Pacemaker (cont.)
How are pacemakers implanted?
Pacemaker systems are often implanted under local anesthesia in a
cardiac catheterization laboratory. Implantation of a pacemaker is
considered a minor procedure. Some hospitals with electrophysiology
laboratories implant pacemakers there. Hospitals without
catheterization labs implant pacemakers in the operating room.
Patients are typically awake or only mildly sedated during the
procedure. A local anesthetic is injected under the skin over the
area where the pacemaker will be implanted, usually in the right or
left upper chest near the collarbone. The numbing injection keeps the
patient from feeling pain when a small incision is made over the same
area to create a small space. The pacemaker lead is then inserted
into a vein located in the upper chest near the collarbone. The lead
is placed in the right atrium or the right ventricle with the visual
guidance of x-rays. The tip of the lead is then attached to the inner
surface of the heart by small tines or with a small screw. If there
is more than one lead, the process is repeated. Because there are no
nerve endings inside the blood vessels and the heart, the patient
usually does not feel the placement of the lead(s).
The other end of the lead(s) is then connected to the pacemaker
chamber, which is then placed under the skin. Closing the incision
with sutures completes the process. The procedure usually takes
about an hour. Patients are discharged the same or the next day if
there are no complications. Patients are given antibiotics to prevent
possible infection, and sent home with pain medications to alleviate
post-surgical pain at the incision site.
Occasionally, leads are placed on the outer surface of the heart,
a process called epicardial (outside the heart) implantation. When
leads are placed in this manner, the chest wall is opened surgically.
The lead or leads are placed onto the heart surface, and the
pacemaker chamber is implanted underneath the skin in the upper
abdomen. Because epicardial implantation is more difficult and
requires more extensive surgery, this procedure is used when leads
cannot be placed inside the heart via the blood vessels. These
situations occur most frequently in children who are too small to
have a lead placed in the blood vessels, or in adult patients with
congenital heart disease. Also, as children grow, the distance
between the pacemaker and the heart increases. Thus the lead(s)
between the heart and the chamber becomes too short.
Next: What are possible complications of pacemaker implantation? »
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