Pacemaker Surgery

In this surgery, the pacemaker, which is a small metal box that generates impulses to regulate your heartbeat, is placed in the upper chest by a specialist surgeon. The procedure takes one to two hours. The surgeon will insert the pacemaker under your skin with the wires attached to it heading towards your heart. After the surgery, the settings of the pacemaker are regulated by the surgeon with the help of a computer, which generates signals and sends them to the pacemaker through your body. The pacemakers functions by increasing or decreasing your heart rate by sensing the activity of the body.

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Pacemakers are of two types - temporary and permanent, each given for a different purpose.

• Temporary pacemakers
  Temporary pacemakers are used in case of emergencies or till the time you get a permanent pacemaker. You need to stay at the hospital till the time the temporary pacemaker is in your body. Temporary pacemakers are used when the heartbeat becomes irregular because of a heart attack, heart surgery or excess dosage of some medication.
• Permanent pacemakers
  The permanent pacemakers are given in case of long-term heart problems like arrhythmia (irregular heartbeat), heart disease and so on.

Conditions in which pacemaker is given

A pacemaker is given when your heart is beating slower than it normally does (bradycardia) or too fast (tachycardia). Heart block and sinus node disease are the two conditions in which your heartbeat slows down.

The conducting activity of the heart is affected because of heart block. Ageing or damage from a heart attack can also lead to heart block.

In sinus node disease, the natural pacemaker in the heart (SA or sino-atrial node) is not able to work properly and fails to generate impulses at a normal pace. The abnormal working of the SA node can lead to slowing down, increasing or sometimes stopping the heartbeat.

In cases of arrhythmia, the heart beats irregularly and you might be having the following symptoms:

• Feeling tired
• Dizziness
• Difficulty in breathing

In case of severe heart failure, to ensure that the two chambers of the heart beat at a regular pace, biventricular (in two of the heart chambers) pacemakers are used.

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During the preoperative assessment, you need to visit the hospital to get a few things and tests done, which are discussed below:

• Some important tests will be carried out like blood test, electrocardiogram (ECG) to check the heart activity, urine test, chest X-ray and so on.
• The doctor will assess your general health and rule out any other heart problems that you may.
• Tell your doctor if you already have underlying medical problems like diabetes, high blood pressure, blood disorders, any allergy to certain medications, kidney, liver or lung diseases and so on.
• The doctor will also ask you if you’ve had any surgery in the past to know if there was any sort of problem during the administration of the numbing agent (anaesthesia) or during the recovery period.
• Tell your doctor about the medications you are presently taking. You will be informed in case you need to stop any of them.
• You will also be advised on when to stop eating before the procedure.
• Tell your doctor if you smoke or drink frequently and quit their consumption because they hinder the healing process and prolong your recovery period.
• During your visit to see the doctor before the operation, you should clear all your doubts related to the surgery.

On the day of surgery

Before you go for the surgery, the following things should be considered:

• Having a bath before you come for the surgery is very important as it removes harmful bacteria on your skin.
• You should come empty stomach for the surgery. So, do not eat or drink for 6 to 12 hours before the surgery.
• Take all the medicines that the doctor has prescribed with a small sip of water.
• Ask a friend or relative to drive you to and from the hospital as you will not be able to drive back home after the surgery.
• If you feel you are not prepared for the surgery, tell your doctor immediately about it.

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The pacemaker will be inserted by a heart specialist surgeon. To make the procedure painless, the surgeon starts by giving you a numbing agent (anaesthesia). The procedure is as follows:

• In local anaesthesia, only the area of the chest where the pacemaker is to be put is made numb. Under general anaesthesia you fall asleep during the procedure and do not feel the pain. You will regain consciousness and get your sensations back a few hours after the surgery.
• An intravenous line (plastic tube) will be inserted into your blood vessels to deliver medicines and necessary fluids.
• Below your collarbone, a needle will be inserted inside a large blood vessel. The wires of the pacemaker will be threaded into the blood vessel using this needle.
• The surgeon will see the wires passing through the blood vessels with the help of X-rays and will place these wires at right place.
• Once the wires are placed correctly, the surgeon will give a one or two-inch cut into the skin of your chest.
• The small metal box of the pacemaker, containing a battery and a generator, is placed under your skin and is connected to the wires leading to your heart.
• The surgeon will then test the pacemaker and ensure that it is working properly.
• He/She will then close the cut by giving stitches and cover the wound with a dressing.

