Your pacemaker

A pacemaker is a device inserted to regulate your heartbeat and helps your heart if it is beating to slowly.

Leads coming from the pacemaker box are placed in to different parts of the heart. An electrical signal from these leads is sent to stimulate the heart muscle to make the heart beat.

If it suggested that a single chamber pacemaker is best, one lead is inserted. For a dual chamber pacemaker, two leads are inserted. It might be suggested that a special pacemaker – a biventricular pacemaker be used. This has 3 leads and helps with heart failure (when the main problem is the strength of the heart muscle).

The team will discuss which pacemaker is best for you, depending on your heart condition.

What happens before the procedure?

You be checked in with the Pre-assessment clinic beforehand. This will be done either in the Cardiac Catheter lab or in a pacing pre assessment clinic

Female patients

If you are or think you might be pregnant please ring the Catheter lab on 020 8321 2618.
For women aged up to 56 years, a pregnancy test will be carried out on your arrival on the day of your procedure.

Eating and drinking

Please follow the instructions given in your confirmation letter about when to eat and drink before your appointment. It is important that you stick to these.

Medication

For your pre admission appointment we will ask you to bring in a list of all your current medications. We will then advise you of any medication you need to stop before the procedure.

Warfarin and other anticoagulants

You may need to stop taking warfarin or other anticoagulants (such as apixaban, rivaroxaban, edoxaban or dabigatran) before your procedure. This depends on your specific medical history; your team will discuss this with you.

On the day of your procedure please take the rest of your medication. As the procedure may take an hour you may prefer to take your diuretic (water tablets) after the procedure.

Please bring all of your medication with you (including your diabetic medication or other specialist inhalers or creams).

Preparing to come to hospital

Shaving- Please do not shave or remove the hair from your chest, arms or legs before coming to hospital.

Hygiene- It is important to have a shower or bath before coming into hospital. Please ensure your nail polish is removed and that you are not wearing lots of make-up.

You will be in hospital for at least 6 hours; please make sure you bring something to read or listen to with headphones. You will also need to bring slippers and a dressing gown. You will need loose clothing to go home.

Coming in to hospital

Please arrive promptly as stated the time on your letter. A number of tests will happen when you arrive so you are ready for your pacemaker. These will be done by the nurse. You may need to repeat some of the questions asked in the pre assessment.

After this, one of the specialist heart doctors performing the test will come and see you to consent you for the procedure. They will explain the risks and the benefits of the test and what it entails.

We will try not to keep you waiting but sometimes this cannot be avoided. We are the only catheter suite in the hospital so if there are emergencies, there can be delays to your case. We will do our best to keep you up to date and will always be happy to discuss things if you have concerns.

During the procedure

You will be brought into the catheter lab by one of the members of the team. In the room you will meet the team looking after you- nurses, radiographer, physiologists and doctors.

You’ll be asked to lie on the x-ray table, and one of the team will stick ECG stickers on you. Each member of the team will introduce themselves and explain their role in the lab. A safety check will be carried out and you will hear your name and other information about the case. You will also notice that all staff are wearing hats and facemasks - this is completely normal.

Once the team are ready, we will expose the shoulder where the pacemaker will be inserted. This will be cleaned. Lots of drapes will be draped over you and your face maybe covered whilst we set up, but this soon will be removed.

The doctor will inject local anaesthetic (usually below your collar bone) and make a small cut. You might feel some pressure but no pain.

The leads will be passed through a main vein in the chest and into the heart. The leads are secured in position and checked to ensure they are working correctly.

The wound is then closed using stitches and a special type of medical glue.

After the procedure

After the test, we will take you back to the day ward, where you will be able to have some food and drink when you feel ready.

After 4 hours you will have a chest x-ray, and have a final check on your pacemaker before you go home. The cardiac physiologists will spend some time with you going through your pacemaker, your Identification (ID) card and what to do.

Going home

Most patients are able to go home on the day of the test.

You will be given lots of information before you leave. One vital piece of information will be your pacemaker’s ID card. You will need to make sure you have this with you at all times.

Before you go home, we will ask you to walk up and down the ward a few times just to make sure you are okay. You will need someone to take you home and stay with you over night.

Looking after your wound

Your pacemaker will be a little bigger than a match box. There may be a small amount of swelling over the pacemaker and you will develop a small scar under the collar bone.

