After the area under the patient's collarbone is numbed, a small incision is made (usually about 3 inches long,) and a “pocket” is fashioned in the tissue overlying the muscle. The leads are inserted through a vein near the site of the pocket, and advanced into the heart using fluoroscopy (x-rays) for guidance. The leads are then attached to the generator, the generator is placed in the pocket, and the incision is closed.
Once a pacemaker is implanted, it is important to program it. Pacemakers today are extremely flexible devices, and can vary their function according to the precise needs of the patient. But to do this, the doctor needs to program the devices. As noted, pacemaker generators are essentially tiny computers, and like any computer, before they can be optimally useful their software needs to be “tweaked” to suit the individual user. Pacemakers can be programmed non-invasively, with a handheld device that communicates with the pacemaker through the skin. The programming can be repeated as often as necessary if the patient’s underlying heart rhythm problem changes.
What happens after the pacemaker is implanted?
Once the incision completely heals (which takes about 2 – 4 weeks,) the patient can largely return to a completely normal life. In fact, since pacemakers alleviate the symptoms of bradycardia, many patients find they are able to do even more after a pacemaker is implanted.Periodic pacemaker checks are necessary, to measure the function of the device and the amount of energy left in the battery. The “scheduled maintenance” for pacemakers generally consists of periodic telephone follow-up (every month or two,) and usually yearly visits to the doctor’s office. The telephone follow-up is a simple procedure consisting of placing a special “trans-telephonic follow-up device” over the pacemaker, and transmitting data over the telephone.
When the battery begins to get low, the doctor schedules an elective pacemaker replacement. This procedure is similar to the implantation procedure, except that usually the pacemaker leads do not need to be replaced. Under local anesthesia, the incision is opened, the generator is detached from the leads and thrown away, a new generator is attached, and the incision is then closed. (This is not merely a "battery change," though doctors sometimes call it that. No batteries are changed; instead, the entire old generator is discarded and a brand new one is placed.)
