Pacemakers

A pacemaker is a small electronic device connected to one or two leads. The lead(s) are positioned within the chamber(s) of the right heart. The pacemaker stimulates the heart to beat regularly at an effective heart rate.

The pacemaker is implanted under the skin and is completely concealed in the body. The pacemaker is smaller than a matchbox in size and is only half a centimetre thick.

The pacemaker contains a power supply (or battery), which will need replacing after 5 to 9 years, depending on individual patient needs.

A pacemaker works by discharging small electrical impulses to stimulate the heart muscle to contract.

Pacemakers work ‘on demand’. This means that they constantly monitor the heart rate and rhythm and produce impulses only when required. This may be all the time or only occasionally.

A normal healthy heart beats at approximately 50-100bpm (beats per minute). The heart has four chambers. The top chambers are called atria and the bottom chambers are called ventricles.

The heart has its own natural pacemaker and a specialised electrical conduction system to stimulate heart cells to contract in a co-ordinated fashion.

Sometimes the natural pacemaker or the specialised conduction system fail to work properly. This can lead to a slow heart rate and poor co-ordination of the heart chambers, which reduces the pumping capacity of your heart.

This often leads to symptoms like:

• Dizziness
• Lightheadedness
• Fatigue
• Blackouts
• Falls
• Confusion

A pacemaker will prevent your heart from beating too slowly and improve the blood flow around your body. This may also relieve any symptoms you have been experiencing.

Rotherham Hospital use two main types of pacemaker. These are single chamber and dual chamber pacemakers. The type you receive depends on your underlying heart condition.

You will usually be invited to attend Pre-Assessment Clinic in the weeks before your device is implanted. This is an opportunity to meet the Physiologist and Nursing staff who will explain the procedure and give you information about living with a pacemaker. It may be useful to bring a friend or relative. Please bring a list of your medications with you.

If you take an anticoagulant (blood thinner) you may be asked to stop taking these before the procedure; this will be discussed at pre-assessment. You should continue with all other tablets. If there is any possibility that you are pregnant, please inform the medical staff before your procedure.

Your pacemaker will be implanted here at Rotherham Hospital in the Cardiac Catheter Suite, Level A. On the day of your device implant, you may have a light meal (e.g. tea and toast) then nothing more to eat or drink until after your procedure.

Please do not bring large sums of money or other valuables into the hospital.

On attending the hospital, the nurse will insert a small needle (cannula) into the back of your hand or arm. This is to administer any necessary medications during the procedure. You will be given antibiotics via your cannula before the procedure to minimise any chance of infection.

The Doctor will explain the procedure in full and you will be asked to sign a consent form. This is to confirm you understand what is involved and agree to proceed.

On average the procedure takes around 30 - 60 minutes. You will be required to lie flat on an x-ray table. The device will be implanted under local anaesthetic using an x-ray machine. You may also be given a mild sedative to make you feel sleepy and relaxed.

During the procedure you may feel slight pressure and some pushing and pulling below your collarbone. You may also experience some brief palpitations.

The doctor guides the lead(s) through a vein below the collarbone and positions them in your heart.

The lead(s) will then be attached to the device. The device is implanted just below the collarbone. The device will be tested during the procedure to ensure it is working well.

Finally dissolvable stitches are used to seal the wound. You will have a small scar approximately 1-2 inch long.

There are some small risks, as with any procedure. The typical risks associated with having a pacemaker device fitted are:

• Small risk of leads slipping out of position. This usually needs lead re-positioning by the doctor, this would involve a second procedure.
• A small risk of infection, bleeding and bruising to the pacemaker site. Please contact pacemaker clinic and your GP if you notice any soreness, swelling inflammation or leakage. You may need a course of antibiotics.
• Small risk of air leaking from the lungs into the chest (Pneumothorax). Sometimes no treatment is required, although a needle or small drain may be used to remove the escaped air.

If you are concerned about the risk of complications, please speak to your Doctor before the procedure.

Following your implantation, you will recover in the Cardiac Catheter Suite and will remain here for at least 4 hours, sometimes longer. The nursing staff will check your observations.

You will usually have a Chest X-ray and an ECG (heart tracing). You may also see a Pacing Physiologist, who will test your device using a specialised computer called a programmer.

The programmer communicates with your device and enables the settings to be adjusted to suit your individual needs. This is called a Device Assessment and is completely painless. Often this assessment is performed whilst you are lying on the x-ray table, so you may be unaware that it has been completed.

You will usually be allowed to go home the same day, unless instructed by the medical team. In some cases the doctor may request that you stay overnight, so we recommend you bring an overnight bag.