The area will be sore for a couple of days and you may notice a bruise. You should keep your wound dry and clean until it is healed. A dressing may have been applied; you can take this off after 3 days.

The glue is waterproof and will flake off by itself after about 5 to 10 days. Do not wet the area for 2 days after the procedure.

Getting back to normal

Once you get home, please rest for the rest of the day but keep moving your arm gently to prevent your shoulder becoming stiff. Do not raise your arm above your shoulder.

For 4 weeks avoid putting strain on the wound so you will need to avoid lifting heavy objects and taking part in sports.

You will receive an appointment for another Pacing Check in clinic. This will be around 4 to 6 weeks after your implant.

You should immediately contact us if you experience the following:

  • A fever or Chills
  • The wound becomes red or sore
  • There is discharge from the wound
  • Fainting/ Light headedness
  • Breathlessness
  • Chest Pain
  • Thumping in the chest

Please call the Cardiac Catheter Lab (8am to 6pm, Monday-Friday) on 020 8321 2618 . At other times, please call Coronary Care Unit on: 020 8321 6944/6582.

Work

You should be able to return to work after the wound has healed and it feels comfortable. People recover at different times so please discuss this with your cardiac team. Some professions can affect your pacemaker; this will be discussed with your specialist team.

Driving

You will not be able to drive for a week after the pacemaker has been inserted and you will need to tell the Driver and Vehicle Licensing Authority (DVLA) that you have a pacemaker. You should also inform your motor insurance company. Stricter rules apply for those with a Heavy Good Vehicle (HGV) license.

Sport

Being active is good for your health but it is advised that you do not play contact sports.

Complications

With all procedures there is a small amount of risk, the cardiologists will speak to you about these before the procedure.

Common complications include:

  • Bruising around the wound will affect about twenty people in a hundred but will only affect about one of those seriously. This might delay your discharge home or require further treatment. The lump will gradually disappear and does not normally require any treatment.
  • Displacement (movement) of the lead(s) in the heart. If this happens you will need to return to the operating theatre so that the leads can be repositioned back where they should be. This complication occurs in about three in a hundred cases for upper chamber leads and about one in a hundred for lower chamber leads. This happens in about 1 in 10 patients with a biventricular pacemaker.

Rare complications include:

  • A small pneumothorax (a small part of your lung might collapse) can occur. The air in the lining of the lung will be reabsorbed in most cases. However, in some cases, it may be necessary to insert a chest drain to remove the air. This affects around one person in a hundred who has this procedure.
  • You may get fluid in the lining of the heart. This may occur when one of the pacing wires goes through the wall of the heart. In most cases no harm is done but, at times, the fluid may need to be drained away. Fluid may be seen in about five in a thousand cases but drainage is only needed in one in a thousand cases.

Later complications can include:

  • Infection of the pacemaker and the wires. This may result in the whole pacemaker system needing to be removed. This happens in less than one in a hundred cases. Antibiotics are usually given to counteract this at the time the pacemaker is inserted.
  • Lead displacement (movement) or fracture happens when the pacemaker wire/lead becomes detached from the lining of the heart or breaks. This means that not all the power from the battery can reach the heart. This can cause the battery to run down early, or a lead fracture, which causes a break in the electrical connections. This happens in about four in a thousand cases each year. However, these problems can usually be detected in the pacing clinic before they cause any harm.
  • Skin erosion or ‘tethering’ means that the skin gathers over the pacemaker site or occasionally the stitch line re-opens. These complications affect about five in a thousand cases. Both complications may be related to a low grade infection, meaning that an urgent visit to the pacing clinic is needed.
  • If you have a biventricular pacemaker, the extra lead can move and stimulate the nerve that controls the diaphragm. This can cause a feeling like a twitch or hiccough. This might happen only when you are in a particular position (such as lying on your side). If this happens, it can often be corrected by re-programming the pacemaker, but sometimes the lead needs to be moved. If you experience this, please contact the pacemaker clinic. 

Please feel free to ask your doctor about any of these complications. Please remember that the risks of a procedure are always balanced by the potential benefits.

Contact details:

Cardiac Catheter Suite: 020 8321 2618
Monday to Friday 8am to 6pm

Cardiac Coronary Unit: 020 8321 6944/ 6582

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