CARDIOVASCULAR
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RECEIVING A PACEMAKER OR ICD DEVICE

Before you have your pacemaker or ICD implant procedure, it is important that you understand what the procedure can involve.

PROCEDURE RISKS

Generally, risks depend on your age, general health, specific medical condition and heart function. You should be aware of the following:

  • A small number of patients develop complications from the operation to implant the pacemaker and the leads in the body. These can include the following complications, which can usually be corrected or cured:
    • Infection
    • A reaction to a drug used during surgery
    • Blood loss
    • Damage to a blood vessel, the heart wall or other organ
  • After the surgery, you may feel some discomfort or feel tired, but these feelings only last a short time. Some patients, however, may continue to feel a bit uncomfortable in the area where the pacemaker was implanted.
  • Modern pacemakers have many safety features. Sometimes a pacemaker may not act properly because it is being affected by outside sources of electromagnetic energy.
  • It is also possible for the tip of the lead to shift in the heart so that the pulse is no longer effective. 
  • Very rarely, the "pocket" in your chest containing the device may open-up.
  • Finally, remember these are man-made devices. It is important to monitor the device regularly with follow-up visits as often as your doctor recommends.
  • Contact your doctor if:
    • You notice you are tired, short of breath or your heart rate is changing.
    • You notice the wound is red, hot, swollen, more painful or beginning to drain fluid.
    • Symptoms you had before the pacemaker was implanted seem to return.

In addition, many people have a small scar after the incision heals and a small bump where the implanted device rests under the skin of the chest. If you are very small or thin, the bump may be more pronounced. If you are concerned about this, your doctor may be able to place your device in a place that is less noticeable.

Never forget that your doctor is your best source of information about risks. Be sure to consult with your doctor about risks before you undergo your procedure, and discuss any concerns you might have afterwards.

IMPLANT PROCEDURE

If you doctor determines you will need a general anesthetic for your procedure, an anesthesiologist will give you medications to put you to sleep. Most patients stay awake during the procedure, and receive a local anesthetic to numb the area where the device will be implanted. If you receive the local anesthetic, you may be able to hear and even talk with the medical team during the procedure, and team members may have instructions for you, too. During the procedure, you may feel some pressure while the team implants your device, but you should not feel any pain.

Implanting a pacemaker or ICD typically follows these steps:

  1. Your doctor makes a small cut in your upper chest and locates a vein. 
  2. Your doctor makes a small puncture in the vein, and guides the leads down the vein to your heart.
  3. The surgical team monitors the lead placement in your heart using a kind of X-ray machine called a fluoroscope.
  4. Once the leads are in place, your doctor tests them to make sure they are in the best position to deliver electrical impulses to your heart. 
  5. Your doctor might ask you to go through some simple maneuvers, such as taking a deep breath or coughing vigorously, to make sure the leads are stable.
  6. Your doctor creates a “pocket” by making a small incision (cut) in the skin and separating the underlying tissue from the muscle beneath it.
  7. The surgical team connects the device to the leads and places it in the pocket. 
  8. The team closes the incision.

The duration of the surgery depends on what kind of device you are getting, as well as your specific anatomy and the time it takes to locate a good position for the lead. In some cases, implanting a pacemaker or ICD can take a number of hours.

IMMEDIATELY AFTER THE PROCEDURE
After the procedure, you will go to a recovery room to be monitored. You may feel some discomfort, and you will be tired. Depending on your condition, you may stay in the hospital from several hours up to several days. Your doctor will tell you how long to expect to stay.

NEXT: Heart Ablation

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