Pacemaker Surgery

A pacemaker implantation is known to be a necessary surgery to solve some heart problems that affect the rate of heartbeat. 

The heart contains four chambers, two upper and two lower, the heart pushes blood from the lower chambers during contracting process, causing the heart beating sound,the sinoatrial (SA) node which is located within the right atrium is responsible in generating electrical signals which spreads through the septal area -between the two upper chambers of the heart- to reach all heart cells in order to regulate heart beats, in some cases a defect may affect the pacemaker which then impedes the normal emission of electrical signals, this can lead to tachycardia, bradycardia, or possibly irregular heartbeats, requiring surgical intervention to implant an artificial pacemaker.

The patient should expect to remain in the hospital overnight in order to be monitored for arrhythmias and to see if the pacemaker is working properly.  After an overnight stay, the patient will not be able to drive themselves home and should arrange for someone to take them home from the hospital. 

For several days or weeks following pacemaker surgery, the patient may have tenderness, swelling, or pain in the area of the incision. The pain is usually not very severe and can be managed by taking over the counter medications, such as ibuprofen, naproxen sodium, or acetaminophen.  In rare cases, prescription medications will be recommended.

The patient may be asked to avoid extreme exercises and should not lift anything heavy for about 4 weeks after pacemaker surgery.  Most patients can return to work and their normal daily activities within a couple of days after having the procedure.

A cardiovascular specialist may use a pacemaker as a result of one of the following problems:

• Tachycardia; heart beats faster.
• Bradycardia; heart beats slowly.
• Irregular heartbeat.

Either of the above is often associated with some symptoms that may indicate a heart problem, such as: a feeling of fatigue and general weakness, fainting, apnea and chest pain.

The cardiovascular specialist performs a range of tests to check on the patient's susceptibility to a pacemaker implantation. These procedures include:

• Know the patient's medical record.
• Blood tests.
• Electrocardiogram (EKG).
• Echocardiogram to measure the efficiency of the heart by performing its functions.
• Holter Monitor, to measures your heart's activity, within 24 hours.
• Stress testing.
• Angiography.

A pacemaker implantation may involve a range of risks and complications. Although rare, but the patient should be aware of them, including:

• Inflammation of the area where the device was implanted.
• Sensitivity to the dye or anesthetic used during the surgery.
• Bruising or swelling at the site of implantation; bleeding from the same site may also occur.
• Damage the nerves or blood vessels surrounding the implanted pacemaker.
• Pulmonary atelectasis is a health problem in which air is released from the lung to the surrounding cavity.
• Allergies to some types of medicines.

This surgery includes three main stages:

• Patient preparation:

The patient is asked to fast before the surgery, and to stop any blood thinners to avoid bleeding during or after the surgery, and then he is taken to a special room to complete the rest of the preparatory things, where the medical team inserts the intravenous needle in the arm near the pacemaker implantation area.

Sterilize and clean the place where the incision is made.

• During the surgery: 

The surgery site is often locally anesthetized without the need for general anesthesia, and then the cardiovascular surgeon make an incision in the upper chest area to the left by 2 inches (5.08 cm), then wires or electrodes are inserted into the veins passing under the collarbone and passes them to the heart with the help of fluoroscopy to find out what is going on inside by observing the live images, then they are fixed in the right place in the heart, and attached to a small device (pacemaker) implanted under the skin below the collarbone.

Before the incision is closed, the cardiovascular specialist will test the pacemaker implanted by an ECG, and then the incision will be close.

• After the surgery: 

The patient remains in the hospital for one night, often to check on his health and the function of the pacemaker, after which he can leave the hospital with a relative or acquaintance; that he will not be able to drive. The patient may experience pain in the chest or site of the incision for two days after the implantation of the pacemaker, therefore, he can use some regular analgesics such as ibuprofen, naproxen or acetaminophen, but in some other cases the surgeon should prescribe the type of analgesic to avoid any possible risks, that it is possible, for example, that a pregnant woman may undergo the surgery.

During his stay in the hospital, the patient remains in contact with the cardiac monitor to continue picking up electrical signals from the implanted device in the patient's chest and to verify that it is functioning properly and monitor the heartbeat, as well as X-ray imaging of the patient's chest to verify that the device is in place.

The patient is given a card containing the type of pacemaker implanted, which should be well maintained and always kept with him in case of any sudden malfunction.

After a pacemaker implantation, the patient may experience pain and swelling at the site where the pacemaker is implanted. These symptoms may last for several days and maybe weeks, as the recovery process may often take up to four weeks.

The patient is also advised to avoid lifting any heavy weight objects for approximately 4 weeks after the surgery. Also, it is preferred not to raise the left arm  (or right in case the  device is implanted in the right part of the chest) for 4 to 6 weeks, The physiotherapist can be consulted to learn the most appropriate exercises to practice after the surgery until the patient is fully recovered.

The patient can return to work or job within a few days after returning home.