FREMANTLE HOSPITAL & HEALTH SERVICE

Department of Cardiology - Testing Unit

Permanent Pacemaker Implant

A permanent pacemaker is a device used to regulate the heart beat when it is too slow.  It sends an impulse to the heart to keep it at a normal rate.  A pacemaker may be implanted in patients whose symptoms include recurrent fainting, palpitations, light-headedness or dizziness.

A pacemaker consists of a pulse generator (battery) and electrodes (leads).  The pulse generator is slightly larger than a fifty cent coin and is inserted just beneath the skin in the upper chest area.  The doctor will put one, two or three leads from the generator via a vein into the heart.  The procedure may be done as an outpatient or inpatient procedure.  It takes between one and three hours in the Cardiac Catheter Theatre.

Pre-Implant

On the day of your procedure, you will be asked to present to the Cardiac Catheter Theatre at around 8am in the morning, having fasted from midnight. You can still take your medication with a small sip of water, however, please check with the Cardiac Catheter Theatre staff if you are taking any diabetic medication or a tablet named Warfarin.

You enter the hospital through the main entrance, which is located on Alma Street and report to the Enquiries Counter.  From there you will be directed to the admissions area where you will have your admission paperwork performed.  You will then be escorted by an orderly to the Cardiac Catheter Theatre preoperative area.

Once you have arrived in the preoperative area, one of the nurses will complete some paperwork relating to your past medical history.  Make sure that you bring along all of the medications that you are currently taking.  You will be required to get changed into a hospital gown, so it might be a good idea to bring a dressing gown and a pair of slippers, as it can get quite chilly.  You may also wish to bring along a book to help pass the time.

Please be aware that due to limited space in the pre-op/recovery area, your friends and relatives will be unable to sit with you during your stay.  They will be asked to return later in the afternoon to collect you.

The Implant Procedure

When taken into the Cardiac Catheter Theatre, you will be asked to move onto a large x-ray table that is surrounded by a lot of equipment.  Nurses and Cardiac Scientific Officers will prepare you for the procedure by placing ECG electrodes on your chest, cleaning your chest area with antiseptic solution and covering you with a sterile drape.

You will be awake during the procedure and should experience very little discomfort.  If you are feeling anxious, you may ask the Cardiologist for medication to help you relax.

The Cardiologist will inject your upper chest with a local anaesthetic that will numb the area.  After the local anaesthetic has taken effect, your Doctor will make a small 2cm nick in your skin.  Leads are then placed into your heart via the veins in your chest.  Once they are in place, one of Cardiac Scientific Officers will test the leads with a computer to ensure they are in a good position.  If the placement is good, the leads are then connected to a pulse generator (battery). A small pocket under the skin that is large enough to fit the generator is then created.  A small amount of discomfort may be felt with this.  If you experience too much discomfort, you should let the Doctor know so they can provide some pain relief through medication.

The Cardiologist will then repair the wound with dissolvable stitches and/or glue, which will not be visible on the outside of the body.  The entire procedure will take one to three hours depending on how many leads need to be inserted and if the doctor has any difficulty getting a good position of the leads.

Post Insertion

After the procedure, you will be returned to a recovery area where you will need to wait for an hour or so before being sent up to one of the wards.  During that time, the nurses may put a small sandbag over the wound to stop a bruise from developing.  In some circumstances, the Cardiac Scientific Officers may also come out and test the pacemaker with their computer.  The recovery area can be quite cold so please let the nurses know if you need a warm blanket.

When the bed on the ward is ready, you will be taken up to a ward where you will be put on a heart monitor overnight.  In the morning, you will have a chest
x-ray and the Cardiac Scientific Officers will check the pacemaker to ensure that it is working well and that you are happy with how it works.

Discharge

You will be discharged usually around lunchtime the next day.  The Cardiac Scientific Officer will give you an instruction book on how the pacemaker works together with a temporary ID card to put in your wallet/purse.  The company will send you a formal card that shows the pacemaker’s model and serial number in a couple of month’s time.

You will have a dressing covering your chest where the pacemaker has been put in.  The Cardiologist will inform you on how long to wear the dressing and how often to change it.  When it is removed, you may notice a small bruise at the incision site.  The bruise may become slightly larger and darker the first few days you are home.  The bruise is the result of the normal healing process and will completely disappear in a week or so.  If you are uncomfortable about the size and appearance of the bruise or the wound is red or appears infected, please contact your GP.

In one week’s time, you need to visit your GP to review the wound and make sure there are no signs of infection.

Four to six weeks after the pacemaker has been put in, you will have an appointment in the pacemaker clinic, where the pacemaker will be tested to make sure it is working properly.  This usually takes about 10 minutes and you should not experience any pain or discomfort.

After that, you will have an appointment in the pacemaker clinic every 6 to 12 months to make sure the pacemaker is functioning correctly and check how much battery life is remaining.

How the Pacemaker Works

A pacemaker is a device that continuously monitors the rate and rhythm of the heart.  If it sees the heart rate drop below a set limit (which is different for each patient) the pacemaker will pace the heart to keep the heart rate normal.  As the pacemaker only kicks in when it needs to, some patients rely on the pacemaker all of the time whilst other may rely on it only rarely.  This reliance can change over time for some patients.

The pacemaker also has a heart rate and rhythm monitor it.  If your heart goes too fast or changes into an abnormal rhythm, the pacemaker will detect this and store the information.  At your next pacemaker clinic appointment, this information can be downloaded for analysis.

The pacemaker battery should last between five and eight years.  When the battery level starts to drop, you will be seen more often in clinic.  Eventually, you will be required to have a new generator implanted.  If the leads are still working well, then the doctor will disconnect the generator from the leads and reconnect a new generator to the old leads.  This procedure is similar to the initial implant, but takes much less time.

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Transoesephageal Echocardiography.     Electrocardiography.     Echocardiography.    Holter Monitoring.    King of Hearts Monitoring.    Exercise ECGs.   

Thallium Exercise ECG.       Cardiac Catheterisation.    Percutaneous Coronary Intervention.    Insertable Loop Recorder.      Elective Cardioversion.         Electro Physiology.