Why is the doctor performing this procedure?

Your physician has recommended that you have a pacemaker implanted for symptoms related to a slow heart rate (bradycardia). These symptoms may include: dizziness, fainting, which is also called syncope, or fatigue. In addition, pacemakers are sometimes used when medications needed for other diseases slow your pulse rate. Occasionally a special pacemaker may be used to attempt to improve symptoms associated with Congestive Heart Failure.

Your physician will discuss with you the type of pacemaker that best meets your clinical needs.

Pacemakers are used to prevent the heart rate from slowing. They do not prevent the heart from going fast.

What is a pacemaker?

A Pacemaker is a system with two main parts:

1. The pulse generator is a smooth, lightweight metal case that contains a battery and a small computer. It continuously checks your heart's electrical signals. If your heart rate drops below the level set by your cardiologist, the pacemaker will generate small electrical signals that cause the heart muscle to contract and create a heart beat. The pacemaker will continue to generate these signals until your own heart rate rises above the "lower rate limit." Then the pacemaker will go back to monitoring your heart rate. The memory in the pulse generator stores information about your heart's activity, as well as the status of the pacemaker battery.

2. The Leads are insulated, flexible wires which are positioned in the heart and are connected to the pulse generator.

There are several different kinds of pacemakers. You may receive a one, two or three lead system. Your electrophysiologist will discuss your treatment plan with you prior to the procedure and review the lead system that will best meet your needs.

When is a pacemaker indicated?

Pacemakers are used for slow heart rhythms. There are several different kinds of slow heart rhythms that may cause the heart to slow down.

Pacemakers are indicated for the following diagnosis:

• Symptomatic bradycardia
• Sick Sinus Syndrome
• Tachy/Brady Syndrome
• Sinus Pause
• Atrial Fibrillation with Slow Ventricular Response
• Second Degree Heart Block Type II
• Complete Heart Block

Although these are the most common reasons for a pacemaker implant, there are others. Your physician will review what is happening to your heart rhythm and the best treatment for your diagnosis.

What happens during the implantation of a pacemaker?

Most pacemakers are implanted in the cardiovascular lab using a local anesthetic and medication to help you relax. For uncomplicated implants, the patient remains in the hospital overnight and goes home the next day.

On the day of the procedure, you will be brought to the cardiovascular lab. The staff will place leads to monitor your heart rhythm, wrap a blood pressure cuff around your arm and place a small clip on your finger to the measure the oxygen saturation in your blood. If you have hair on your chest where the device will be placed, the staff will clip the hair to help prevent infection. You will also receive an antibiotic in your IV. The area where the physician will work will be painted with a solution that kills bacteria.

You will receive medication in your IV to help you relax. In general, patients who receive pacemakers are drowsy, but are able to talk to the physician and the staff.

A local anesthetic is injected to numb the area in the upper chest where the device is to be implanted. The doctor will form a pocket under the incision for the pulse generator. The doctor will then insert the lead(s) in to a vein through the same incision. The leads are positioned in the appropriate chambers of the heart using X-ray guidance. The staff will assist the doctor in testing the leads to be certain that the device will be able to see your own heart rhythm and to determine the minimum amount of electrical energy needed to pace the heart muscle.

When the doctor is satisfied with the position of the leads, they will be connected to the pulse generator and the incision will be closed. Once awake, you will be returned to your room and may eat and drink.

How long does the procedure take?

Implantation of a pacemaker takes from 2-6 hours, depending on the lead system and the anatomy of the patient.

Special Instructions for Pacemakers

• MRI is contraindicated for patients with a pacemaker. You may have a CT scan.
• Please carry your Pacemaker Identification Card with you at all times.
• You may use cellular phones. If you hold the phone on the same side as your pacemaker, you may notice your heart rate speeding up slightly. The same is true if you keep your cell phone in a pocket over your pacemaker. This only applies to cellular phones and not to cordless phones you may have at home.
• It is safe to walk through the theft detection devices at stores. If you stand in them or near them for more than a few seconds, you may notice a slight increase in your pulse rate.

Airport Safety

• You may walk through the metal detector at the airport without harm. If you stand in or near the detector for more than a few seconds, you may feel your pulse rate increase slightly.
• Carry your Pacemaker Identification Card with you so that airport security knows you have a pacemaker.
• Airport security may use the wand on you.

Do pacemaker batteries wear out?

A pacemaker pulse generator runs on a battery and will eventually need replacing. The length of time a battery lasts is dependant on several factors:

• The type of device you received
• The amount of time the pacemaker is used to pace your heart
• The amount of energy that is needed to pace your heart.

The Pacemaker/ ICD Clinic can estimate the amount of time left on the battery when they check the device in the clinic. In addition, pacemakers have battery indicators that the clinic staff may notice when checking your device over the phone. Pacemakers have protective mechanisms built in to the programming to allow plenty of time for notification that the battery needs replacing. The Pacemaker/ ICD clinic will let you know at your clinic visits that the battery is starting to get low, so that you may plan when to get it replaced.

To change the battery on a pacemaker, the entire pulse generator has to be replaced. Most patients are discharged from the hospital the same day as the procedure.

You will be brought to the cardiovascular lab and prepared as if you were having a new implant. The physician will numb the skin and make an incision at the site of the pulse generator. The old generator will be removed and the staff will assist the physician in checking the lead system to be sure it is still working well. Then a new pulse generator will be connected to the leads and placed back in the pocket. The suture line will be closed and you will be returned to your room.

Because changing the battery does not usually require the placement of new leads, the procedure is generally quicker. Typically, the procedure takes approximately two hours.

8/3/2008