The pacemaker is an electric device, which analyses the rhythm of the heart continuously and if it senses that the heart rhythm is too slow, it is capable of delivering electrical impulses to achieve the necessary heart rate. Special pacemaker electrode transmits the electric signs of the heart to the device and – if needed – electrical impulses travel the same way to cause contraction of the heart.
Pacemakers are implanted by a surgical way. We only use local anaesthetics during this procedure, after injecting the anaesthetic medication, patients generally do not feel substantial pain. The operating physician cuts the skin about 5 cm long and then looks for one of the brachial veins. If it is possible, the electrode(s) are positioned through this and then the subclavian vein into the heart. If this is not possible for any reason (the vessel is too small or tortuous), we need to stick the main vein under the clavicle. According to the heart rhythm abnormality, we position the electrode(s) into the right ventricle, right atrium or in some cases into one of the side veins of the heart. The generator is implanted under the skin of the chest.
If the patient arrives from another hospital for implantation, then after a few hours of observation, we transfer the patient back with ambulance to the original hospital. If the patient arrives from home and the electrode can only be positioned by puncturing the subclavian vein, then one night should be spent in the hospital. If the electrode is positioned through the brachial vein, then the patient is discharged after few hours of observation.
Some medications must be discontinued prior to the operation!
Important information for patients scheduled for defibrillator-pacemaker implantation
- Blood thinners (Syncumar, Marfarin): If You take any of these medications, You should discontinue it 3 days prior to the procedure, otherwise the implantation cannot be performed because of the increased risk of bleeding! If needed, these medications can be substituted by subcutaneous injections, You should discuss the details with Your physician. (You should receive the last injection the night before the procedure!)
- Diabetes mellitus: If You are suffering from diabetes, You should receive no or decreased dose of insulin or antidiabetic medications. You should discuss the details with Your physician, as well.
It is allowed to eat the night before the procedure. You may consume small amounts of fluid on the day of the procedure. Considering the above mentioned, please also take Your medications. You are not allowed to eat or drink 6 hours prior to the operation!