A pacemaker is a device that sends electrical signals (impulses) to the upper and lower parts of your heart. This helps keep a safe heart rate (pulse). A pacemaker has two parts, a generator (battery) and the lead(s). Leads are wires that connect the generator to your heart tissue.
Traditional Pacemaker
This is a traditional pacemaker that is placed under your skin just below the collarbone. The lead(s) go inside of your heart. The number of leads can vary. You may have a:
1 lead (Single chamber pacemaker)
2 leads (Dual chamber pacemaker)
3 leads (Cardiac resynchronization therapy, also called CRT-P)
A “conduction system” pacing lead may be used in any of the above systems.
Day Before Surgery
A nurse will call you the day before surgery (or the Friday before a Monday surgery). The nurse will review your instructions, including medicine holds, and discuss arrival time. Please let your nurse know if you have a contrast dye allergy. If you do not hear from us by 4 pm, please call (608) 263-1530.
If you feel sick or have a fever over 101.5°F the day before surgery, call the clinic.
Day of Surgery
In the pre-op area, an IV will be placed in your hand or arm and blood may be drawn for labs. If needed, a small area around the surgical sites will be shaved. Your skin will be cleaned with a special soap. You may receive antibiotics through your IV to help prevent infection.
The procedural team will determine a sedation (anesthesia) plan to make sure you are comfortable.
Sterile drapes will cover you from the top of your head to over your feet, so that only the surgical site(s) are exposed.
The Procedure
The vein below your collarbone is used because it travels to your heart. A small “pocket” is made under your skin for the new device generator and lead(s) to sit in. The leads are then threaded through the blood vessel into the heart, using x-ray for guidance. Once the lead(s) is/are in the right place, they are secured. Then, the lead(s) is/are connected to the generator (which contains the battery). The site is closed with dissolvable sutures or surgical glue. The whole process takes about 1-3 hours.
Going Home
You may go home the same day or stay in the hospital overnight. Your device will be checked before you leave, and you may have an x-ray. We will review discharge instructions with you.
If you go home the same day as your procedure, someone should stay with you overnight and you may be asked to send a remote transmission the following morning to check your device.
You cannot drive yourself home. You need to arrange for someone to drive you home. You may resume driving after 1 week. In some cases, it may be more than 1 week depending on what your clinician recommends.
Restrictions
When a device is first put in or there are new leads added, you will have restrictions. This allows the device/leads to fully heal in the heart. The restrictions help make sure the device does not dislodge and the leads do not move as healing occurs. Some restrictions vary by person based on the reason you received the device. The most common guidelines are:
Do not swim, golf, play tennis, or any other contact sports for 3 months.
Avoid dental work for 1 month.
For 6 weeks after surgery:
Do not raise your arm over your head on the side of your device.
Do not reach behind you on the side of your device.
Do not lift more than 10 pounds (i.e., a gallon of milk) with the arm on the side of your device.
You may want to wear your arm in a sling when you sleep for the first 1-2 weeks. This will help prevent involuntary motions while you sleep.
Medicines
Any medicine instructions or changes will be reviewed with you prior to going home.
Incision Care
It is important that you take care of your incision site to prevent an infection.
Keep the site clean and dry.
Leave the current bandage on for 72 hours.
Do not shower for _____days.
When you can shower, let the soap and water run down the incision and gently pat dry.
Leave the “Steri-strips” under the bandage in place until they fall off on their own. The nurse may also remove them at your follow-up visit.
If surgical glue was used, this will fall off over time (usually 5-7 days). Do not pick, scratch, or rub the surgical glue.
Do not use any lotions or ointments on the incision.
Do not scratch or rub the site. As the site heals, you may feel itching. This is normal.
Do not soak in a bathtub, hot tub, or go into a pool, lake or river until your incision is completely healed.
Infection
Look at the site daily for signs of infection:
Redness
Swelling
Fever (101.5°F or higher)
Drainage
Tenderness
Warm to touch
Pain
You may take a mild pain reliever such as acetaminophen (Tylenol®). You may also apply an ice pack. Ibuprofen (Motrin®) or other NSAID medicines increase your risk of bleeding, especially if you are on a blood thinner. Please ask your surgical team if these medicines are safe for you to take after the procedure.
Device ID Card
You will receive a temporary ID card and will receive your permanent card in about 2 months. Carry your card with you all the time. Tell your health and dental care providers that you have a permanent cardiac device.
Electrical Hazards
You will need to avoid certain types of electrical devices. For more information, call your device company.
Avoid
Working under the hood of a running car.
Arc welding.
Cautions
Therapeutic radiation machines.
Electrocautery: Discuss with your physician if you will need electrocautery for a procedure in the operating room or the dentist’s office.
Cell phones: Keep cell phones at least 6 inches from your device. Place the phone on the ear opposite of your device or use a headset.
Theft detection devices: These are often around the entrances of stores. Walk through them as you normally would. Do not linger near these.
Airport security: Tell security staff you have a device. Show them your Medical Device ID card.
Magnets: Magnetic snap closure (in jackets), magnetic name badges, and any equipment with a magnetic strip. Keep anything with a magnet 6-8 inches from your device.
MRI (magnetic resonance imaging): Discuss with your physician before having an MRI.
Safe Devices
Microwaves
Hair dryers
Electric blankets and heating pads
Computers
Radios, TVs, and stereos
Follow-up Visit
Location: _________________________
Date: ____________ Time: _____________
After your first visit, your device will be checked every 3-4 months either in clinic or with home remote checks.
When to Call
If you feel lightheaded, pass out or if your symptoms return that you had before your device.
You have any signs of infection.
Who to Call
UW Heart and Vascular Clinic
Monday – Friday, 8:00 am – 4:30 pm
(608) 263-1530 or 1-800-323-8942
After hours, nights, weekends, and holidays this number will give you the paging operator. Ask for the cardiology fellow on call. Give your full name and phone number with the area code. The clinician will call you back.
For questions about your device, call the device company:
Medtronic: 1-800-633-8766
Boston Scientific: 1-800-227-3422
St. Jude/Abbott: 1-800-722-3423 • Biotronik: 1-800-547-0394
