Pacemaker Implantation

What is a pacemaker?

How does a pacemaker work?

How is a pacemaker implanted?

Before Your Procedure

During the Procedure

After the Procedure

Follow-up Programs

Other Resources

What is a pacemaker?

The Cardiac Electrophysiology / Heart Rhythm Center offers pacemakers for patients whose hearts are beating too slowly. These devices are used to take over the role of the heart's natural pacemaker -- the sinus node or the atrioventricular node -- when either fails to function correctly. A pacemaker consists of two main parts:

- A pulse generator , about the size of a matchbook, which contains a small computer, electronic circuitry, and a battery. This unit is usually implanted under the skin in the upper chest. The memory in the generator stores vital information about how the pacemaker has worked in regulating your heart rhythm. This information is periodically retrieved and analyzed to determine if your pacemaker is working properly or if it needs to be reprogrammed.

- One or two pacing wires, or leads , which carry electrical impulses from the generator to your heart to maintain the proper heart rate. Single-chamber pacemakers have one lead that is inserted into either the right atrium or right ventricle. Dual-chamber pacemakers have two leads, one inserted into the right atrium and one into the right ventricle. Your doctor will discuss which type is right for you.

The Cardiac Electrophysiology / Heart Rhythm Center is participating in national trials to evaluate new types of biventricular pacemakers, which contain two leads extending into both ventricles of the heart. These devices hold promise for relieving symptoms in patients with congestive heart failure or atrial fibrillation.

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How does a pacemaker work?

When your heart beats too slowly, the leads from the pacemaker sense this and send signals from the heart to the pulse generator. Upon receiving these signals, the generator sends electrical impulses through the leads into the heart to stimulate it so it will beat at the proper rate.

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How is a pacemaker implanted?

Pacemakers are implanted in the Cardiac Electrophysiology Laboratory on the 5th Floor of Tisch Hospital, using local anesthesia and sedation. This approach obviates the need for surgical procedures in the operating room that require general anesthesia. (Open-chest surgery may be used to implant pacemakers in patients who are having another type of heart surgery, such as bypass surgery.) The Heart Rhythm Center assumes full responsibility for preparation, implantation, discharge planning, and long-term follow-up of all implanted devices.

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Before Your Procedure

Pacemaker implantation, including preparation and recovery time, may take several hours. Be sure to plan accordingly and to bring a care partner with you to the hospital.

You will undergo Pre-Admission Testing several days to a week before the procedure. This testing will include blood tests, an EKG, chest x-ray, and a medical history assessment. You will also be asked to sign a form giving NYU consent to perform the procedure.

Do not eat or drink anything after midnight the night before your procedure. You may be permitted to take your regular medications with a sip of water; check with your doctor.

On the day of your procedure, report to the Admitting Department on the first floor of Tisch Hospital at the scheduled time. The Admitting Clerk will direct you to the Cardiac Electrophysiology Laboratory on the 5th Floor of Tisch Hospital when the team is ready to perform your procedure.

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During the Procedure

When you arrive at the Cardiac Electrophysiology Laboratory, you will be assisted to a special x-ray table and attached to a heart monitor and blood pressure cuff.

You will receive a sedative intravenously so you will feel drowsy and relaxed during the procedure. A local anesthetic will be injected into the area where the generator will be implanted.

Your doctor will make a small incision, most often in the upper chest (but sometimes in the abdomen) and create a pocket under your skin in which to insert the generator of the pacemaker.

He will then insert the pacemaker leads into a vein through this incision. Guided by an x-ray camera, your doctor will pass the leads through the vein and position them into the appropriate area of your heart.

After testing the leads to ensure that they can sense the heart's signals clearly, your doctor will attach them to the pulse generator.

The pulse generator is programmed to treat your particular arrhythmia, and is then inserted into the pocket of skin in your chest or abdomen. After ensuring that the device works correctly, your doctor will close the incision and cover it with a sterile dressing.

When the procedure is over, you will be brought to the Observation Room in NYU's Cooperative Care Unit on a stretcher.

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After the Procedure

Once in the Observation Room of the Cooperative Care Unity, the staff will monitor you closely, taking your blood pressure, pulse, and temperature frequently and checking your incision for bleeding or swelling. Your care partner should stay with you in the Observation Room.

You will be able to eat once you awaken fully from the sedation.

Keep the arm on the side of the incision close to your body. Avoid excessive movement, pulling, or straining.

Do not try to get out of bed alone; a staff member will help you get out of bed for the first time after your procedure.

If you feel palpitations, chest pain, or any unusual sensations, tell your nurse immediately.

You will stay at least one night in the Cooperative Care Unit so we can monitor you after your pacemaker implantation.

Going Home
Your doctors will meet with you before your discharge and discuss the results of your pacemaker implantation. Our nurse practitioner, Aileen Ferrick, will meet with you after the procedure to provide you with specific discharge instructions. She is also available before the procedure, and can be reached by calling 212-263-3556.

