Preparing for a Pacemaker Implant

At the University of Ottawa Heart Institute, pacemakers are implanted by cardiologists who specialize in the electrical system of the heart. This specialty is called electrophysiology. There are several electrophysiology doctors working at the Heart Institute.

The electrophysiology doctors work as a team in caring for all patients who are having pacemaker implants. This means, depending on the booking schedule, the doctor who does your pacemaker implant may not be the same doctor you first saw in the clinic.

What Are the Risks of a Pacemaker Implant?

Pacemaker implant procedures are considered to be very safe; however, with any invasive procedure, there can be complications. These include:

  • Excessive bleeding 
  • Infection at the implant site 

Rarely, the heart or lung can be punctured. If this were to happen, you would be treated immediately.

Occasionally, while everything is still healing, a pacemaker lead may slip out of position inside the heart. If this occurs, it will be seen on the X-rays and other checks that you have after your procedure. Although this usually causes no harm, you will probably need a second operation to fix it.

Before you are discharged, the nurse will review any signs or symptoms you should watch for that may mean there is a problem.

Before Your Procedure

Please use the Patient Responsibility Checklist to help you prepare for your admission to the Day Unit at the Heart Institute.

Day of Procedure

Expect to be at the Heart Institute for six to 12 hours. Plan to arrive at the Day Unit according to the instructions you received the night before.

The Day Unit is located on the first floor. Take the elevators from the main lobby at the Heart Institute up to the first floor. When you get to the first floor, follow the path of green hearts to the Day Unit.

You will be in the Day Unit ar ea until you are ready to go for your pacemaker implant and you will come back to the Day Unit once your procedure is completed. The actual implant procedure will take place in a special room called the Electrophysiology Lab. Before you go for your implant, the doctor will come and meet with you in the Day Unit; this will be a good time to ask any final questions.

Only one friend or relative will be able to sit with you while you are waiting because space is limited. During your procedure, your relative or friend will be able t o wait in the lounge area. Once you are back and recovering, the staff will call your relative or friend back in to sit with you until you are ready to go home.

Once you are in the Day Unit, the final preparations for your procedure will start. You will change into a hospital gown. You may have a small intravenous (IV) tube placed in your arm. The implant area on your chest will be clipped of hair and cleaned.

In the Electrophysiology Lab

There will be a team of doctors, nurses and lab technologists involved in your procedure. All staff will be wearing gowns, masks and special lead aprons.

Your chest area will be washed with a cold solution and sterile sheets will be placed over you. It is important that you don’t move or touch the top of the sheets once they are in place. A nurse will be available to assist you if you have any concerns during your procedure.

During your procedure, you will receive medications through your IV that will make you feel very relaxed. You might even fall into a light sleep. To make sure you stay comfortable, you will also receive pain medications through your IV, as needed.

A local anesthetic will be given to numb the area below your collarbone, which is where the
pacemaker will be inserted.

Once the anesthetic has taken effect, the doctor will make a small incision. Using a special X-ray, the pacemaker leads will be threaded into your heart through a vein in your chest. You will not feel any pain, but you may feel some pressure as the veins are entered. The generator is then put into place just under the skin. Tell the nurse immediately if you feel any discomfort or have any concerns. It is very important you remain as still as possible during the pr ocedure.

Once the procedure is finished, the incision will be closed with special stitches. You will not need to have them removed. They will dissolve on their own. The whole procedure will probably take one to two hours to complete.

After Your Procedure

After your procedure, you will be taken back to the Day Unit on a stretcher or bed. You may be hooked up to a heart monitor that will keep track of your heart rate and your blood pressure. Shortly after your procedure, you will go for a chest X-ray to check your pacemaker placement.

You may experience some discomfort at the incision site. If you are uncomfortable, tell your nurse and you can be repositioned and given pain medication to make you more comfortable.

While you are recovering, it is important to avoid moving your affected arm; in particular, you must not raise this arm above your head because that could displace the pacemaker leads.

You may experience some bruising and discolouration around the insertion site. If you were on a blood thinner before your procedure, this may be particularly noticeable.

You may eat and drink as normal when you return to the Day Unit. Your nurse will assess and assist you as necessary. If you are feeling okay, the nurse will bring you a light snack and something to drink.

Once you are feeling better, you will be able to go home.

You must have someone pick you up at the hospital and drive you home. The day you arrive home, you will need someone to stay with you during the day and overnight.