A pacemaker is a small device that regulates your heartbeat with electrical pulses by carrying electrical impulses to your heart. Pacemakers are implanted in patients with slow heart rhythms, heart failure or fainting episodes. Pacemakers have two components called the “leads” and “pulse generator”. The pulse generator is placed just under your skin and has a battery and miniscule computer. The leads are inserted into your veins and heart muscle.
There are three types of pacemakers:
Which pacemaker your doctor recommends will be based on your medical condition. In excess of 100,000 pacemakers are implanted annually in the United States alone.
THE PACEMAKER IMPLANTATION
A pacemaker implant is performed in hospital and dependent on the type of surgery, lasts between 2 and 5 hours.
There two types of implantation methods:
Once again, you should consult with your doctor as to the best approach for your circumstances.
THE PROCEDURE
An intravenous line will be inserted into your hand or arm and you will be given a medication through the IV to make you relaxed and drowsy.
You will be awake during the procedure, but should feel no pain.If you do have pain, inform the doctor immediately.
You will be connected to monitors, which record your blood pressure and heart rate during the implantation.
After your chest has been shaved and cleansed, the doctor will give you a local anesthetic where the incision will be located.
Once the incision has been made, the doctor will insert the leads into a vein and guide them into your heart muscle with the assistance of a special x-ray machine. The leads are then tested to ensure they are working properly.
The doctor will then connect the leads to the pulse generator and place generator into the incision just underneath your skin.
The incision is then closed.
Risks associated with Pacemaker Surgery
Risks associated with pacemaker surgery are internal bleeding, infection, embolism, heart perforation and scarring.
Discuss the risks of pacemaker implantation with your medical specialist to make certain you are fully aware of the possible hazards.
PREPARATION FOR YOUR PACEMAKER IMPLANTATION SURGERY
Before traveling to Cyprus, as part of your preparation for your procedure we require detailed medical information in the form of a medical questionnaire, ECG, Pulmonary tests and blood work. In some cases an Angiogram is required. All of this information will allow the doctors that we work with to determine your eligibility for the procedure.
Your doctor will give you specific instructions about any activity restrictions you should follow before the procedure.
If you smoke, it is advisable you stop 6 to 8 weeks before the procedure to reduce the risk of breathing problems during the procedure and delayed wound healing.
Bring a complete list of your current medications (including over-the-counter drugs, vitamins and herbal supplements), allergies, your medical records and any health insurance information.
Ten days prior to your arrival in Cyprus, you will receive all the necessary pre procedure instructions, to prepare yourself both physically and mentally.
Upon arriving in Cyprus, as part of the pre-procedure tests done at our partner hospitals you will again receive chest X-rays, blood tests, an electrocardiogram and a coronary angiogram, which is a special type of X-ray procedure that uses dye to visualize the arteries that feed your heart.
Your doctor may order tests to record your heart’s electrical activity and rhythm. Your doctor may also ask about any other conditions you have, including diabetes or kidney disease.
Your doctor will also go through you medical issues with you and discuss your procedure and answer any questions at this time.
2 days before
If you take any 'blood-thinning' medicine such as warfarin or another anticoagulant, you will need to stop this for 2-3 days before the test (to prevent excessive bleeding from the site of the thin, flexible tube (catheter) insertion).
If you take insulin or medicines for diabetes, you may need to alter the timing of when you take these. Some medicines may need to be stopped for 48 hours. Your doctor should clarify this with you.
Day before implementation
You will likely be requested to stop eating or drinking after midnight the evening prior to your procedures.
Your doctor may also ask you to consume only clear fluids for one or more days in advance of the implant.
Morning of the procedure
On the day of your procedure, your designated SALUS Patient Concierge along with a nurse may talk with you and your loved ones. They shall tell you what to expect. You will most likely feel a little nervous before, so the SALUS team and the hospital staff will do all they can to answer your questions and help you relax.
Make sure all your medicines in their original containers with you to the hospital.
You may be asked to stop eating and drinking for a few hours before the procedure.
You should leave jewelry, watches, money and other valuables with the person who accompanies you or with our staff member who will place them in our safe.
