Locations across Queensland within Queensland Cardiovascular Group

Phone (07) 3016 1111

Pacemakers

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What is a Pacemaker?

A pacemaker is a small implantable medical device that supports the heart’s natural rhythm and restores regular electrical impulses when required. It consists of a battery and electrical leads, and it sits under the skin on the left or right side of your chest.

Your Doctor may recommend a pacemaker if your heartbeat has become too slow, or as part of a ‘pace and ablate’ treatment strategy.

A pacemaker has two core parts:

  1. Pulse Generator: this contains the battery and internal programmable computer that monitors the heart rhythm and sends pacing impulses when needed to keep the heart at a regular beat.
  2. Pacing Leads: these are insulated electrical wires through which electrical impulses travel from the pulse generator to the electrodes at the tips of the leads, inserted in the heart. These leads are connected to the pulse generator and are extremely flexible and able to withstand twisting and bending movements caused by the heart beating and normal body movement. Metal electrodes at the tips of the pacing leads are in direct contact with the heart muscle and deliver the electrical impulses to cause the heart to beat.

Pacemakers work as clock timers, sending out an electrical impulse to trigger your heart to beat if the natural heartbeat has not happened within set time periods (eg, one second). This is called ‘demand pacing’. The pacemaker supports the heart when it needs to, and allows the heart to beat itself when the natural heart beat is faster than the pacemaker. 

Pacemakers also contain sensors which can detect when you are active and can be programmed to increase your heart rate during periods of activity and settle back down to a resting heart rate when you are at rest. 

Pacemakers store your cardiac data, including inforamtion about your heart rhythm and heart rate. The information collected can be used to improve your device’s programming and also optimise your medical therapy. The information from your device is routinely reviewed at your clinic appointments. We also offer remote monitoring for pacemakers. 

How do I Prepare?

  • You will be admitted to hospital for the procedure. 
  • Your doctor will advise you if any medication needs to be ceased prior to the procedure. 
  • You may be required to fast for 6 hours prior to the procedure.  
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What Should I Expect?

Before the Procedure

  • Some patients may be required to have their chest shaved.  
  • You will have a cannula inserted into your arm vein and connected to a drip.  
  • You will be given preoperative IV antibiotic to reduce the risk of the device becoming infected. 


During the Procedure

  • At the beginning of the procedure, you will be given medication to help you relax.  This may either be a sedative or an anaesthetic. 
  • Local anaesthetic is injected under the skin to numb the area in the region of the left or right upper chest a few centimetres below the collarbone.  The local anaesthetic will take away your pain sensation, though it is normal to still feel some pushing and pulling.
  • An incision will be made in the skin to make a pocket for the device to sit in, below your collarbone.   
  • The pacing leads are inserted in place, from the pocket, through your vessels under your collarbone and into the heart.
  • The leads are secured in place in the heart and tested to check that they are working well.
  • The pulse generator is connected to the leads, and then inserted into the pocket under the skin. The skin is closed using sutures (stitches). 
  • A sterile waterproof dressing will cover the site. 


After the Procedure

  • You will most likely need to stay in hospital overnight after the procedure. 
  • You will be connected to  continuous ECG monitoring while you are in hospital. 
  • You may need some pain relief medication. Pain after a pacemaker insertion is usually mild and often controlled with paracetamol. 
  • Before leaving the hospital, a cardiac scientist will check your device to make sure it is working properly and confirm with the Electrophysiologist. Any issues identified will be corrected before you are discharged from hospital. 

 

On Discharge

  • Most people will be discharged from hospital the following day. 
  • You will receive some information about how long to keep your waterproof dressing on over your device implant site. 
  • You will not need to have any stitches removed because they are buried below the skin and are dissolvable.  
  • You will receive a cardiac device identification card along with an information booklet produced by the manufacturer of your device. 
  • You will also receive information about how to get your cardiac device connected to your remote transmitter. 
  • Your doctor will advise you on your follow up appointments prior to discharge. 
  • It is common to leave hospital feeling emotionally and physically drained. This will improve as you recover.  Most people adapt very well to living with their implanted cardiac device and return to most of their previous activities. 

 

Returning to Daily Life

  • Driving: Austroads Assessing Fitness to Drive 2016 Guidelines advise no driving for 2 weeks following a pacemaker implant. 
  • Exercise: You may walk for gentle exercise the day after you get home from hospital. 
  • Returning to work: For sedentary work you may only need a few days off work. For physical jobs, depending on what is required, you may need a week off work. 
  • Restricted Arm Movements: You will be given information about arm movement restrictions for the arm on the side of the implant – generally doctors advise to avoid lifting the arm above should height for a period of time. Check with your doctor on your specific recommendations. 
  • Household Appliances: You can safely use all common household appliances including microwaves, televisions, computers etc. 
  • Mobile Phones: Avoid putting a mobile phone in a shirt breast pocket in close contact with your device. 

Future Medical Procedures 

  • Always tell any your health professional that you have a cardiac pacemaker device implanted and if needed, show your Cardiac Device ID card. 
  • MRI Scans: Most cardiac devices are now MRI compatible. If you need an MRI scan please contact us to obtain an MRI compatibility checklist to submit to the radiology company. 
  • Most medical procedures are unlikely to interfere with your pacemaker, except MRI scanners. In fact, having a cardiac device implant that keeps your heart rate stable can make your medical or surgical procedure safer. 

Follow up Appointments and Device Checks

  • Follow-up arrangements can vary between doctors. Generally, an annual check is scheduled in the clinic and a remote monitoring check is also performed during the year.   
  • The pacemaker is checked for its records of your heart rhythm, the effectiveness of its pacing and for battery life. Most pacemaker batteries are expected to last approximately 10 years. 
  • Your cardiac device will be programmed appropriately at implant according to your heart rhythm issue; however, this might require adjustment as time goes by. Cardiac device programming is always reviewed routinely at clinic and via remote transmission follow-up.

Remote Monitoring Service

  • QCG offers a remote monitoring service that enables ‘virtual check-ups’ for your implanted cardiac device. Your device is able to directly and securely transmit data from your device to your Cardiologist from the comfort of your own home.  
  • This enables us to detect significant events such as an abnormal heart rhythm, monitor the performance of your device such as battery life, and optimise your care through device programming or medication change. 
  • Remote monitoring takes the form of a scheduled check-up once a year where all of the device data is reviewed.  Also, we respond to alerts generated and transmitted by the cardiac device on any given day, if an event or issue is detected. 

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