To care for your incision, keep the protective Steri-Strips dry and open to air, allowing them to fall off on their own over the next couple of weeks. You may shower, but do not bathe or swim. Lightly pat the strips dry after showering.

The incision will usually heal over the next two weeks. The sutures will dissolve on their own and do not need to be removed.

If your incision bleeds or develops signs of infection (swelling, increased pain, redness, drainage, increased temperature, or opening), call us at 212-563-5555 , 24 hours a day to speak with a physician.

You can usually resume your normal activities the following day, or as directed by your doctor. Avoid lifting or straining, heavy housework, sports, or exercise for the next two weeks. Between two and six weeks, avoid any exercise or repetitive movements that place significant strain on the affected side (such as swimming, golf, or tennis).

Be sure to schedule a follow-up appointment with Aileen Ferrick, the Heart Rhythm Center's Nurse Practitioner, for two weeks after the procedure. She can be reached at 212-263-3556.

You will need to see us every 3 months at the Heart Rhythm Center's offices -- or contact us by telephone (Phone: 212-263-7149) -- so the data stored in your pacemaker can be retrieved and analyzed. For more information, see the section below on Follow-up Programs.

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Follow-up Programs

For Patients with Pacemakers

Two weeks after the procedure: We will see you at the Heart Rhythm Center two weeks after your implantation procedure to check the implantation site and your pacemaker and to answer any questions you may have. To check the pacemaker, we will place a special wand over your device, which will transmit information stored in the generator to tell us how your pacemaker is working.

Three months later: We will see you again three months later at our center. At that time we will once again check the function of your pacemaker to see how it is working. We may reprogram your pacemaker to the voltage level that is most appropriate for you.

Every three months thereafter: We will need to check the status of your pacemaker every three months to make sure it is working properly and to check its battery life. You can choose to come to our center for your visits, or you can alternate office visits with telephone monitoring. Your pacemaker is capable of transmitting its stored information to us by telephone using special equipment we can give you to take home, should you wish to do so. If you would like to pursue telephone monitoring, speak to Ralph Tanzi, Pacemaker Coordinator. Note that if your pacemaker needs to be reprogrammed, you will need to come to our offices. Reprogramming cannot be done over the phone.

After 3 to 4 years, we will need to monitor your pacemaker more frequently as it ages. This schedule varies depending on whether your device is a single-chamber or dual-chamber model. You will be informed of the monitoring schedule that is appropriate for you.

What to avoid: Appliances and machinery that generate a strong electromagnetic field may interfere with your device's ability to function correctly, or may cause it to stop completely.

You should therefore avoid:

  • magnetic resonance imaging (MRI) procedures
  • nerve stimulators (sometimes used to treat lower back pain, and now being marketed to "tone" abdominal muscles)
  • ultrasound tooth cleaning (manual scaling is preferred)
  • older model microwave ovens (choose one manufactured since 1996)
  • arc welders and other industrial equipment
  • antitheft devices in stores -- pass through them quickly, and avoid standing next to them
  • electromagnetic scanning devices in airports -- request being searched by hand

Tell every healthcare professional you visit -- other doctors, your dentist, chiropractor, optometrist, or whomever -- that you have a pacemaker so they will be sure not to use any treatments or appliances that may interfere with it.

Identification cards: You will receive a temporary I.D. card when you leave the hospital identifying you as a patient with a pacemaker. You will receive a permanent card later from the manufacturer.

Carry this card with you at all times. It has important information about your device and includes your doctor's contact information, in case of an emergency. You can also show it to airport security personnel and to retail store security personnel, should your device set off their antitheft system as you pass through it. If you lose your card or need to change the information, you can contact the manufacturer by phone (consult the booklet you will receive) or visit their Web site. A list of sites for the most prominent device manufacturers appears below in the Other Resources section of this site.

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Other Resources


The following Web sites* offer more detailed information about pacemakers.

Heart Rhythm Society

If you already have a pacemaker or ICD, you may wish to visit the Web site of your device's manufacturer to find more information about the device or about arrhythmias in general. These sites also enable you to change or replace your device I.D. card.

Boston Scientific

Medtronic

St. Jude Medical, Inc.

* NYU Medical Center is not responsible for the content of any off-site pages or any other sites linked to this site.

Cardiac Electrophysiology / Heart Rhythm Center

NYU Langone Medical Center
403 East 34th Street, RIV-2nd Floor
New York, NY 10016
Phone: 212-263-7149

Larry A. Chinitz, M.D.
Director, The Heart Rhythm Center

Neil E. Bernstein, M.D.
Assistant Director, The Heart Rhythm Center

Anthony Aizer, M.D.
Instructor of Medicine

Douglas S. Holmes, M.D.
Assistant Professor of Medicine

Sabrina Wilbur, M.D.
Assistant Professor of Medicine

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