Implanting Your Pacemaker Implanting your pacemaker does not require open heart surgery. Rather, it is a minor surgical procedure done under local anesthesia. It is usually done in an operating room or a cardiac catheterization lab. Preparing for implantation Unless you are already in the hospital, you will most likely be asked to arrive in the morning the day of the procedure, or perhaps the night before. You may have several routine tests, such as an ECG, x-rays and blood tests. (These tests may be done a few days before the procedure.) The doctor will review your medical history and examine you. (You may see the doctor at the office several days before the procedure.) The doctor or nurse will talk with you about the procedure and its purpose, benefits, and risks. This is a good time to ask questions and, most important, to share any concerns you may have. You will then be asked to sign a consent form. An intravenous (IV) line will be inserted into a vein in your arm. The line allows drugs to be injected directly into the vein, if they are needed. To help you relax, you will be given a sedative. Before the procedure Generally, you'll be asked not to eat or drink anything for 6 to 8 hours before the procedure. This helps prevent nausea. You may have small sips of water with your medications. Check with your doctor a few days before the pacemaker is to be implanted. You may be asked to stop some medications (such as aspirin) for a few days before the procedure. Make arrangements with a friend or family member to drive you to and from the hospital. You will not be allowed to drive home after the procedure, since you may be sedated. Pack a small bag for your hospital stay. You may want to include a robe, slippers, pajamas or nightgown, and toiletries. Bring a list of the names and dosages of all the medications you are taking. Tell the doctor or nurse if you have had any allergic reactions to medications or if you have a history of bleeding problems. Pacemakers can be placed near the right or left shoulder. If you prefer a particular side, let the doctor know. Be sure to empty your bladder before the procedure starts. (A bedpan or a urinal will be available, in case you need it.) During the procedure Most often, the pacemaker is implanted in the upper chest, near the right or left shoulder. Occasionally, it may be implanted under the skin in the abdomen. A local anesthetic is injected to numb the area where the pacemaker will be inserted. An incision is made below the collarbone and a "pocket" is created under the skin, where the pulse generator will be placed. The lead is inserted through the chest incision and into a vein. With the help of an x-ray camera, the lead is passed through the vein and placed inside the heart. If a second lead is needed (dual-chamber pacemaker), this process is repeated. After a lead is in place, it is tested to make sure it senses the heart signals correctly. Each of the leads is then connected to the pulse generator. The pulse generator is set to treat your arrhythmia and placed in the "pocket" in the chest. The device is tested to make sure it is working properly. Then the incision is closed and covered with a sterile dressing. You will be given medication to help you relax and make you drowsy. You may be awake, or you may sleep through part or all of the procedure. The staff will be monitoring you at all times. Be sure to let them know if you feel any pain or discomfort. The procedure usually takes 1 to 2 hours. Is implanting a pacemaker safe? Implanting a pacemaker is a simple procedure with little risk. However, as with any surgery, problems or complications can occur. Some patients may develop bleeding at the incision or pocket site. Blood collects under the skin, resulting in local swelling and/or a bruise. In rare cases, the procedure may lead to more serious complications, including damage to the heart and blood vessels, a punctured lung, infection and blood clots. Death is very rare. After the procedure After the pacemaker is implanted, you will be taken to the recovery area or to your room. A nurse will take your pulse and blood pressure and will also check the incision for bleeding or swelling. During your hospital stay, your heart rhythm will be monitored at all times. Your doctor may also test the pacemaker to make sure it is working properly. This is done from outside the body. It is normal to have some pain and stiffness around the incision site for a few days. Your doctor will most likely prescribe pain medication to help make you more comfortable. Do not raise the arm on the side of the incision above shoulder level. Most patients stay in the hospital overnight; some will stay an extra day. Before you go home, you be given instructions about caring for the incision, physical activity and medications. When it is time to leave, have a friend or family member drive you.