Proceed with your routine morning care:
When it is time for you to have your procedure, your family/ companion will be asked to wait in the waiting area. Your doctor will talk to your family/ companion there after your procedure.
You will have to sign a consent form at some point before the test to confirm that you understand the procedure, understand the possible complications (see below) and agree to the procedure being done
RECOVERY OF THE IMPLEMENTATION PROCEDURE
After the procedure, you will go to a recovery room and lie still for four to six hours to help your body recover.
Nurses will monitor your heart rhythm during recovery. You may go home on the same day, or you may need to stay in the hospital overnight.
You may have pain in your groin area, arm, or wrist. This is from the catheter (flexible tube) that was inserted to do the procedure.
You may also have some bruising around and below the incision.
If the doctor put the catheter in through your groin:
If the doctor put the catheter in your arm or wrist:
Hospital discharge and home instructions
Before leaving the hospital, our doctor and staff will help you adjust to recovery in every way possible. You will receive specific instructions and precautions from your doctor and nursing staff and they will show you safe techniques of simple activities like getting in and out of bed, bathing, going to the bathroom, managing steps at home and getting in and out of a car.
You will be able to leave the hospital when you are:
LIFE AFTER PACEMAKER IMPLANTATION SURGERY
These guidelines give you an overview of what you may expect as part of your care after you leave the hospital. Be sure to follow your doctor’s discharge instructions if they are different from what is listed here.
You may be tired and experience some discomfort during the first 48 hours after the procedure.
You may notice bruising, pain and tenderness around the incision site for the first few weeks after the implant. This is usually mild.
For a catheter in your groin, arm, or wrist:
Do NOT do yard work, drive, squat, carry heavy objects, or play sports for at least 2 days, or until your doctor tells you it is safe.
Periodic electrocardiograms (EKGs) and rhythm strips will be done to monitor the heart rhythm.
You should be able to return to work in 2 to 3 days if you do not do heavy work.
Your doctor will likely prescribe medications (anticoagulants) to prevent blood clots, relax your arteries and protect against coronary spasms.
You will usually have your pacemaker checked after four to six weeks at the hospital where it was implanted. Provided this check is satisfactory, you'll have your pacemaker checked every 3 to 12 months.
If after having the pacemaker fitted and leaving hospital you feel you're not getting as much benefit as you imagined, your pacemaker may need some small adjustments. The cardiologist or cardiac technician will be able to do this.
In general, people who have a Pacemaker implanted procedure can walk around within 6 hours after the procedure.
YOUR ACTIVITY
You will be able to feel the pacemaker, but you will soon get used to it. After release from the hospital, the patient may experience side effects such as:
Many of these side effects usually disappear in less than 2 weeks.
Patients are often advised to eat less fat and cholesterol and to walk or do other physical activity to help regain strength.
Doctors also often recommend following a home routine of increasing activity- doing light housework, going out, visiting friends, climbing stairs. The goal is to return to a normal, active lifestyle.
Most people with sedentary office jobs can return to work in 1 week. Those with physically demanding jobs will have to wait longer.
Physical Activities
You may do light, quick activities where your arms are above your shoulders, such as brushing your hair. But do not do any activities where your arms are above shoulder level for a long time, such as washing a window or dusting a high shelf. Do not do any activity that causes pain or pulling across your chest.
To get the most out of your day, plan to do the most important activities first. Don't try to do everything at once, and schedule unfinished activities for another day. Make sure that you get plenty of rest in between activities.
Climbing Stairs and Steps
Unless restricted by your doctor, it's okay for you to climb stairs and steps. If you need to, stop and rest before you finish walking up or down a full flight.
Fatigue
Fatigue is probably the number one patient complaint following any heart procedure. Fatigue results from an extended lack of sleep while in the hospital, energy used by your body to heal its wounds, and energy used to fight off pain. To combat fatigue, listen to what your body is telling you. Space your activities to allow for rest periods. Take plenty of naps, walk regularly, eat well, and use your pain medication as needed. It's important that you rest and get a good night's sleep. Even if it's early in the night, if you feel tired, go to bed.
