Pacemaker Implantation Surgery: Symptoms, Classification, Diagnosis & Recovery

Several tests are conducted before pacemaker implantation to check whether the patient is suitable for it or not. These include the following:

• Electrocardiogram: Electrodes, which are sensor pads, are attached to the chest or limbs at times to measure the heart impulses.
• Holter monitoring: Ambulatory or Holter monitor records the rhythm of the heart for 24 hours. Wires go from the chest to a battery-operated recording device, which is carried in the pocket or worn as a belt or a shoulder strap. A diary is kept with the patient. The doctor compares the diary with the recordings to figure out the cause.
• Echocardiogram: Harmless sound waves are employed to allow the doctor to see the heart functioning. Without incision, a transducer is placed in the chest to collect the waves from the heart and it transmits them to a machine. The sound wave patterns are interpreted to compose an image of the beating heart on a placed monitor.
• Stress test: An electrocardiogram is taken before and after a patient walks on a treadmill and then nuclear imaging is done.

1. The pacemaker insertion process involves a minimally invasive procedure with transvenous access, commonly through the subclavian or cephalic vein. This provides access to the infraclavicular region for subcutaneous placement of the pacing generator. Pacemaker leads are surgically implanted via thoracotomy, positioned in the abdominal area. Antibiotic prophylaxis is administered for infection prevention. Percutaneous central vein access, along with fluoroscopic examination, ensures accurate placement.
2. Guidewire placement is crucial, with access to the subclavian vein and advancement to the right atrium or vena cava. Fluoroscopy aids visualization, and phlebography confirms deep vein thrombosis. Subsequent subclavian vein access and guide wire advancement facilitate lead placement.
3. Pacemaker lead implantation involves creating an incision and subcutaneous pocket for the pacemaker generator. A special sheath and dilator are advanced over the guide wire, facilitating the insertion of the lead-style combination. Fluoroscopy guides the positioning of leads, and measurements of lead impedances are taken, followed by testing.
4. The securing of the lead involves suturing the proximal end to the pectoralis tissue, and the pulse generator is connected to the leads. Surgeons often secure the generator to the tissue to prevent migration. A final fluoroscopic confirmation of lead positioning precedes the closure of the incision.
5. Post-procedure care includes the application of a sterile dressing, and patients are advised to limit movement for 12 to 24 hours. Surgeons may employ adhesive strips and absorbable sutures for incision closure.

Usually, a patient is kept under observation for more than a day after the pacemaker implantation surgery. It takes around six weeks for the patient to get used to the implanted device. Heavy work must be avoided initially. One should ensure that the concerned arm is not rendered immobile during this time to prevent a frozen shoulder. A physiotherapist can exactly show the movements that you need to perform to keep your arm healthy. Carry the duly filled pacemaker implant card for emergencies to avoid any unwanted situation.