Background Information:

What are the other Names for the Procedure?

• Artificial Cardiac Pacemaker Implantation
• Pacemaker Implantation Surgery

What is Pacemaker Implantation surgical procedure?

• A pacemaker is a battery-powered device connected to the heart muscle that sends out weak electronic impulses, which causes the heart muscle to contract and maintains a normal heartbeat
• Pacemaker Implantation is a procedure that involves temporarily or permanently placing a pacemaker, within the chest wall

What part of the Body does the Procedure involve?

A Pacemaker Implantation Surgery involves the veins within the back or underlying collarbone, tissues under the skin beneath the collarbone, and the heart.

Why is the Pacemaker Implantation surgical procedure Performed?

The Pacemaker Implantation procedure is performed for the following reasons:

• Restoring normal heart function
• Treating heart block
• Regulating heart rate after cardiac surgery

What are some Alternative Choices for the Procedure?

There are usually no alternatives to placing an electrical pacemaker.

What are the Recent Advances in the Procedure?

The recent advances in Pacemaker Implantation Surgery are related to more advanced pacemaker devices.

What is the Cost of performing the Pacemaker Implantation surgical procedure?

The cost of Pacemaker Implantation procedure depends on a variety of factors, such as the type of your health insurance, annual deductibles, co-pay requirements, out-of-network and in-network of your healthcare providers and healthcare facilities.

In many cases, an estimate may be provided before the procedure. The final amount depends upon the findings during the surgery/procedure and post-operative care that is necessary. 

When do you need a Second Opinion, prior to the Procedure?

• It is normal for a patient to feel uncomfortable and confused by the information regarding the Pacemaker Implantation Surgery on what needs to be done
• If the patient needs further reassurance or a second opinion, a physician will almost always assist and also recommend another physician, if required
• Also, if the procedure involves multiple surgeries or has many alternatives, the patient may take a second opinion to understand and choose the best one. They can also choose to approach another physician independently

What are some Helpful Resources?

Complete Guide to Symptoms, Illness & Surgery; Written by H Winter Griffith, M.D.; Revised and updated by Stephen Moore, M.D. and Kenneth Yoder, M.D.; The Berkley Publishing Group, 5^th Edition, New York, 2006

http://www.surgeryencyclopedia.com/La-Pa/Pacemakers.html (accessed on 10/19/2014)

Prior to Pacemaker Implantation surgical procedure:

How is the Pacemaker Implantation surgical procedure Performed?

• The Pacemaker Implantation procedure may be performed under local anesthesia
• An incision is made above the collar bone and an insulated wire (lead) is guided through this incision, and through a large vein into the heart chamber
• The number and position of leads depend on the clinical scenario
• The lead wires are then attached to a pacemaker that is placed under the skin of the chest

Where is the Procedure Performed?

A Pacemaker Implantation procedure is performed at an out-patient surgery center facility or a hospital.

Who Performs the Procedure?

A cardiovascular surgeon, or a cardiologist trained in Pacemaker Implantation, or a cardiac electrophysiologist physician, performs the procedure.

How long will the Procedure take?

The Pacemaker Implantation procedure may take up to 90 minutes.

What do you need to tell your Physician before the Procedure?

It is very important to provide the following information to your healthcare provider. This enables your healthcare provider in assessing the risks for the Pacemaker Implantation procedure and helps avoid unnecessary complications.

• Provide a complete list of medications you are currently, taking to your physician. This information is useful for a variety of reasons. For example, it can help your healthcare provider prevent complications due to a drug interaction
• If you are allergic to any specific medication or food items
• If you are taking blood thinners, such as aspirin, warfarin, herbal supplements, or any other such medications
• If you or your family members, have a history of bleeding disorders, or if there is a tendency to bleed more than normal
• If you have diabetes, high blood pressure, chest pains, or have previously suffered from a heart attack
• If you have ever been diagnosed with blood clots in your leg (deep vein thrombosis) or lung (embolism of lung)
• If you have a history of frequent bone fractures (this may affect bone-healing, if bones are involved as part of your procedure)
• A list of all previous surgical procedures you have undergone, like for example: Removal of appendix, gallbladder, or any other part, of your body; surgical repair of any body part, such as hernia repair, perforation of bowel wall, etc.

What Preparations are needed, prior to the Procedure?

• The physician may evaluate the individual’s medical history to gain a comprehensive knowledge of the overall health status of the patient including information related to the medications that are being currently taken
• Some medications increase a person’s chances of bleeding and it may be recommended to discontinue them for a period of time, before the procedure is performed
• Blood tests may be performed to determine if there is a bleeding tendency or any other medical conditions that prevents the person from undergoing the procedure
• Inform the physician if you are allergic to any local anesthetics, lidocaine, etc
• Avoid application of any cosmetics, deodorant, or topical medicines on the area, prior to the procedure
• It is advisable to quit smoking and the use of any nicotine based products, for a while, before the surgery
• Consumption of alcoholic drinks must also be avoided for a period of time, as instructed
• The patient must avoid eating or drinking at least 8 hours prior to the surgical procedure, depending on when the procedure is arranged
• For persons suffering from diabetes, it is important that the blood sugar stays within the normal range; if not their diabetologist may have to control blood sugar by recommending insulin and/or a combination of oral medicines

What is the Consent Process before the Procedure?

A physician will request your consent for Pacemaker Implantation procedure using an Informed Consent Form.

Consent for the Procedure: A “consent” is your approval to undergo a procedure. A consent form is signed after the risks and benefits of the procedure, and alternative treatment options, are discussed. This process is called informed consent.

You must sign the forms only after you are totally satisfied by the answers to your questions. In case of minors and individuals unable to personally give their consent, the individual’s legal guardian or next of kin, shall give their consent for the procedure.

