Pacemaker Implantation: What to Expect Before, During and After

A pacemaker is a small, battery-powered device that is implanted under the skin to help regulate the heart's rhythm. It sends electrical impulses to the heart when it beats too slowly or irregularly, ensuring that the heart maintains a steady and adequate rate.

Pacemaker implantation is one of the most commonly performed cardiac procedures worldwide. If you or a family member has been advised a permanent pacemaker and you are looking for an experienced pacemaker cardiologist in Rohini, Delhi, understanding the procedure can help reduce anxiety and prepare you for what lies ahead.

Who Needs a Pacemaker?

A permanent pacemaker procedure may be recommended for patients with:

• Bradycardia (slow heart rate): When the heart beats too slowly to pump enough blood to meet the body's needs, causing fatigue, dizziness or breathlessness.
• Heart block: A condition where electrical signals from the upper chambers of the heart are delayed or blocked before reaching the lower chambers. Complete heart block often requires a pacemaker.
• Recurrent fainting spells (syncope): Unexplained blackouts or near-fainting episodes caused by abnormally slow heart rhythms.
• Heart failure with CRT: In selected patients with heart failure and a wide QRS complex on ECG, a special type of pacemaker called a Cardiac Resynchronisation Therapy (CRT) device can improve heart function and symptoms by coordinating the contraction of both ventricles.
• Sick sinus syndrome: A group of heart rhythm disorders in which the heart's natural pacemaker (the sinus node) does not function properly.

The decision to implant a pacemaker is made after a thorough evaluation by a cardiologist, based on symptoms, ECG findings, Holter monitoring and other relevant investigations.

Before the Procedure

Before pacemaker implantation, your cardiologist will carry out a detailed assessment. Here is what to expect:

• Blood tests, a chest X-ray and an ECG or echocardiogram to evaluate your heart.
• A review of all medications you are currently taking. You may be asked to stop certain blood-thinning medicines a few days before the procedure.
• Inform your doctor about any allergies, previous surgeries, and whether you have any implants or prostheses.
• You will usually be asked to fast (not eat or drink) for six to eight hours before the procedure.
• You may be given antibiotics before the procedure to reduce the risk of infection.

During the Procedure

Pacemaker implantation is performed in a cardiac catheterisation laboratory or an operation theatre by an interventional cardiologist or cardiac electrophysiologist. The procedure typically takes one to two hours.

1. You will be given local anaesthesia to numb the area below the collarbone (usually the left side). You will be awake but comfortable throughout the procedure. Mild sedation may also be given.
2. A small incision (about 5 cm) is made just below the collarbone.
3. One or more thin, insulated wires called leads are guided through a vein into the heart chambers under X-ray (fluoroscopy) guidance.
4. The leads are positioned in the appropriate chambers of the heart and tested to ensure they sense the heart's electrical activity and can stimulate the heart effectively.
5. The leads are connected to the pacemaker generator, a small metallic device about the size of a large coin, which is placed in a pocket created under the skin below the collarbone.
6. The incision is closed with sutures or surgical adhesive, and a sterile dressing is applied.

You may feel some pressure during the procedure, but significant pain is not expected. The cardiologist and team will monitor your heart rhythm continuously throughout.

Recovery and Hospital Stay

After pacemaker implantation, most patients stay in the hospital for one to two days. During this time:

• Your heart rhythm will be monitored to ensure the pacemaker is functioning correctly.
• A chest X-ray will be done to confirm the position of the leads and to rule out complications such as pneumothorax.
• You will be advised to keep the arm on the side of the implant relatively still and avoid raising it above shoulder level for four to six weeks. This allows the leads to settle firmly into position.
• The wound site should be kept clean and dry. Your doctor will give you specific instructions on dressing care.
• Mild discomfort or swelling near the implant site is normal for the first few days and can usually be managed with simple painkillers.

Most patients can return to light daily activities within a few days and resume normal activities within four to six weeks, depending on their overall health and doctor's advice.

Life After a Pacemaker

Living with a pacemaker is straightforward for the vast majority of patients. Here are the key things to know:

• Device checks: Your pacemaker will need regular check-ups, usually every six to twelve months. These checks can often be done in the clinic using a device programmer that reads the pacemaker's data through the skin, without any needles or incisions.
• Airport security: Pacemakers can trigger metal detectors. You will be given a pacemaker identification card to carry with you. Inform security personnel before passing through scanners. Walk through metal detectors at a normal pace; hand-held wands should not be held over the device for a prolonged time.
• MRI compatibility: Many modern pacemakers are MRI-conditional, meaning MRI scans can be performed under specific conditions. Always inform the MRI facility and your cardiologist before scheduling an MRI.
• Driving: Most patients can resume driving within a few weeks after implantation, provided they are feeling well. Your cardiologist will advise you based on your specific situation and the reason for the pacemaker.
• Exercise: Regular, moderate exercise is encouraged after recovery. Avoid contact sports or activities that risk a direct blow to the pacemaker site. Your doctor will guide you on the level of physical activity that is safe for you.
• Household devices: Most household appliances, including mobile phones, microwaves and computers, do not interfere with pacemakers. Keep mobile phones at least 15 cm from the pacemaker and avoid holding them directly over the device.

Pacemaker batteries typically last eight to fifteen years, after which the generator is replaced in a shorter, simpler procedure.

When to Contact Your Doctor After Implantation

While complications after pacemaker surgery are uncommon, you should contact your cardiologist promptly if you experience:

• Fever or chills after the procedure
• Increasing redness, swelling, warmth or discharge from the wound site
• Persistent or worsening pain at the implant site
• Dizziness, fainting or near-fainting episodes
• Shortness of breath or chest pain
• Hiccups that do not stop (this can occasionally indicate lead displacement)
• Swelling of the arm on the side of the pacemaker

Early medical attention can help identify and address any issues before they become serious.

Expert Pacemaker Implantation in Rohini, Delhi

Dr. Abhinav Aggarwal is an experienced Interventional Cardiologist at CardioSight Clinic in Rohini, Delhi, providing comprehensive evaluation and management of heart rhythm disorders, including permanent pacemaker implantation, CRT device implantation and device follow-up.

If you or a loved one has been advised a pacemaker, or if you are experiencing symptoms such as recurrent dizziness, fainting, an unusually slow pulse or unexplained fatigue, a specialist consultation can help determine the most appropriate course of action.

Frequently Asked Questions

This article is intended for general patient education and does not replace a professional medical consultation. Please discuss your individual reports and treatment options with your cardiologist.