Driving and Riding in a Car
You should not drive for 1 week from the date of your procedure.
Traveling
Delay vacations or extended trips away from home for approximately 2-3 weeks, or until after the first post operative visit with your surgeon. Avoid air travel for two weeks from the date of your discharge. This restriction is designed to prevent you from being too far away from your surgeon should a problem arise.
Sex
You may resume sexual activity after 1 week of your procedure.
Exercise
Proper exercise will help your healing and recovery, as well as increase your stamina, maintain your ideal weight by burning calories, and lower stress in your everyday life.
Tips for exercising:
YOUR DIET
Along with exercise, eating healthy will speed up your recovery and healing. If your appetite is poor, try to eat smaller but more frequent meals.
Depending on your condition, your doctor or dietician may put you on a special diet. For example, patients with heart failure must follow a 2,000 mg low-sodium diet. Diabetic patients must follow a low-sugar, low-fat diet.
Tips to healthy eating:
Poor Appetite and Nausea
Many patients lose weight in the postoperative period. They complain of lack of appetite and mild nausea. Certain medications such as pain pills may cause nausea. Try eating small frequent amounts of food, and take medications on a full stomach unless otherwise directed. If you continue to experience nausea or lack of appetite, call your primary physician.
Constipation
Constipation is due to inactivity, limited fluid intake and lack of dietary fiber. It is aggravated by medications such as pain pills and iron. Eating plenty of fiber and fresh fruits, drinking 6-8 glasses of water daily and using your prescribed stool softener (Colace) as instructed can usually relieve constipation. If this does not work, Milk of Magnesia or Dulcolax may be helpful. Avoid Milk of Magnesia if you have kidney problems.
Caloric Restriction
Your total calories may be changed to increase, decrease, or maintain your weight as necessary. Being overweight increases the work of the heart. Your drug therapy may cause you to be hungry, you may eat more, and you may then gain weight. It is, therefore, very important that you pay attention to the total amount of food you take in. In addition to adding to the work of your heart, being overweight is associated with high levels of Triglycerides (fats) in the blood stream. Having a lot of fats in your blood increases the possibility of having the blood vessels of your heart become thickened. This will be described in more detail in the section on cholesterol and fats that follows.
Cholesterol and Saturated Fat Restriction
Cholesterol is a necessary fatty substance found in the body and many animal foods. Fats are concentrated sources of energy which occur in three forms: polyunsaturated, monounsaturated, and saturated. People who have large amounts of cholesterol and saturated fats in their blood are at increased risk of having thickening of their blood vessels throughout their bodies. This is because saturated fats and cholesterol in your blood will gather along the walls of your blood vessels causing them to narrow. If this narrowing becomes severe in the blood vessels of your heart, the blood supply to your heart will not get enough oxygen, and the cells of your heart will die. This is called "Coronary Artery Disease."
In addition to your diet, your medications may also increase the level of fats in your blood. Thus, in order to prevent coronary artery disease, your overall fat intake must be restricted after the procedure. Generally, your overall fat intake should not be more than 30% of your total calories each day. Increasing the proportion of monounsaturated and polyunsaturated fat in your diet and decreasing your total saturated fat intake to less than 10% of your total fat intake will actually help to lower cholesterol and saturated fat levels in your blood. The aim of this diet is to keep the levels of fats in your blood within normal limits.
Foods high in cholesterol & saturated fats
Animal products :Liver and organ meats, luncheon meats like liverwurst & salami, other meats, egg yolks, whole milk, butter, cream, and whole milk cheeses.
Vegetables high in saturated fats :Coconut, palm, and cocoa.
Other : Fried foods.
Note : Instead of frying your foods, try to bake, boil, or steam when preparing foods.
Foods high in monosaturated and polyunsaturated fats
Meats and other protein foods
Lean meats, low fat dairy products, and fatty fish (salmon, tuna, trout, bluefish).
Vegetable fats
Olive oil, corn oil, soybean oil, sesame oil, sunflower oil, and tub margarine.
