This leaflet has been compiled to help you understand the test you are having and to give you some general information about what to expect during your stay.
Please ensure you read this leaflet carefully.
What does the procedure involve?
A pacemaker is a small, sealed metal device (pacemaker box) which contains a battery and electronic circuits. The device is connected to your heart by one or more wires (leads).
The leads are passed along a blood vessel to your heart and the pacemaker box is usually implanted under the skin in your upper chest close to your collar bone. The pacemaker can monitor your heart and if it detects a slower heart rate it can produce an electrical stimulus to make the heartbeat. Pacemakers are largely used to treat slow heart rhythms although if you have been diagnosed with heart failure a CRT (Cardiac resynchronisation therapy) biventricular pacemaker may be implanted to increase heart function. Your pacemaker may be single chamber (one lead), dual chamber (two leads) or CRT (three leads). Each type is implanted depending on the underlying heart rhythm problem.
How is the pacemaker implanted?
The procedure is performed under local anesthetic given by injection which will numb the area so you will not feel anything.
Before the procedure starts you will be covered in sterile drapes and your skin will be cleaned with an antiseptic solution. The device is usually implanted on the left side. The doctor will pass a small lead and electrode down a vein into the heart. You may have 1, 2, or 3 leads depending on the type of pacemaker you need. The leads are then connected to the pacemaker box. A pocket is created in your chest for the pacemaker box to sit under the skin. The area will be stitched with dissolvable sutures and closed with steri-strips or glue. The procedure should take approximately 60-90 minutes.
Box Change
Most pacemaker batteries (box) last 6-10 years, sometimes longer. You will then need to have a Box Change procedure to replace the box with a new one. The leads do not usually need to be replaced during this simple procedure. It is similar to the procedure to implant the pacemaker and is usually as a daycase.
Benefits
Sometimes the heart’s electrical system does not work as well as it should which causes a slow, heartbeat. A pacemaker can prevent the heart from beating too slow. A CRT pacemaker helps to improve the pumping action of the heart.
Are there any risks?
The implantation operation is usually successful, but as with all procedures there are some risks.
· There is some risk of puncture of the lung (between 1% – 2%) as the vein used for the wire runs close to it. Usually no treatment is required and sometimes any escaped air has to be removed using a needle and drain
· There is a small risk of a wire slipping out of place (between 1% – 4%). If this happens it must be repositioned under X-ray guidance
· The risk of infection for pacemaker implantation and pacemaker box change is about 2%
If you have any concerns regarding the potential risks of this procedure then please do not hesitate to discuss this on the day of your admission.
It can be helpful to some people to write down their questions, as it is common to forget them when in hospital.
Alternatives
Your cardiologist should have discussed alternatives with you.
Preparation
Requests for Tests / Investigations Prior to Your Admission
You will / should have been sent THREE forms, an admission form which should be completed and brought in with you on the day of admission. Also there is a form for an ECG (green card) and one for a blood test. An ECG is a simple test used to check your hearts rhythm and electrical activity.
These tests must be done at the hospital before 1pm on the day prior to your admission OR at your pre-assessment appointment.
Please bring the forms to the hospital with you and take them to the relevant departments to be carried out. The ECG should be done in Cardiology and the blood test in Pathology, if you do not have a pre-assessment appointment.
It is essential that you have these tests done before the day of admission otherwise your procedure may be cancelled.
Prior to Admission
If your procedure is in the morning we advise you to have a light breakfast (toast / cereal) and a drink before 7.00am. If your procedure is in the afternoon then you should have a light snack no later than10.00am. Please do not eat or drink after the stated times.
Please bring a list of your medication with you. If you take any of the following medications please follow the instructions below.
Warfarin
Please stop taking this 5 days prior to your admission unless instructed otherwise. If you have had a valve replacement or have been told you have a heart murmur you will be advised at a pre-assessment appointment about possible replacement therapy. If you do not receive a preassessment appointment please contact the hospital on the phone numbers at the end of this sheet.
Novel Anti-Coagulants (Edoxaban, Pradaxa – Dabigatran Etexilate, Eliquis – Apixaban and Xarelto – Rivaroxaban)
Your Cardiologist will have given you instructions regarding stopping your medication prior to your appointment, if you are unsure please contact us.
Clopidogrel (Plavix)
Your Cardiologist will have given you instructions regarding stopping your medication prior to your appointment, if you are unsure please contact us.
Diuretics (Water tablets)
Please do not take these on the day of the test.
Diabetic Medication:
– Tablet controlled
Do not take diabetic tablets on the morning of the procedure (with the exception of Metformin where instructions are given above).
– Insulin Dependent
Fast acting – have half your normal dose on the morning of your procedure.
Slow release – do not take on the morning of the procedure.
Please continue to take all other medications unless advised otherwise.
Forms
Please complete the enclosed admission form and bring it with you on the day of admission.
What to Bring into Hospital with You
- Dressing gown
- Slippers
- Nightwear
- Medications or list
- Reading material & glasses
- Please leave valuables and large amounts of money at home.
Visitors
Unfortunately we do not allow visitors to stay due to patient privacy. We do ask that you organise a friend / relative to bring you into hospital and take you home.
Prior to the Procedure – On the Day
A needle (cannula) will be inserted into one of your veins, usually in the back of the hand or forearm to administer an antibiotic prior to the procedure. This is to help minimise the risk of infection. This will be removed before you are discharged.
Following the Procedure
You may need a chest X-ray to check the lungs as well as the position of the leads and an ECG (electrocardiogram). You will then be given something to eat and drink. You will probably be able to go home the same day or the next day provided there are no complications.
A pacemaker check will also take place, making sure the pacemaker is working and you will be given a registration card which has the details about your pacemaker. This card should always be carried with you in case of an emergency.
A wound check appointment will be made for you and either given to you or posted to you. Following the procedure you will be given an advice sheet. The advice on the sheet will be explained to you before you leave the hospital.
Discharge
You may require to stay overnight at the hospital after the procedure. If you are discharged home it is necessary to have a friend or relative stay with you. It is important that you rest completely for the rest of the day.
If you do not have a relative or friend to stay with you overnight your procedure may be cancelled or you will have to stay overnight in hospital providing there is a bed available.
Driving
After having a pacemaker or box change, driving is restricted for 7-10 days following discharge so it is advisable that you do not drive yourself to the hospital and public transport is not suitable for travelling home.
References
Should you require further information regarding heart investigations you may find the following websites useful:
Contact Details for Further Information
If you have any queries regarding any of the information contained within this leaflet, or your admission date and time please contact the Cardiology Department at:
Diana Princess of Wales Hospital on:
03033 306539 (Secretary)
03033 304659 and 03033 306081(Nursing Staff)
03033 303058 C1 Glover
Scunthorpe General Hospital on:
03033 306542 (Secretary)
03033 302327 (Planned Investigations Unit)
03033 302367 (Coronary Care Unit)
Any Comments, Compliments, Concerns or Complaints
If you have any other concerns please talk to your nurse, therapist or doctor. Our Patient Advice and Liaison Service (PALS) is available on 03033 306518 (Grimsby, Scunthorpe and Goole). You can also contact nlg-tr.PALS@nhs.net
As a Trust we value equality of access to our information and services, therefore alternative formats are available on request at nlg-tr.interpreters@nhs.net
Review Information
Date of issue: October 2022
Review Period: October 2025