What Tests are needed, before the Pacemaker Implantation surgical procedure?

Before a Pacemaker Implantation procedure, the patient has to undergo certain tests, such as:

• Electrocardiogram (EKG)
• Body system studies

What are some Questions for your Physician?

Some of the basic questions that you might ask your physician are as follows:

• What is a Pacemaker Implantation procedure?
• Why is this procedure necessary?  How will it help?
• How soon should I get it done? Is it an emergency?
• Who are the medical personnel involved in this procedure?
• Where is the procedure performed?
• What are the risks while performing the procedure?
• What are the complications that might take place, during recovery?
• How long will it take to recover? When can I resume normal work?
• How many such procedures have you (the physician) performed?
• Are there any follow-up tests, periodic visits to the healthcare facility required, after the procedure?
• What are the costs involved?

During the Pacemaker Implantation surgical procedure:

What kind of Anesthesia is given, during the Procedure?

Local anesthesia by injection is administered for a Pacemaker Implantation procedure. Sedation of the individuals may also be performed.

How much Blood will you lose, during the Procedure?

There is hardly any blood loss during an uncomplicated Pacemaker Implantation procedure.

What are the possible Risks and Complications during Pacemaker Implantation surgical procedure?

There are general factors that increase the risk of getting complications during surgery and they include:

• Obesity: Generally greater the degree of obesity, greater is the surgical risk
• Smoking: Longer the smoking history (in pack years smoked), greater the surgical risk
• Advancing age
• Poorly controlled diabetes, as evidenced by a high hemoglobin A1c and a high fasting glucose
• Poorly functioning kidney, as evidenced by increased BUN (blood urea nitrogen) and blood creatinine
• Poorly functioning liver, as evidenced by increased blood liver function tests
• Hypertension (increased blood pressure), especially if it is poorly controlled
• Poor nutritional status (malnutrition with mineral and vitamin deficiencies)
• Poor lung function, as evidenced by abnormal lung function tests
• History of bleeding disorders
• Longstanding illness, such as autoimmune disorders, chronic infections
• Poor immune system due to a variety of causes

The possible risks or complications that may arise during the Pacemaker Implantation Surgery are:

• Excessive bleeding
• Injury to heart chamber
• Infection in the surgical wound
• Anesthetic complications

What Post-Operative Care is needed at the Healthcare Facility after Pacemaker Implantation surgical procedure?

At the healthcare facility, usually there is no requirement for any post-procedure care, unless any complications arise.

After the Pacemaker Implantation surgical procedure:

What are the possible Risks and Complications after the Pacemaker Implantation surgical procedure?

The possible risks and complications that may arise after Pacemaker Implantation procedure are:

• Excessive bleeding
• Infection in the surgical wound
• Failure of the pacemaker to accurately provide electronic impulses in the correct location, to stimulate the heart
• Sometimes, a condition called pacemaker syndrome, arises with the use of some types of pacing systems. This is manifested by a slow heart rate and low blood pressure. Your physician will monitor you for this complication

What is the Prognosis after the Surgery?

Correctly placed pacemakers are very effective in controlling irregular rhythms of the heart.

When do you need to call your Physician?

Do contact your physician if you notice any of the following symptoms:

• Pain that worsens and swelling of the surgical wound
• Bleeding or fluid drainage from the surgical wound
• Development of arrhythmia, or irregular heartbeat
• Signs of an infection
• Dizziness
• Muscle aches, headache
• Fever, feeling sick
• Complications associated with prescription medications used in treatment

What Post-Operative Care is needed at Home after Pacemaker Implantation surgical procedure?

At home, the following post-operative care is recommended, after a Pacemaker Implantation procedure:

• Slowly resume regular/daily activities as early as possible, which aids in a faster recovery
• Resume showering and keep the wound clean and dry. Gently wash the surgical wound with an unscented soap
• Complete the course of prescribed medication
• Take antibiotic medication to help combat or prevent infection, as per your physician’s advise
• Avoid all activities that are physically strenuous for about 2 weeks, as advised by your physician
• Resume driving a few days after being discharged from the healthcare facility, or as determined by your physician
• Avoid sex till complete healing has taken place (under advise by the physician)
• Regularly monitor the status of the pacemaker batteries
• Individuals have to avoid magnetic resonance imaging (MRI) scans

How long does it normally take to fully recover, from the Procedure?

It generally takes about 2 weeks to fully recover from the Pacemaker Implantation procedure.

Additional Information:

What happens to tissue (if any), taken out during the Procedure?

The Pacemaker Implantation procedure does not involve the surgical removal of any tissue.

When should you expect results from the pathologist regarding tissue taken out, during the Procedure?

Since no tissue is removed during the procedure, a pathologist does not get involved in the care of the patient.

Who will you receive a Bill from, after the Pacemaker Implantation surgical procedure?

It is important to note that the number of bills that the patient may receive depends on the arrangement the healthcare facility has with the physician and other healthcare providers.

Sometimes, the patient may get a single bill that includes the healthcare facility and the consultant physician charges. Sometimes, the patient might get multiple bills depending on the healthcare provider involved. For instance, the patient may get a bill from:

• A outpatient surgical center facility or a hospital
• An anesthesiologist (if anesthesia was administered)
• A cardiovascular surgeon or a cardiologist

The patient is advised to inquire and confirm the type of billing, before the Pacemaker Implantation procedure is performed.

Thanks and Gratitude:

We sincerely acknowledge and thank Dr. Douglas J. Jones for reviewing the article. His valuable input and feedback has helped enrich the contents of this article.

Douglas J. Jones, MD FACS
Board Certified General Surgeon and Faculty Member
University of Illinois, College of Medicine at Urbana-Champaign
506 S. Mathews Ave., Urbana, IL 61801, USA