Items to bring may include:

• Toiletries
• Nightwear
• Dressing gown
• Slippers
• A book/newspaper for whilst you are waiting
• Please do not bring large sums of money or other valuables into the hospital

You will be sent an appointment to attend Device Clinic in approximately 4-6 weeks. You will also receive a device Identification Card, which you should carry with you at all times. It contains important information about your pacemaker.

Your dressing is waterproof, so you can bath and shower with this dressing still in place. You should remove the dressing after 5 days. At this point you should leave the wound uncovered, unless otherwise instructed by the medical team.

Your stitches are dissolvable, so no further action is necessary. They usually dissolve within 7-10 days.

You should inspect your wound site regularly. Please check for any signs of soreness, inflammation, swelling or leakage. If any of these occur you should contact Device Clinic or your GP as soon as possible. You may require further treatment.

In some cases, the pacemaker may appear a little prominent. This is usually completely normal.

After your pacemaker is implanted, you should soon be able to return to your normal activities when you feel ready. Many people find that having a pacemaker improves their quality of life and eliminates symptoms such as dizziness and blackouts.

Your shoulder may feel uncomfortable for a week or so and you may have some bruising and swelling. This usually subsides in 2-3 weeks.

It is natural that you may feel worried about having a pacemaker. Some common questions are:

Driving

The DVLA have clear rules about driving. You must not drive for 7 days after your pacemaker is implanted (6 weeks if you have a LGV/PCV group 2 license). If you have any concerns then contact your Device Clinic.

You must inform DVLA that you have a pacemaker:

Drivers Medical Group
DVLA
Swansea
SA99 1TU
Telephone: 0300 790 6806
DVLA website

You will also need to inform you insurance company.

Physical activity

You should take a little extra care with the arm adjacent your pacemaker for the next four to six weeks (until your first follow up appointment). This is to prevent the lead(s) from moving out of position. Please avoid stretching your arm upwards above your shoulder height or unnecessary lifting or weight bearing. You may be asked to wear a sling immediately after your pacemaker is fitted. This is to remind you to be to be careful whilst dressing, washing etc. Please remove the sling after 24 hours. It is very important to continue other normal arm movements.

A certain level of exercise is needed to keep your heart healthy. It is advisable to avoid any activities which require strenuous arm movements, such as golf, squash or swimming. Contact or rough sports such as rugby and football are not advised as the device or leads may become dislodged.

Travel

Please ensure you carry your identification card and show it to the security staff who may have to search you by hand. Also you will need to make sure your travel insurance company are aware you have an pacemaker fitted.

Home appliances

Most mechanical and electrical devices that you use everyday will not affect your pacemaker. Ordinary radios, fridges, cookers, televisions, computers and microwaves will not affect your pacemaker as long as they are in good working order. Some specific hand held electrical appliances (such as power tools and base chargers) must be kept at least 6 inches away from the pacemaker.

Mobile phones

Keep your mobile phone at least 6 inches away from your device and ideally hold the phone to the ear opposite to your device.

Shop security systems

There is a very small risk of interference to your pacemaker, so you are advised to walk through shop doorways at a normal pace.

Magnets

Do not carry magnets or products containing magnets close to your pacemaker. Avoid contact with large magnets and strong electromagnetic fields, such as:

• car motors
• induction cookers
• electric arc welding
• amateur radio
• large stereo speakers
• wireless connections
• TENS machine/abs stimulator
• body fat scales etc.

Your pacemaker will be checked regularly in Pacemaker Clinic at Rotherham Hospital. This is a Physiologist led Clinic and you do not usually see a Doctor except in specific circumstances.

During each visit the Physiologist will check your device using a special computer known as a programmer.

The Physiologist will:

• assess your symptoms and device site
• ensure the pacemaker and leads are functioning well
• monitor any abnormal rhythms
• assess important information about the battery
• optimise pacemaker function to your individual needs
• offer advice and support

Therefore it is very important that you attend your device checks regularly. Following your discharge from hospital after having the device fitted you will be sent an appointment for 4-6 weeks for a device check in clinic. After the initial appointment you will be seen at regular intervals. Most patients are given a remote monitor, this is a small box that you plug in at the side of your bed allowing us to monitor your cardiac device from your home.

Pacemaker Clinic is held in Cardiac Device Suite, Level A.

The battery in your Pacemaker will typically last 5 to 9 years, but this varies between individuals and different types of device.

Your battery is checked every time your device is assessed so the Physiologists are able to predict when you need a replacement. At this point you will receive a brand new device, your battery will not be allowed to run down.

Pacemaker Clinic

01709 424794
Monday to Friday
8:30am to 6pm
Ask to speak to a Pacing Physiologist

Outside of these hours please contact:

Coronary Care Unit (CCU)
01709 424226