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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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