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After your surgery, you will be advised to stay in the hospital for a day or two so that the doctor can monitor your heart rate and be certain that the pacemaker is working properly. Initially, you may feel uncomfortable with the pacemaker but gradually you will get used to it. There are a few things that need to be carried out after surgery. These are discussed below:

• To get your stitches removed, you will have to visit hospital 7 to 10 days after the surgery.
• The wound area should be kept clean and dry and the dressing should be changed as advised by the doctor. Women should wear a bra with wider straps.
• 3 to 7 days of rest is advised after you have undergone this procedure.
• You may feel pain in the operated area during the first few days after the surgery and for that, you will be given painkillers.
• Avoid movements like stretching, twisting and jerking the arm which is close to the pacemaker.
• Do not lift anything heavy for about a month after the surgery.
• You should not completely restrict movements in your arm. Slight and gentle motions are important otherwise your shoulder might get stiff.
• Vigorous sports activities should be avoided for 4 to 6 weeks after surgery.
• You will be given a pacemaker registration card. This card has the details of your pacemaker model and contacts for emergencies.

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When can you resume driving?

Firstly, you need to inform the driver and vehicle licensing agency and your insurance company about the pacemaker surgery you had.

You can start driving again if you:

• Don't feel lightheaded or that you may faint.
• Are going to the hospital for regular check-ups and everything is normal.
• Have not experienced a recent heart attack.

You will be advised to wait for 6 weeks to resume driving in case you drive a large or passenger vehicle.

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Pacemaker and other electrical equipment

Since a pacemaker is made of metal and sends electrical signals, it is important to know that you use other electrical equipment with care. Some of the things that you should really look out for are discussed here:

• While working on an electrical appliance, if you feel that your heart is beating very fast, then leave that appliance immediately and move away from it.
• You can use equipment like mobile phones, hairdryers, microwave oven among others but make sure that you keep them 15 cm away from your chest area where the pacemaker is placed.
• Also, while using a mobile phone, place it on the ear of the side opposite to the pacemaker.
• Do not put your mobile phone or mp3 player in your pocket over the area where the pacemaker is placed.
• Try to avoid very close and prolonged usage of any household electrical equipment as they may interfere with the functioning of your pacemaker.
• When you go for security system checks, inform the security staff about your pacemaker. Walking through the security system metal detector will not create any problem in the pacemaker. However, the metal detector wand should not be held near the pacemaker for too long.
• Before going for any other surgery, always inform your doctor about your pacemaker. These three procedures can interfere with the working of a pacemaker:
  • Magnetic Resonance Imaging (MRI), a scanning procedure that gives details of the inner organs of the body.
  • Lithotripsy, a treatment method for kidney stones.
  • Electrocauterisation to control bleeding during surgery.

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there are certain risks associated with pacemaker surgery. These are:

• Redness, swelling and bleeding in the operated site.
• Infection, which may also cause fever.
• Failure of the lungs or heart.
• Damage to blood vessels or any nerve.
• Allergy to any medicine during the surgery.

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You have to visit your doctor every 3 months after pacemaker surgery. During your visits, the doctor will make sure that the pacemaker is working properly by analysing its output, the strength of the impulse generated and the way your heart is responding to the signals generated by it.

In case you have any of these problems, immediately tell your doctor:

• Shortness of breath.
• Lightheadedness.
• Fainting.
• Feeling weak.
• Swelling on the arm near the pacemaker.
• Pain in the chest.
• High fever, 100° F or above.
• Pain, soreness and swelling in the operated site.

In case you have any query or doubt related to the pacemaker, discuss it freely with your doctor.

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A pacemaker corrects the abnormal heartbeat and thus helping you to again start a more active lifestyle. Most of the pacemaker batteries last for a period of 5 to 15 years. After this period, your doctor will plan another surgery to replace the battery along with the generator.

The surgery for replacing the battery is less invasive as compared to the one done for the placement of the pacemaker.

Sometimes, the wires of the pacemaker also have to be replaced with time.

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A pacemaker regulates the rate and rhythm of the heart. After getting a pacemaker, you will get relief from the symptoms you were having before like shortness of breath, dizziness, tiredness among others. Here’s what you can do to ensure your health and your pacemaker are in good condition:

• Talk to your doctor if you feel any kind of stress after getting the pacemaker. Ask your doctor to introduce you to others who have undergone the pacemaker surgery.
• Start doing activities like walking, riding a bicycle as these will help your body to gain strength and improving your heart health.
• Avoid sports like football and rugby, which may involve falling or getting hit as these may dislodge your pacemaker.
• Eat healthy foods, which have high fibre content, low fat, and low salt.
• If you have high blood pressure, get it checked regularly and take medications as advised by your doctor.

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