How Does a Doctor Install a Pacemaker?

When the patient enters the operating room, a nurse starts an IV to deliver anesthesia, antibiotics and vital fluids in order to keep the patient stable throughout the surgery. The nurse then shaves and sterilizing the area of the chest where an incision will be made and the upper body is then covered with a sterile drape.
While waiting for the anesthesia to take effect, several monitors are hooked up to the patient. A defibrillator allows the doctor and nurse to monitor the heart rate during the surgery and keep it at a regular pace. An electrocardiogram monitors electrical impulses to and from the heart.
Once the patient is drowsy but awake and can feel no pain, the implantation procedure begins.
There are several different methods for implanting pacemakers, but the endocardial transvenous approach is the most common. First, local anesthetic is applied to numb the area where the incision will be made, which is just beneath the color bone. The surgeon then makes a 2- to 3-inch long incision where he or she will insert the pacemaker along with several leads, which are inserted into a vein and guided to the heart. A tip on the end of the lead is attached to the heart muscle and the opposite end is attached to the pacemaker. The pacemaker is then inserted into a pocket created under the skin in the upper chest. Before closing the incision, the doctor tests the leads by speeding up and slowing down the heart rate and asking the patient to explain what she is feeling.
The pacemaker implant procedure can be expected to take somewhere between two to five hours. The procedure is generally painless except for a slight burning or pinching sensation that may occur when the anesthesia is injected, or a pulling sensation when the doctor creates the pocket in the tissue in the chest to hold the pacemaker.
Once the doctor has tested the leads and is satisfied they are working properly, the incision is closed up and the patient is taken to a room to be monitored overnight. For the first 12 hours the patient must stay still and refrain from raising his arms so that the leads do not get dislodged. The heart rhythm is monitored throughout the night, and if there are no problems, the patient is usually discharged the next day.

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