What is it?

A pacemaker is used to supplement the electrical activity of the heart in patients whose heart is not conducting correctly.

The pacemaker consists of two components, 1. The generator or battery, and 2. The leads or wires. The generator is about the size of two stacked 50c coins and is implanted under the skin beneath your collarbone.  This is connected to the leads or wires which rest inside your heart. The wire is very soft and flexible and can withstand the twisting and bending caused by body movements.

The patient can expect to be in hospital for at least 1 night.

For any patient enquiries please speak to your cardiologist or contact Mildura Cardiology by phone (03) 5023 8111 or email [email protected] 

Procedure Information

What to bring

+ Any concession cards including Medicare and private heath fund cards.
+ All current medication in its original packaging.

* For all procedures requiring overnight stays, please ensure you bring with you night attire, including dressing gown, non-slip slippers and toiletries.

Pre-Procedure

+ Patients are required to fast for 6 hours prior to the procedure.

* Your cardiologist will advise any cessation of blood thinning medications prior to procedure.

Procedure

+ On admission to the hospital you will have an ECG and may have bloods taken

+ Your chest will be shaved and painted with an antiseptic solution called Betadine. The procedure will take about half to one hour

+ You will be given some light sedation via an intravenous line to help you relax and feel comfortable during the procedure. You will be awake but drowsy

+ The surgeon will give some local anaesthetic to numb the area just below your collar bone where the pacemaker will be inserted

+ When the area is numb the surgeon will then make a small cut (approx. 4-7cm long) to insert the pacemaker

+ The leads are then guided through a vein into your heart and then connected to the generator or battery

+ The skin is sewn together and a small dressing is placed over the wound site

+ The stitches (if not dissolvable) will be removed in approximately 10-14 days

+ The dressing is usually removed the day after the procedure

+ If you require a shower while the dressing is still intact it will be covered with plastic to prevent it getting wet

Public patients will undergo this procedure at the Mildura Base Hospital, while those patients with private health fund insurance will be accommodated at Mildura Health Private Hospital.

Post care

+ Upon returning to the ward,  your heart rhythm and blood pressure will be monitored.

+ Another ECG and chest X-ray will be taken

+ The wound site will be observed for swelling and bleeding.
*Pain relief for wound discomfort will be given if required.

Discharge

Patients undergoing a pacemaker implantation will be required to stay overnight with discharge being the following day.

* It is important to discuss with your Cardiologist instructions for dressing removal and wound care. Once the dressing(s) has been removed it will require little care. Keep clean and dry and avoid using powder. Check wound daily and report any possible signs of infection to your Cardiologist promptly.

+Your cardiologist will discuss a time for a follow up appointment (Usually within a week or two).

+ You will be discharged with the appropriate medications.

^ Please discuss any limitations or restrictions directly following your procedure and any medication changes with your Cardiologist.

fi If you have travelled from regional or remote centres, your Cardiologist may advise you to stay in Mildura for 2-3 days following your procedure.

Depending on your procedure, time and recovery you will be discharged the same day or early the next morning provided you’re accompanied by an consenting adult. Your cardiologist will arrange a follow up appointment prior to discharge.

For 24 hours following procedure, it is recommended you do not;

+ Drive a vehicle

+ Travel on public transport

+ Drink Alcohol

+ Sign important documents

+ Use heavy machinery

Prior to discharge patients will receive a visit from a Cardiac Nurse from Mildura Cardiology who will;

+ Interrogate your pacemaker to assess the settings and test lead placement

+ Give you an information booklet detailing information about living with a pacemaker

+ Provide you with a temporary ID card to carry regarding your new device, your permanent card will arrive via mail and should be carried with you at all times

+ Give you an appointment to see the Cardiac Registrar at Mildura Cardiology for the following week

+ Give you an appointment to have your device checked at Mildura Cardiology 1 month post implant

The hospital staff will give you an appointment to see the surgeon who implanted the pacemaker 10-14 days post implant.

Care following discharge

+ Do not lift your arm above shoulder level (on the side that the pacemaker has been implanted), or lift any heavy objects for the first 4 weeks.

+ Do not drive until the pacemaker site is no longer tender and the Cardiac Registrar has given you permission.

Patients will need to have regular appointments with their cardiologist to ensure further adjustments of device settings are appropriate to the individual. These are usually arranged for 1 day post implant, 1 month post implant, 3 months post implant, and every 6 months following.

Risks

Although serious problems are rare, as with any medical procedure there are always some risks involved. Every effort is made to minimise your risk, though should complications arising from you procedure occur, emergency equipment is readily available.

Exact risks vary from patient to patient, however, some symptoms that may occur include;

Haematoma (Bruising and swelling)

It is usual for most patients to have bruising and tenderness at and around the catheters insertion point for a few days following procedure.

Infection

Infection is rare, however if infection does occur it is usually contained to the area of skin overlying the catheter insertion point. Any infection will be treated with the appropriate antibiotic.

Allergic reaction to dye

A dye, or ‘Contrast’ is used to enable the coronary arteries to be seen using x-ray. Minor reactions can result in hives and rare occasions where a dramatic fall in blood pressure is evident, shock. Risk to patients with no previous reaction to contrast dyes extremely low. Inform your Cardiologist if you have had any previous reaction to contrast mediums.

Acute Closure or rupture of coronary artery

In rare cases, coronary angioplasty can cause the artery to become completely blocked or rupture. In this situation an emergency coronary artery bypass operation would be performed.

Heart Attack

In extreme cases, patients may endure cardiac arrest during this procedure. Rest assured your Cardiologist is well prepared to deal with this situation.