A pacemaker is a small electronic device prescribed for people whose heart is beating too slowly, and/or whose two lower chambers beat out of rhythm with one another. The pacemaker stimulates the heart muscle with precisely timed electrical pulses, which keep the heart beating at the right pace. A pacemaker has two main parts: a pulse generator and one, two or three leads.

The pulse generator is a smooth, lightweight metal case containing a battery and circuitry. The battery supplies the electrical energy. The circuitry produces tiny electrical pulses and controls the timing of the electrical pulses delivered to the heart.

A lead is an insulated, flexible wire that is placed in the heart. The lead carries electrical energy from the pacemaker to the heart. It also relays information about the heart’s activity back to the pacemaker. Most leads are threaded through a vein from the pacemaker to the inside of the heart. Depending on the type of pacemaker that’s implanted, one to three leads may be used.

Implanting a pacemaker is a common procedure typically with no major associated risk. However, as with any surgery, problems or complications can occur.

Main types of pacemakers

Single-Chamber Pacemaker
A single chamber pacemaker uses one lead. The lead is placed either in the right upper chamber (atrium) or right lower chamber (ventricle,) depending on the location of the signal problem. For example, in people with sick sinus syndrome and a normal conduction pathway, the lead is usually placed in the right atrium. The pacemaker stimulates the upper chambers, and then the impulse continues to the lower chambers to complete the heartbeat. If the conduction pathway is partly or completely blocked (a condition known as heart block), the lead is generally placed in the right ventricle.

Dual-Chamber Pacemaker
A dual chamber pacemaker has two leads. One lead is placed in the right atrium, the other in the right ventricle. This type of pacemaker has the ability to monitor and deliver pulses to both chambers. The pulses are timed so that the upper chambers are stimulated to contract just before the lower chambers. This timing ensures the upper and the lower chambers beat “in synch,” and therefore helps the heart beat more efficiently.

Rate -Responsive Pacemakers
Normally, a heart’s rhythm slows down or speeds up many times during the day. The heart beats slower while you are resting or sleeping. Activity makes the heart beat faster because the body requires more blood to be circulated. A rate-responsive pacemaker uses special sensors to recognize body changes, such as motion or rate of breathing. By monitoring these body changes, the pacemaker helps the heartbeat speed up or slow down to meet the body’s changing needs. This type of pacing mimics the heart’s natural function and may allow a more active lifestyle. Rate-responsive pacemakers can be single-chamber or dual-chamber devices.

Resynchronization Pacemakers
The two lower chambers of the heart may beat out of rhythm with one another, which can worsen the symptoms of a failing heart in some patients. Inserting a pacing lead into each of the two lower chambers of the heart can result in the resynchronization of these chambers. This type of pacing may help to improve the efficiency of the heart function as well as alleviate some of the symptoms of a failing heart.

• You will be asked to not eat or drink anything after midnight on the day of your procedure.
  
  
• Unless you are already hospitalized, you probably will be admitted on the day of the procedure, or the night before.
  
  
• Several routine lab tests will be done, including an ECG and blood tests. (Blood tests may be done one or two days ahead of the procedure.)
  
  
• When you arrive at Abbott Northwestern Hospital, you should report to the Day Angiogram admitting desk in the Piper Building lobby (on the northeast corner of the campus, on the corner of 26th Street and 10th Avenue; Choose from the following links to view maps and directions or a campus guide.) You will then be taken to the Cardiovascular Outpatient Care Unit to prepare for the procedure.
  
  
• The doctor performing the implantation will review your medical history and examine you. (Your primary care physician or a cardiologist may see you several days before the procedure.) The doctor will explain the procedure, its purpose, potential benefits, and possible risks. This is a good time to ask questions and, most importantly, to share any feelings or concerns you may have. You’ll then be asked to sign a consent form.
  
  
• During the procedure, you will receive fluids and medication (to help you relax) through an IV (intravenous) line. You will not be anesthetized (“put to sleep”) during the catheterization procedure.

• Implanting a pacemaker is a minor surgical procedure that may be performed in the electrophysiology (EP) lab under local anesthesia. (In some cases, the pacemaker is implanted through open-chest surgery, usually along with surgery for another heart problem, such as a coronary bypass. In these cases, general anesthesia is used.)
  
  
• Most pacemakers are implanted in the upper chest, near the right or left shoulder. (Occasionally, it may be implanted in the abdominal area.)
  
  
• A local anesthetic is injected to numb the area where the pacemaker will be inserted. An incision is made below the collarbone and a “pocket” is created under the skin, for the pulse generator to sit in.
  
  
• The lead is inserted into a vein through the chest incision. With the help of an x-ray camera, the lead is passed through the vein and is positioned inside the heart. If a second lead is needed (dual chamber pacemaker), this process is repeated.
  
  
• After the lead is in position, it is tested to make sure it senses the heart signals clearly. Each lead is then connected to the pulse generator.
  
  
• The pulse generator is set to treat your heart rhythm problem and is placed in the pocket in your chest. The device is tested to make sure it is working properly. Finally, the incision is closed and covered with a sterile dressing.
  
  
• The implantation usually takes one to two hours. Be sure to let the staff know if you feel any pain or discomfort at any point during the procedure.

• After the pacemaker is implanted, you’ll be transported to the recovery area or to your room.
  
  
• A nurse will take your pulse and blood pressure and will also check the incision for bleeding or swelling.
  
  
• You will be on bedrest for four to six hours and you will stay overnight in the hospital.
  
  
• The morning after your procedure your doctor will see you and someone from the pacemaker clinic will check your pacemaker and review discharge instructions.
  
  
• When it’s time to leave, have a friend or family member drive you home – you may resume driving in 24-48 hours.

• Cardioversion 
• Electrophysiology Study and Catheter Ablation 
• Implantable Cardioverter Defibrillator 
• Pacemaker & ICD Follow-up/Evaluation 
• Tilt Table Testing