When choosing the most appropriate method, the doctor must consider the age, overall health, and lifestyle of the patient. There are two primary methods of pacemaker implantation.

• Endocardial lead placement
• Epicardial lead placement

• Battery
• Pulse generator (produces the electrical signals that cause the heart to beat)
• Wires (also called leads) carrying the electrical signals from the pulse generator to the heart

A pacemaker works by sending electrical impulses from the pulse generator to stimulate the heart to contract and produce a heartbeat, thus restoring the heart’s natural rhythm. The wires carry the pulses between the generator and the chambers of the heart.

• Do not consume food or drinks 8 hours prior to the procedure.
• Consult with your doctor regarding medications from which you may need to refrain.

• Endocardial lead placement: The doctor inserts the lead(s) (thin insulated wires) and guides it through a vein to the patient’s heart. Once the lead(s) have reached the heart, the surgeon will then attach the lead tip to the heart muscle, guided to the correct position with the aid of x-ray images. After this, the doctor will connect the lead(s) to the pacemaker generator and insert the device under the skin through the small incision either on the right or left side of the patient’s upper chest (just below the collarbone). The patient may feel slight pressure while the lead(s) and pulse generator are inserted under the skin. Once the implantation has been completed, the doctor will then check the x-ray images and test the pacemaker to ensure it is in the correct position and that it is working properly to meet the patient’s medical needs.

• Epicardial lead placement: An incision is then made in the chest, after which the lead(s) are attached directly to the surface of the heart. The pulse generator is then placed under the skin in the upper abdomen, or may be placed in the upper chest area, although this method is less common.

• Bleeding or blood clots due to internal bleeding or hemorrhaging under the skin
• Infection at the site of the pacemaker implantation
• Allergic reaction to medications used during the procedure
• Damaged blood vessels
• Pacemaker leads dislodged or pulled out of their original position
• Lung or heart leaks
• Thrombosis, causing the cerebral blood flow to be constricted, myocardial infarction or death of heart muscle tissue, as well as other related conditions – all of which are rare
• Death (life-threatening complications of pacemaker implantation are extremely rare)

• Rest in the recovery room for close observation and monitoring of vital signs.
• Expect to stay in the hospital for 1-2 days following surgery so that the doctor can ensure the pacemaker is working properly and that the heart is beating at its correct natural rhythm.
• Avoid lifting with or reaching the affected arm above shoulder level on the side the pacemaker was inserted.
• Refrain from lifting any heavy objects for at least 1 month following surgery.
• Meet with the doctor for regularly scheduled appointments in order to monitor progress, during which the doctor will check to ensure the pacemaker is functioning properly. On average, a pacemaker battery lasts for about 10 years.

Notify the doctor if any of the following symptoms occur after pacemaker implantation surgery:

• Increased bleeding, swelling or pain at the site of the implantation
• Fever
• Chest pain
• Breathing difficulties