How can a doctor check a pacemaker

Pacemaker implantation

Important NOTE:
The description of the interventions was compiled with the greatest care. However, it can only be an overview and does not claim to be complete. The websites of the service providers and the personal consultation with the doctor or the surgical explanation in the respective operating facility provide further information.
The persons responsible for the content of this website do not guarantee the completeness and correctness of the information, as constant changes, further developments and specifications are made as a result of scientific research or adaptation of the guidelines by the medical societies.

Here you will find:

In order to optimally fulfill its function as a pump and to maintain the blood circulation, it is important that the heart beats in a regular rhythm - neither too fast nor too slow. In some patients this rhythm is too slow (bradycardia) or the heart even skips a few beats, which can lead to loss of consciousness.
In such cases, the doctor will recommend the implantation of a so-called pacemaker. This small device can correct various disturbances in the electrical conduction system of the heart by emitting an electrical impulse when the heart rhythm slows down or when the heart comes to a temporary standstill, which makes the heart muscle beat and thus get it back on track.

An important part of the pacemaker is the so-called aggregate, which contains a pulse generator, the electronics and a battery. This part of the system is no more than the size of a slightly flatter matchbox and is transplanted under the skin. From there, depending on the type, one or two thin electrode cables lead via the vein directly into the heart and are anchored here in the muscle tissue of the atrium or chamber (ventricle). The device continuously receives information about the heart rhythm via these cables. This information is compared with the previously stored data. If the rhythm is too slow, too fast or irregular, electrical impulses are sent to the heart via the electrodes to stimulate it to beat evenly.
The implantation of the pacemaker is a relatively small procedure that can also be carried out on an outpatient basis without any problems.

What happens during this procedure?

With the most common implantation method, the doctor makes a small "pocket" under the skin for the pacemaker after anesthesia and disinfection of the operating area below the collarbone. After the device has been inserted into this pocket, the thin, deformable electrodes are carefully advanced through a vein located just below the clavicle under an X-ray view into the atrium or chamber until the tip is in direct contact with the heart muscle tissue.
So that the electrodes do not slip again, they are anchored in the muscle tissue. With one type of electrode, this is done through an anchor-shaped end that literally “hooks” into the muscle fiber bulges (trabeculae) of the right ventricle. Another type of electrode is fixed with a kind of tiny screw in the muscle tissue of the atrium. Both types of electrodes establish a firm connection with the heart muscle after just a few weeks.
The electrodes are then firmly connected to the aggregate, which is fixed to the muscle tissue with a suture.
As soon as the pacemaker system is correctly placed, it is tested to ensure that it is working properly. You may feel a faster heartbeat during this test.
If the pacemaker works, the skin over the pacemaker is sutured and covered with a bandage.
In rare cases, the pacemaker is placed in the abdomen and the electrodes are attached to the outside of the heart.

When does the doctor advise you to have this procedure?

The doctor will recommend a pacemaker for certain cardiac arrhythmias that are accompanied by a slowing down of the heart rhythm or a temporary stopping of the heartbeat. Such disturbances can be detected by chance during an EKG examination or they are manifested by symptoms such as dizziness and brief loss of consciousness.

Which stunning method is usually used?

A pacemaker is usually implanted under the collarbone under local anesthesia. (Reference: local anesthesia). In addition, calming and relaxing medication is usually given.
The pacemaker is implanted in the abdomen under general anesthesia (reference: general anesthesia).

How long does the procedure take on average?

The procedure takes about 30 to 60 minutes.

Who may not be suitable for this procedure?

If certain cardiac arrhythmias make the implantation of a pacemaker necessary, it can in principle be used in every patient. Sometimes, however, the usual placement has to be deviated from due to the physique or other special features.

How is the risk to be assessed?

The implantation of a pacemaker is a very low-risk procedure. As with any surgical procedure, however, risks cannot be completely ruled out. Before the procedure, your doctor will provide you with comprehensive information about rare complications such as wound infections or lung injuries.
If the original heart problems recur after initial improvement, this indicates a malfunction of the pacemaker. This can happen, for example, if in rare cases the electrodes slip. In such a case you should consult your doctor as the position of the probes may need to be corrected.

Few patients retain a feeling of foreign body permanently, but this is usually only slightly.

What do you have to consider before the procedure?

If you regularly take medication for other illnesses, you should inform your doctor in advance, as some medications such as blood-thinning substances should be discontinued a few days before the procedure.

If the procedure is performed under general anesthesia, you should not eat or drink any more cloudy liquids on the day of the procedure 6 hours before the anesthesia! Also, no clear liquids should be drunk 2 hours before the anesthesia
become. (Exception: preparation tablet (s) with a little water) No more smoking on the day of anesthesia. If you take medication in the morning, please discuss with your anesthetist which medication you can still take before anesthesia.

What happens after the procedure and what should be considered?

Even after the outpatient pacemaker implantation, you will remain under observation for some time after the procedure - until you feel fit for the way home. Due to the calming medication, it may take some time before you are completely clear in your head again. You are therefore not allowed to drive your own car on the day of the procedure and you should also not use public transport on your own. Let family or friends pick you up or take a taxi home. After an operation under general anesthesia, it must always be ensured that you are not at home alone for the first 24 hours

For the first one to two weeks after the procedure, you may experience unpleasant sensations in the surgical area, which you can combat with commercially available painkillers.

In the first few days after the operation, you should behave as calmly as possible, as during this time you can still loosen the electrode cables through vigorous movements or activities.

Before you go home, the doctor will give you a pacemaker ID card, which contains important information about the type and function of the pacemaker, and which you should always have with you. Your doctor will also provide you with comprehensive information about the rules of conduct that you must observe as a pacemaker.

When does the next doctor's appointment usually take place?

Just a few days after the operation, the doctor will order you to go to the practice for a check-up. In your own interest, you should absolutely keep this appointment. The doctor will check the wound and check that the pacemaker is working.

If you get a fever or severe pain at home, or if you notice reddening or other signs of inflammation on the wound, you should contact your doctor immediately. Shortness of breath, a swollen arm, or recurring cardiac arrhythmia should also be reasons to see a doctor immediately. Even if you are unsure and still have questions about the normal course of healing, in practice no one will be angry with you if you call for advice.