Concentrated Carbohydrate Restrictions
You may be asked to cut down on the amount of sugar and concentrated sweets in your diet as well. Carbohydrates not only add to calories, but large amounts may contribute to an increase in the Triglycerides on the blood.
Fluid and Sodium Restriction
Salt is made up of two minerals - Sodium (Na+) and Chloride (C). It is the sodium portion of salt that we are concerned with in your diet. Sodium must be restricted in your diet because it causes your body to hold fluids.
You must also control your sodium and fluid intake since Prednisone causes your body to hold both of these. The result of holding fluid and sodium is that extra fluid builds up in your veins and arteries. To avoid this fluid and sodium build up, you should cut down on both.
To cut down on fluids, choose solid foods instead of liquids; for example, eat fruit instead of drinking juice. To cut down on salt, your doctor may prescribe a sodium-restricted diet for you. Your diet order may read: "No added Salt" or 3 to 4 gram Na+ diet. The doctor may also prescribe a water pill to help get the sodium and fluid out of your system.
Foods High in Sodium (Na+) Content
Meat and Other Protein Foods
Ham, bacon, luncheon meats, frankfurters, sausages, scrapple, pepperoni, dried beef, chipped beef, corned beef, canned meats, pastrami, canned fish, sardines, herring, lox, anchovies, smoked salmon, caviar, cheese, regular peanut butter, and frozen TV dinners.
Vegetables
Sauerkraut or other vegetables prepared in brine, olives, pickles, relish, vegetables packed with sauces or seasonings, salted mixed vegetable juice (V-8), regular tomato juice, regular spaghetti sauce, tomato sauce or tomato paste, frozen peas, and lima beans.
Breads & Cereals : Bread and rolls with salt toppings, corn chips, potato chips, salted pretzels, salted popcorn, and other salted snack foods.
Fats : Bacon fat, salt pork, olives, salted nuts, party spreads and dips.
Soups : Canned broth soups, commercially prepared stews, bouillon cubes, and instant or dried soups.
Other : Be careful of monosodium glutamate (MSG) used in Chinese food. When you order Chinese food, you can request that it be prepared without MSG.
Note : You should check with your doctor or dietician before using salt or salt substitutes.
MEDICATIONS
Your medicines: Take the medicines you were taking before procedure, unless your surgeon has made a change.
Your doctor will likely prescribe medications (anticoagulants) to prevent blood clots, relax your arteries and protect against coronary spasms.
Call your surgeon right away if you have:
SLEEPING PATERNS
You'll be able to feel the pacemaker, but you'll soon get used to it. It may seem a bit heavy at first, and it may feel uncomfortable when you lie in certain positions. You should return to your normal sleeping patterns within 2-3 weeks. Try these tips to help you sleep:
If you still have problems sleeping after 2-3 weeks, call your doctor.
Night Sweats
Patients often complain of night sweats for the first few weeks. Should you experience this, check your temperature to make sure that you do not have a fever. If your temperature is 101 degrees Fahrenheit or greater, call your doctor. If you do not have a fever, there is very little that can be done, but you should make yourself as comfortable as possible while waiting for the night sweats to go away. Change your linens and pajamas so you do not sleep in a damp bed. Night sweats usually disappear in a few weeks.
Disturbed Sleep
Following the procedure, some patients experience nightmares or insomnia. This will also disappear with time. To help you sleep better, try shortening your naps during the day and/or increasing your afternoon activities so that you will feel tired in the evenings. It is OK to sleep on your back, side or stomach. You will not hurt your incisions.
FOLLOW- UP
Follow-up after your procedure is extremely important and our surgeons at Salus are committed to providing all the post surgical care you need. In order to identify and treat any complications as they may arise, close, lifetime follow-up is essential.
You will usually have your pacemaker checked after four to six weeks at the hospital where it was implanted.
Provided this check is satisfactory, you'll have your pacemaker checked every 3 to 12 months.
If after having the pacemaker fitted and leaving hospital you feel you're not getting as much benefit as you imagined, your pacemaker may need some small adjustments. The cardiologist or cardiac technician will be able to do this.
Any time before your appointments, you should call your doctor if you: