Pacemaker Implantation
Dr. Jim Stone and Dr. Karthik Prasad Patients
A pacemaker (pacer) is a small device that acts as a backup or takes over for the natural pacemaker of the heart. The heart has its own electrical system to regulate the beating of the heart muscles. The heart pumps best when it beats in a regular, coordinated rhythm.
A pacer consists of a small device (generator) which produces electrical signals that tell your heart to beat. The generator contains a lithium battery and a tiny computer. Wires (leads) connect the generator to the heart. The pacer is placed under the skin through a small cut. It senses every heartbeat and only fires when the heart rate falls outside certain levels. When the pacer triggers a heart beat, it is called "capture."
PROBLEMS THAT MAY BE HELPED BY A PACER:
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Your heart rate is sometimes too slow or irregular.
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Fainting, dizziness, weakness or confusion as a result of low blood flow.
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Shortness of breath.
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Chest pain or angina if the heart needs more blood and oxygen.
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Disturbed sleep as a result of abnormal heart rhythm.
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Palpitations or the feeling that the heart is beating too fast, too hard or in an irregular way.
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Weak heart muscle pumping ability.
PROCEDURE:
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The pacer may be placed under the skin near the collarbone, while you are under sedation. An abdominal wall location may be another option.
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The leads are inserted into a vein that lies just under the collarbone, then guided into place under x-ray. The tips of the wires touch the inside of the heart. The near end of the pacer wires are connected to the generator under the skin.
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In thinner chest walled individuals, it is possible to feel the device under the skin, and a slight bump may be seen.
INSTRUCTIONS FOR CARE:
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It is normal to have some discomfort in the area of the implant for the first week or two. You may take Tylenol for this discomfort. You may experience some bruising and swelling at the insertion site. This will improve.
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You should avoid repetitive activity with affected arm/shoulder while sore.
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If you are told NOT to drive, you will need to discuss with your doctor on your three (3) month follow-up appointment when you should resume driving.
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Your incision may be closed with stitches, if so; they cannot be seen and will dissolve on their own. Your incision may be closed with staples, if so; they will be removed when you return for your office visit in 7-10 days.
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In addition, if you develop a fever or chills, you need to notify your physician. Please call our office Monday-Friday from the hours of 8 am-5 pm at (662) 620-6800 and nights and weekends call the NMMC hospital at (662) 377-3000 and ask for the cardiologist on call.
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Remove dressing daily and check for signs of infection. Look for the following signs: Redness, Swelling, Drainage, Warmth
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Change your dressing daily. Do NOT apply any ointments, creams, or lotions to the incision site. A small gauze dressing should be reapplied each day and secured with tape.
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Do NOT get your incision wet. Do NOT take a shower. You may take a sponge or tub bath.
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You should receive an appointment to see a nurse in approximately 7-10 days. After you see the Device Nurse, you will need to start washing your incision. You may shower or continue taking a tube bath, whichever you prefer. You may leave the site open to air and no longer cover it with a dressing.
Activity:
Incision Site:
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When changing your dressing you should observe the site.
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There may be some normal bruising and swelling. This should improve.
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If there is an increase in swelling you should call your doctor.
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If there is continuous drainage (longer than 12 hours) on the bandage you should call your doctor.
Work: You may return to work as soon as you feel able to perform your usual work duties. You will need to discuss with your doctor and confirm a time that is appropriate for you to return to work.
Follow-up: You will be scheduled to come in to see the Device Nurse for a wound check in 7-10 days at one of the CANM clinics in Columbus, Oxford, Starkville or Tupelo. You will follow up with your doctor in three (3) months after the procedure (our office will call with the appointment date and time). If your device is not checked the day of your wound check, then you should have an appointment to see your doctor in one month following the procedure.
General Information: Currently pacemakers last 7-10 years and ICD's (defibrillators) last 5-7 years (approximately), before the battery will need replacing. Replacing the device battery is generally an outpatient procedure. Your device will tell us when the battery is approaching the end of life. This can only be determined by the checks done in our office or via the phone interrogation, so it is very important you keep all of your appointments. You will receive a registration card in the mail in 4-6 weeks to your home address. You should carry this card with you at all times.
Do NOT:
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Manipulate or scratch the area around the incision as this may lead to infection.
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Stand in the metal detectors or door monitors in stores for a long period of time. Walking through at a normal pace is fine.
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Carry a cellular phone in a shirt/jacket pocket over the device. Using the phone is fine!
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Work on electric generators while the machine is running.
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Do NOT weld (If necessary, talk with your physician).
Microwaves are fine!
Please contact our office from 8 am-5 pm Monday-Friday at 1-866-620-6800 or one of the following numbers, if you have any questions.
CARDIOLOGY ASSOCIATES OF NORTH MISSISSIPPI
Tupelo (662) 620-6800
Oxford (662) 234-7441
Columbus (662) 327-3092
Starkville (662) 324-1475
After 5pm, holidays and weekends call the NMMC hospital at (662) 377-3000 and ask for the cardiologist on call.
Sedation: If you had sedation, please pay particular attention to the following instructions.
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Do not drink alcoholic beverages including beer for 24 hours. This enhances the effects of anesthesia and sedation.
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Do not drive a motor vehicle; operate machinery or power tools for 24 hours.
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Do not make important decisions or sign important papers for 24 hours.
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You may experience lightheadedness, dizziness and sleepiness following surgery. Please do not stay alone. A responsible adult should be with you for this 24-hour period.
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Rest at home with moderate activity as tolerated. It may not be necessary to go to bed, however, it is important to rest for 24 hours following anesthesia.
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Progress slowly to a regular diet unless your physician has instructed you otherwise.
ADDITIONAL NOTES AND INSTRUCTIONS
We hope your stay was very good. We are committed to providing very good service. Your satisfaction with our hospital is a top priority for us. In the next few weeks you may receive a letter in the mail from a company called Press Ganey requesting you to answer a confidential satisfaction survey. We would appreciate you taking the time to complete and return it in the postage-paid envelope provided. We value your opinion and will use your comments to improve our service. We appreciate your honest feedback.
Document Released: 7/31/2012 Document Revised: 9/6/2012