after the procedure, make sure you call our office before taking any pain relievers.

Test location: Pacemaker implantation is performed at Denton Regional Medical Center and Texas Health Resources Presbyterian Hospital Denton.

Special Notices:

  • Try to stay a minimum of two feet away from any high voltage power generating equipment. If you work around such equipment, make sure you let your doctor know.
  • Passing through the metal detector at the airport won’t interfere with your pacemaker function, but avoid leaning against the metal detector or lingering near it. The metal in your pacemaker may set the alarm off. Carry your ID card stating you have a pacemaker.
  • It’s safe to use your cell phone, but avoid placing your cell phone directly over your insertion site/pacemaker.
  • If you are seeing a physician who wants to order any sort of medical test that exposes you to high amounts of electromagnetic energy, such as an MRI or radiation, make sure you let that physician know. If you are going to have surgery, inform your surgeon that you have a pacemaker. 

HOSPITAL PRIVILEGES:   •  Denton Regional Medical Center   •  Texas Health Presbyterian Hospital Denton
   •  Muenster Memorial Hospital   •  North Texas Medical Center

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