Pacemaker implantation is a heart surgery that can be performed on an outpatient basis. The procedure can be a bit different depending on the patient’s condition and the practices adopted by the surgeon.
The urinary bladder will be completely emptied before the procedure and excessive hair shall be removed from the site of the incision. An intravenous line is started in the arm or hand for the administration of fluids and medication as and when required.
The patient is made to lie on their back on the procedure table. The patient will be connected to an electrocardiogram or ECG/EKG monitor that aims to record the activities of the heart with the help of adhesive and small electrodes. The vital signs like blood pressure, heart rate, breathing rate and oxygenation levels of the blood are kept track of the procedure.
On the back and front of the chest, large electrode pads are kept. The patient will be given a mild sedative but most likely they will stay awake during the procedure.
After the pacemaker insertion site will be cleansed with antiseptic soap, sterile towels and sheets are placed around the region. A local anesthetic is injected at the site of insertion around the collar bone.
A small incision of 5 to 6 cm is now made in the region and a sheath or introducer is gradually put inside the blood vessel underneath the collar bone. The pacer lead wire is inserted into the blood vessel via the plastic tube or the sheath to access the heart. The patient is kept totally still to ensure that the catheter does not move out of the place and prevent any damage to the site of insertion.
The lead wire is now slowly inserted into the blood vessel through the introducer, and the surgeon must advance the lead wire further to enter the heart.
After the lead wire has reached the heart, it will be tested for the verification of the proper location to ensure it works. Depending on the type of device that is chosen by the surgeon as per patient’s condition there maybe 1, 2 or even 3 lead wires inserted in the heart. For the testing of the location of the leads, a special type of X-Ray called fluoroscopy where the advances can be checked on a monitor and can be employed.
Under the skin through the incision below the collarbone, the pacemaker generator is gradually slipped after the lead wire is attached to the generator. The location of the generator is so chosen that it stays in the non-dominant side of the patient’s body (suppose if the patient is left-handed then it will be placed on the upper right chest and vice versa).
The leads are placed in the outer surface of the heart called the epicardium. The generator box is placed in a special pocket made under the skin in the abdomen.
The working of the pacer has to be monitored via the ECG displays. Once confirmed of its working the skin incision is closed with sews, special glue or adhesive strips. After this sterile bandage and dressing shall be applied.