Permanent Pacemaker Implant Surgery – PreOp® Patient Education
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Your doctor has recommended that you receive a permanent pacemaker implanted in your body. But what does that actually mean?
The heart is located in the center of the chest, enclosed by the breast bone and rib cage. By contracting in a rhythmic way, it causes the blood in your body to circulate.
A normally functioning heart beats at a rate of between 60 and 100 contractions per minute.
These contractions are triggered by a small piece of heart tissue called the SA node. The SA node generates a small electrical signal that is transmitted by nerves to the surrounding muscle. These electrical impulses are what cause the heart muscle to contract.
In some people, the SA node fails to cause the heart to contract with its normal rhythm, causing an abnormal heartbeat or arrhythmia. The most common form of arrhythmia, for which pacemaker surgery is often recommended, is bradyarrythymia – or slow heart rate.
There are a number of reasons why you may have developed an arrhythmia, but in most cases the problem is caused by a disruption in the SA node or in the system of nerves that conducts electrical signals to the heart muscle.
A pacemaker is a device that is designed to provide an electrical signal to the heart muscle and to help it maintain a proper rhythm. There are several types of pacemakers and the particular model selected for you will be based on your specific condition. But all pacemakers share a common design.
Your pacemaker will consist of two major pieces . . . a small metal box that contains a battery and other electronic components and an insulated wire, called a lead, which will carry the electrical impulses from the pacemaker to the heart.
Your pacemaker will be permanently implanted in your chest and, depending on your condition, either one or two leads will be attached to the heart muscle.
On the day of your operation, you will be asked to put on a surgical gown.
You may receive a sedative by mouth and an intravenous line may be put in.
You will then be transferred to the operating table.
To begin, skin is swabbed with an antiseptic solution and a sterile drape will be placed around the operative site.
Then the surgeon will make a small skin incision in the upper chest, just below the collarbone.
A pocket is then created between the skin and the tissue that covers the chest muscle.
Next, the team will use instruments called retractors to hold back the skin and underlying tissue. They’ll locate a large blood vessel called the subclavian vein.
Using a special needle and syringe, your doctor will puncture the wall of the vein.
A thin guide wire is then inserted through the needle and into the vein. Your doctor gently pushes the wire until it reaches the heart.
Using an instrument called a fluoroscope the surgical team is able to see the wire’s progress through the vein and into the beating heart.
Once the wire is in place, the needle is removed and a catheter – or hollow tube – is passed over the guide wire and into the heart.
One or two leads are then passed through the catheter.
When the lead or leads are in their proper position, the catheter is removed.
Finally, the lead is connected to the pacemaker, the pacemaker is inserted into the pocket below the collar bone and the incision is closed.
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Now let’s learn about what may occur after surgery, some risks of surgery, and what you can do to help.
It is important for you to “speak up” and tell your care team if you have more than expected pain or problems.
They will be watching for early, rare complications.
For the best recovery, follow your instructions after surgery that may include information about,
Call your doctor if you have trouble with diarrhea, vomiting or worsening constipation. Call if you cannot urinate, have a fever, or pain that is getting worse even with rest and medication.
Call 911 if you have chest pain, shortness of breath, dizziness, bleeding that doesn’t stop, and any other sign that you may be having a complication from the procedure.
Hospital admission, medication or (additional) surgery may be needed to correct some problems.
To avoid cancellation or complications from anesthesia or your procedure, your job as the patient is to
not eat, drink or chew gum after midnight, the night before the procedure unless you are given different instructions
take only medications you were told to on the morning of the procedure with a sip of water
follow instructions regarding aspirin and blood thinners before surgery,
and arrive on time
This video is intended as a tool to help you to better understand the procedure that you are scheduled to have or are considering. It is not intended to replace any discussion, decision making or advice of your physician.