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A pacemaker is a device that sends small electrical impulses to the heart muscle to maintain a suitable heart rate or to stimulate the lower chambers of the heart (ventricles). A pacemaker may also be used to treat fainting spells (syncope), congestive heart failure and hypertrophic cardiomyopathy.

Types of pacemakers

Your doctor will decide what type of pacemaker you need based on your heart condition. Your doctor also determines the minimum rate (lowest heart rate) to set your pacemaker. When your heart rate drops below the set rate, the pacemaker generates an impulse that passes through the lead to the heart muscle. This causes the heart muscle to contract, creating a heartbeat.

Before the procedure

  • You and your doctor will review your complete medical history, including any allergies and which medicines you take. Ask if you should stop taking any medications before the procedure, especially blood thinners or medicines that affect heart rate or rhythm.
  • Your doctor may order routine tests, such as blood tests, echocardiogram, or imaging tests to help with planning and preparation for your procedure.
  • Don’t eat or drink anything after midnight the night before the procedure, or 8 hours before the procedure.
  • On the day of your procedure, your doctor will explain the test to you and give you a chance to ask questions.
  • You will be asked to sign a consent form that gives your permission to do the test. Read the form carefully and ask questions if anything is not clear.

During the procedure

  • The procedure typically takes about 1 to 2 hours.
  • You will be given medicine through an intravenous line (IV) to help you relax. An IV antibiotic is given to help reduce the risk of infection.
  • The surgical site (usually the left or right chest, or, in the case of a leadless pacemaker, the right groin) is carefully cleaned and prepared. A sterile drape is placed over your from head to toe.
  • Your skin is numbed with a local anesthetic. Some people will feel a slight burning as the numbing medication starts to work.
  • An incision is made in the chest where the leads 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 leads are then tested and the device is placed into the pocket. The incision is then closed with absorbable sutures and a dressing is placed over the incision.
  • You will typically stay in the hospital over night, although in some instances your physician may make arrangements for you to go home the same day.

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