With our state-of-the-art facility and highly trained personnel, Southern California Heart Centers commits to provide excellence in pacemaker implantation and an enhanced overall patient experience.


PACEMAKER IMPLANTATION

WHAT IS A PACEMAKER?

A pacemaker is a small implanted device that sends electrical impulses to the heart muscle to maintain a suitable heart rate or to stimulate the lower chambers of the heart (ventricles).

A pacemaker consists of a battery, a computerized generator, and wires with electrodes on one end. The battery powers the generator, and a thin metal box surrounds both it and the generator. The wires connect the generator to the heart.

The pacemaker's generator sends the electrical pulses that correct or set your heart rhythm. The pacemaker determines what types of electrical pulses to send to the heart and when those pulses are needed. To do this, the computer chip uses the information it receives from the wires connected to the heart.

The pacemaker also records your heart's electrical activity and heart rhythms. Your doctor will use these recordings to set your pacemaker so it works better at making sure you have a normal heart rhythm. The pacemaker can be evaluated ("interrogated") and programmed non-invasively.

WHY DO I NEED A PACEMAKER?

The rhythm of your heart is regulated by an electrical signal which is produced by a special node inside your heart. Some diseases may affect the electrical system, causing your heart rhythm to become slow or irregular. A pacemaker can help correct this problem. Your doctor may recommend a pacemaker implantation if you have an abnormally slow heart rhythm (bradycardia), if you have suffered a syncope (unexplained fainting spell), or if you have heart failure or hypertrophic cardiomyopathy.

IS THE PROCEDURE SAFE?

Pacemaker implantation is a well-established and safe procedure. However, as with any surgery, there is a small amount of risk of complications. Your doctor will discuss these risks with you prior to the procedure.


PREPARING FOR A PACEMAKER IMPLANTATION

Medications:

If you take Coumadin, the results of your INR test (a blood test to evaluate the blood clotting) must be within a suitable range before the implant procedure can be performed. Usually you will be instructed to stop taking aspirin or Coumadin (warfarin) a few days before the procedure.

Your doctor may also ask you to stop taking other medications, such as those that control your heart rate.

Don't stop any of your medications without first talking to your doctor. He will tell you which medications you should stop taking and when to stop taking them.

If you have diabetes, ask the nurse how to adjust your diabetes medications or insulin.

Food and drink

Eat a normal meal the evening before your procedure. However, DO NOT eat, drink or chew anything after midnight before your procedure. This includes gum, mints, and water. Try to take all your medications before midnight. If you must take medications after midnight, only take them with small sips of water. When brushing your teeth, do not swallow any water.

What should I wear?


BEFORE A PACEMAKER IMPLANTATION

The patient should wear comfortable clothing and leave all jewelry and valuables at home. You will change into a hospital gown for the procedure. Remove all makeup and nail polish.

Please bring the followings items with you:

  • Prescription or referral from your physician
  • Insurance cards and identity cards issued by government
  • A one-day supply of medications. Do not take the medications without first talking with the doctor or nurse.

DURING AN PACEMAKER IMPLANTATION

WHERE IS THE PROCEDURE PERFORMED?

Pacemaker implantations are performed at a local hospital affiliated with our clinic doctors.

WHAT HAPPENS BEFORE THE PROCEDURE?

Before the procedure begins, a nurse will help you get ready. You will lie on a bed and the nurse will start an IV (intravenous line) in your arm or hand. The IV is used to deliver medications and fluids during the procedure.

To prevent infection and to keep the pacemaker insertion site sterile:

  • An antibiotic will be given through the IV at the beginning of the procedure.
  • The left or right side of your chest will be shaved
  • A special soap will be used to cleanse the area
  • Sterile drapes are used to cover you from your neck to your feet
  • A soft strap will be placed across your waist and arms to prevent your hands from coming in contact with the sterile area

WILL I BE AWAKE?

A medication will be given through your IV to relax you and make you feel drowsy, but you will not be asleep during the procedure.

WILL I BE MONITORED?

The nurse will connect you to several monitors that allow the health care team to check your heart rhythm and blood pressure during the procedure. The nurse continually monitors you during the procedure.

The monitors include:

  • Defibrillator/pacemaker/cardioverter: Attached to the center of your back and to your chest. This allows the doctor and nurse to pace your heart rate if it is too slow, or deliver energy to your heart if the rate is too fast.
  • Electrocardiogram or EKG: Attached to several sticky electrode patches placed on your chest, as well as inside your heart. Provides a picture on the monitors of the electrical impulses traveling through the heart.
  • Blood pressure monitor: Connected to a blood pressure cuff on your arm. Checks your blood pressure throughout the procedure.
  • Oximeter monitor: Attached to a small clip placed on your finger. Checks the oxygen level of your blood.
  • Fluoroscopy: A large X-ray machine will be positioned above you to help the doctors see the leads on an X-ray screen during the procedure.

WHERE IS THE PACEMAKER IMPLANTED?

A pacemaker can be implanted using the endocardial or epicardial approach.

The endocardial (transvenous) approach is the most common method. A local anesthetic (pain-relieving medication) is given to numb the area. An incision is made in the chest where the leads (wires) and pacemaker are inserted. The lead(s) is inserted through the incision and into a vein, then guided to the heart with the aid of the fluoroscopy machine. The lead tip attaches to the heart muscle, while the other end of the lead (attached to the pulse generator) is placed in a pocket created under the skin in the upper chest.

The epicardial approach is a less common method in adults, but more common in children. During this surgical procedure, general anesthesia is given to put you to sleep. The surgeon attaches the lead tip to the heart muscle, while the other end of the lead (attached to the pulse generator) is placed in a pocket created under the skin in the abdomen.

Although recovery with the epicardial approach is longer than that of the transvenous approach, minimally invasive techniques have enabled shorter hospital stays and quicker recovery times.

The doctor will determine which pacemaker implant method is best for you.

HOW IS THE PACEMAKER TESTED?

After the leads are in place, they are tested to make sure they function properly and can increase your heart rate. This lead function test is called "pacing." Small amounts of energy are delivered through the leads into the heart muscle. This energy causes the heart to contract.

Once the leads have been tested, the doctor will connect them to the pacemaker. The rate and settings of your pacemaker are determined by your doctor. After the pacemaker implant procedure, the doctor uses an external device (programmer) to program final pacemaker settings.

WHAT WILL I FEEL?

You will feel an initial burning or pinching sensation when the doctor injects the local numbing medication. Soon the area will become numb. You may feel a pulling sensation as the doctor makes a pocket in the tissue under your skin for the pacemaker.

When the leads are being tested, you may feel your heart rate increase or your heart beat faster. Please tell your doctor what symptoms you are feeling. You should not feel pain. If you do, tell your nurse right away.

HOW LONG DOES THE PROCEDURE LAST?

The pacemaker implant procedure may last from 2 to 5 hours.


AFTER A PACEMAKER IMPLANTATION

After a pacemaker is implanted, the patient will be admitted to the hospital overnight for evaluation and monitoring. The doctor and pacemaker technician will test the device to make sure it is functioning properly, as well as monitoring the patient's heartbeats.

Following discharge, the patient may be asked to avoid strenuous activity and heavy lifting for a few weeks. Most people are able to return to normal activities after a few days.

About one week after the procedure, the patient will be asked to return to the office for a checkup to evaluate the healing of the wound and the function of the pacemaker. The patient will be asked to return periodically (about every six months) to continue to monitor the function of the pacemaker.

The pacemaker is a battery-powered device, and its battery typically last between five and fifteen years, depending on how often it is needed to pace your heartbeats. The amount of charge left in the battery is monitored during the regular checkup, and when it begins to run out, the device may need to be replaced.

HOW WILL A PACEMAKER AFFECT MY LIFESTYLE?

Most patients can return to their daily activities after recovering from pacemaker implantation surgery. However, people with pacemakers need to be aware of important recommendations and precautions about electricity and magnets. Always tell medical or dental office personnel that you have a pacemaker. Their recommendations will help you know what medical procedures represent a risk for the proper functioning of your pacemaker and which do not.

You can walk through security system metal detectors at your normal pace. You also can be checked with a metal detector wand as long as it isn't held for too long over your pacemaker site. However, some security systems can detect the metal in your device, so you should notify the screeners that you have a pacemaker. Your doctor can give you a card that states what kind of pacemaker you have. Carry this card in your wallet. You should avoid sitting or standing close to a security system metal detector.

Most modern pacemakers are protected from outside interference, and patients are protected from the possibility of their pacemakers malfunctioning as a result of the daily electrical signals to which we are exposed. However, to be on the safe side, you should avoid close or prolonged contact with electrical devices or devices that have strong magnetic fields. These devices can disrupt the electrical signaling of your pacemaker and stop it from working properly. These include high-tension wires, metal detectors, industrial welders, and electrical generators. Some medical procedures are contraindicated, such as magnetic resonance imaging (MRI).


PARKING AT SOUTHERN CALIFORNIA HEART CENTERS

The entrance for the parking lot is on Valley Boulevard. Underground parking is available as well. There is also temporary street parking along Valley Boulevard.