Most patients referred for permanent pacemaker implantation

are already either hospitalized or will require hospitalization.

Exceptions to this include patients who already have pacemakers

which have reached their end of life (EOL) status and require

replacement. Another group of patients that do not necessarily

require immediate attention are those in whom the bradycardia

is well tolerated and a period of observation is desirable.

Pacemaker implantation is usually performed in the electrophys-

iology lab but can be done in the operating room. After sterile

preparation of the left and right upper chest, moderate sedation

is provided. Infiltration of a local anesthetic is provided in the

region where the pocket is to be created. A 2" skin incision is all

that is necessary. The pocket is formed by blunt separation of

the soft tissue beneath the skin from the underlying muscle tissue.

Using standard techniques, a large vein is entered with a small tube.

This provides the ability to insert the permanent pacemaker lead(s)

into the heart. Once the lead is tested and secured in place, it is

connected to the pacemaker generator. The generator is placed in

the pocket and the incision closed. Usually, the suture material

selected is the type which absorbs over time and, thus, stitches

need not be removed. A dressing and bandage are placed and can

usually be removed the following day. Steri-strips are often used

to help keep the wound edges approximated neatly and can be

removed after a 7-10 day period.

Discharge instructions are provided to each patient and their

families so that frequently asked questions as well as guidelines

are clarified.

Activity

These instructions may vary from physician to physician, but
reflect the general recommendations for most.

-No strenuous activity for 2-3 weeks.

-Avoid lifting objects heavier than 10 lbs or raising your affected
-arm over your head for 4 weeks.

-Avoid driving for 1 week.

-No golf or shooting for 4 weeks.

-Microwave oven operation is safe.

-Use cellular phones on the side opposite your pacemaker.

Your Pocket and Care for the Incision

The pocket may be sore and have a slightly bruised appearance for
2-3 days but this should continue to improve. Some slight bulging
of the pocket is normal.

Keep the incision clean and dry for 7 days.

Paint the incision line with Betadine swabs and let air dry. Repeat
this once-a-day for a minimum of 5 days or until the swabs are gone.

Steri-strips will eventually fall off but they may be removed by 7-10
days. You may then shower or bathe as you normally do.

Notify your doctor's office if any of the following occur or are noticed:

-Increased pocket swelling or tenderness or new redness

-Increased redness of the incision

-Any drainage from the incision

-A small piece of thread sticking out from the incision

-Fever, if you don't think you have a cold or the flu

If you should experience recurrence of the symptoms you had before

the pacemaker was implanted, please notify our office. If you are having

chest pain or breathing problems, you should seek immediate medical

attention.

Always carry the identification card for your pacemaker. It is a good idea

to obtain a Medic-Alert bracelet from your pharmacy stating that you have

a pacemaker.

Please click name, for information regarding
pacemaker implantation.

Introduction

Indications

Hospitalization Expectations

Pacemaker Follow-Up


	Hospitalization Expectations Most patients referred for permanent pacemaker implantation are already either hospitalized or will require hospitalization. Exceptions to this include patients who already have pacemakers which have reached their end of life (EOL) status and require replacement. Another group of patients that do not necessarily require immediate attention are those in whom the bradycardia is well tolerated and a period of observation is desirable. Pacemaker implantation is usually performed in the electrophys- iology lab but can be done in the operating room. After sterile preparation of the left and right upper chest, moderate sedation is provided. Infiltration of a local anesthetic is provided in the region where the pocket is to be created. A 2" skin incision is all that is necessary. The pocket is formed by blunt separation of the soft tissue beneath the skin from the underlying muscle tissue. Using standard techniques, a large vein is entered with a small tube. This provides the ability to insert the permanent pacemaker lead(s) into the heart. Once the lead is tested and secured in place, it is connected to the pacemaker generator. The generator is placed in the pocket and the incision closed. Usually, the suture material selected is the type which absorbs over time and, thus, stitches need not be removed. A dressing and bandage are placed and can usually be removed the following day. Steri-strips are often used to help keep the wound edges approximated neatly and can be removed after a 7-10 day period. Discharge instructions are provided to each patient and their families so that frequently asked questions as well as guidelines are clarified. Activity These instructions may vary from physician to physician, but reflect the general recommendations for most. -No strenuous activity for 2-3 weeks. -Avoid lifting objects heavier than 10 lbs or raising your affected -arm over your head for 4 weeks. -Avoid driving for 1 week. -No golf or shooting for 4 weeks. -Microwave oven operation is safe. -Use cellular phones on the side opposite your pacemaker. Your Pocket and Care for the Incision The pocket may be sore and have a slightly bruised appearance for 2-3 days but this should continue to improve. Some slight bulging of the pocket is normal. Keep the incision clean and dry for 7 days. Paint the incision line with Betadine swabs and let air dry. Repeat this once-a-day for a minimum of 5 days or until the swabs are gone. Steri-strips will eventually fall off but they may be removed by 7-10 days. You may then shower or bathe as you normally do. Notify your doctor's office if any of the following occur or are noticed: -Increased pocket swelling or tenderness or new redness -Increased redness of the incision -Any drainage from the incision -A small piece of thread sticking out from the incision -Fever, if you don't think you have a cold or the flu If you should experience recurrence of the symptoms you had before the pacemaker was implanted, please notify our office. If you are having chest pain or breathing problems, you should seek immediate medical attention. Always carry the identification card for your pacemaker. It is a good idea to obtain a Medic-Alert bracelet from your pharmacy stating that you have a pacemaker. Please click name, for information regarding pacemaker implantation. Introduction Indications Hospitalization Expectations Pacemaker Follow-Up