Pacemaker Implantation

What is Pacemaker Implantation?

At our facility, we specialize in treating patients with excessively slow heartbeats, often caused by issues with the heart’s electrical conduction system. Pacemaker implantation is one of the most common treatments for this condition. It involves placing a small device to regulate the heart’s rhythm. During the procedure, patients receive local anesthesia. A small incision is made beneath the collarbone to create a subcutaneous pocket where the pacemaker will be placed.

How the Procedure Works

We insert one or two flexible, insulated electrode wires into the heart’s chambers. The other ends of the wires connect to the pacemaker. The pacemaker monitors the heart’s rhythm. If it detects an abnormal pause or slowdown, it sends electrical impulses through the electrodes to stimulate the heart and restore a normal rhythm. The procedure usually takes about one hour. Most patients can go home the same day, experiencing significant improvement in their symptoms and quality of life.

Traditional Pacemaker Implantation

Anesthesia and Preparation

Local anesthesia is administered, and sedation is often used. A small incision is made beneath the collarbone, where a subcutaneous pocket is created to house the pacemaker.

Electrode Placement

One or two flexible, insulated electrode wires (leads) are inserted into the cardiac chambers, typically the right atrium or right ventricle. These wires are then attached to the pacemaker, which is placed under the skin.

Pacemaker Functionality

The pacemaker monitors the heart’s rhythm continuously. If it detects that the heart rate falls below a preset threshold, it stimulates the heart through the leads, ensuring the heart beats at the proper rate. The pacemaker only activates when necessary, such as during a pause in the heartbeat or when the heart rate slows down.

Procedure Duration and Recovery

The procedure usually takes about one hour. Most patients are able to go home the same day, though some may need to stay overnight for observation.

Newer Leadless Pacemaker

In recent years, a newer type of pacemaker has become available—the leadless pacemaker. Unlike traditional pacemakers, which require leads (wires), the leadless pacemaker is self-contained and implanted directly into the heart without the need for external leads.

Advantages of Leadless Pacemaker

Minimized Risk of Infection: Traditional pacemakers carry a risk of infection at the site where the leads enter the body. Leadless pacemakers eliminate this risk since they do not require leads to pass through the veins.
Smaller and Less Invasive: The leadless pacemaker is small and inserted into the right ventricle through a catheter inserted into the groin, similar to a cardiac catheterization procedure. This procedure is minimally invasive, as it does not require a subcutaneous pocket or large incision.
Better for Patients with Vein Issues: Leadless pacemakers are ideal for patients with poor vein access, as they do not require threading leads through the veins.
Longevity: While still a newer option, the leadless pacemaker has shown good longevity and effectiveness. However, it may need replacement earlier than traditional pacemakers due to its smaller size and limited battery life.
Improved Aesthetics: Because there is no visible pacemaker under the skin, the cosmetic result is generally more favorable.

Choosing Between Traditional and Leadless Pacemaker

The choice between a traditional pacemaker and a leadless pacemaker depends on several factors, including the patient’s specific condition, anatomy, and the doctor’s recommendation. Some patients may benefit more from a traditional pacemaker, particularly if they need a dual-chamber pacemaker or have conditions that make a leadless pacemaker unsuitable.

At our practice, we provide a comprehensive evaluation to determine the most suitable pacemaker option for each patient, ensuring the procedure is safe and effective for their needs.