Pacemaker/Implantable Cardioverter Defibrillator Insertion

The picture above is a chest x-ray. The large, white space in the middle is the heart. The dark spaces on either side are the lungs. The small object in the upper corner is an implanted pacemaker.

What to Expect

During the Procedure

• Description of the room, monitoring devices, positions, and equipment that will be used - From the holding area, you will be taken to the room where the procedure will be performed. The room will feel cool. You will lie on a firm but padded x-ray table and you will be connected to equipment that will monitor your heart rhythm, blood pressure, and oxygen levels. A nurse will accompany you at all times. Please feel free to ask questions at any time.
  
  You will lie flat on your back during the entire procedure. There will be several monitor screens in the room, showing your vital signs (EKG, heart rate, blood pressure, breathing rate, and oxygen level).
  
  The cath lab is a sterile area, so everyone in the room will wear gowns, masks, and caps. The physician and assistants actually performing the procedure will wear sterile gloves.
  
  

• Anesthesia - You will be given a sedative medication in your IV prior to the procedure to help you relax. However, you will remain awake during the procedure.
  
  
• Basic description of the procedure:
  
  
  • The cath site will be cleansed again with antiseptic soap.
    
    
  • Sterile towels and a sheet will be placed around this area.
    
    
  • A numbing medication (lidocaine or xylocaine) will be injected into the skin at the cath site.
    
    
  • Once the numbing medication has taken effect, the physician will make a small incision at the insertion site.
    
    
  • A sheath, or introducer, is inserted into the blood vessel. This is a plastic tube through which the pacer/ICD lead wire will be inserted into the blood vessel and advanced into the heart.
    
    
  • It will be very important for you to remain still during the procedure so that the catheter placement is not disturbed and to keep from causing damage to the insertion site.
    
    
  • The lead wire is inserted through the introducer into the blood vessel. The physician advances the lead wire through the blood vessels into the heart.
    
    
  • Once the lead wire is inside the heart, it will be tested to verify proper location and that it works. There may be two lead wires inserted, depending on which device your physician has chosen for your condition.
    
    
  • Once the lead wire has been tested, an incision is made close to the location of the catheter insertion. You will receive numbing medication before the incision is made.
    
    
  • The pacemaker/ICD generator is slipped under the skin through the incision after the lead wire is attached to the generator.
    
    
  • Once the procedure has been completed, the catheter will be removed from the insertion site.
    
    
  • You will be assisted onto a stretcher and taken to the recovery room.
    
    
• Procedure time - The procedure itself will last about one to two hours.

After the Procedure

• Recovery process - Once the procedure is completed, you will return to (client to insert location of recovery area). Your physician will visit with you in your room while you are recovering. He/she will give you specific instructions and answer any questions you may have.
  
  Bed rest is required until the effects of the sedative medication have worn off and you are fully awake. You will be able to eat or drink once you are completely awake. The insertion site may be sore or painful, but pain medication may be administered if needed.
  
  
• Length of stay - If the procedure is performed on an outpatient basis, you may be allowed to leave after you have completed the recovery process (usually about two to four hours after the procedure is finished). However, if there are concerns or problems with your EKG, you may stay in the hospital for an additional day (or longer) for monitoring of the EKG.
  
  
• Average recuperation time - You will most likely feel tired for a day or so following the procedure. The insertion site will be sore for a few days.
  

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