Sydney Cardiothoracic Surgeons

Pacemaker Surgery

What is a pacemaker?

A pacemacker is a small electronic device, which is used to help the heart maintain the correct rhythm. There are two main parts to a pacemaker. There is the pulse generator and then there are one or two leads depending on the type of pacemaker you require. The pulse generator is a small computer powered by a special battery, which is very reliable and lasts many years. The average size of a pulse generator is slightly larger than a 50c piece and is about as thick as two 50c pieces.

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Do I have to have a general anaesthetic?

In most cases, your pacemaker will be inserted under general anaesthesia. This means that you are asleep while the pacemaker is implanted and you will not feel or know anything about the actual surgery. Your surgeon and anaesthetist will discuss the type of anaesthetic best for you prior to your surgery.

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How is a pacemaker implanted?

The most common site for the pulse generator is just under the skin between the collarbone and the top of the breast. It can be implanted on either the left or right side of the chest. Your surgeon will discuss with you the most appropriate position for your pulse generator.

Once the site has been prepared for the pulse generator, the lead or leads are then moved into position in the heart. This is done using image intensification (a special type of x-ray) which helps the surgeon guide the leads into the correct position. Only the tips of the leads touch the heart. The pacemaker is then tested and the small incision where the pacemaker was inserted is sutured closed with dissolving stitches.

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How do I care for my wound?

You will return to your hospital bed from having your pacemaker inserted with a small plastic skin over the insertion site. You should leave this dressing in place for about 3 days. There will be no stitches to be removed.

Once you get home, if your wound becomes inflamed, hot, painful, swollen or weeps you should contact your local GP (family doctor) IMMEDIATELY. If you are unable to contact your GP (family doctor) then you should go to the emergency department of your nearest public hospital as soon as possible. Please do not delay! Quick attention will ensure you get the best performance from your pacemaker.

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What do I need to know about my stay in hospital?

Most people spend between 2 to 4 days in hospital. This includes the night before your surgery if your surgery is scheduled for early in the day.

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If you are being admitted on the morning of your surgery you should not eat or drink anything from 12 midnight the night before. You can still brush your teeth but you must not swallow. If you are being admitted the day before your surgery the nurse will advise you when to fast.

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You should not take any medications on the morning of your surgery unless your surgeon has given you specific instructions to do so. It is, however, important that you remember to bring all your medications in their original packets or bottles with you to the hospital.

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What else do I need to bring?

You should pack your pyjamas and enough toiletries to last you up to 4 days. It is also a good idea to pack a dressing gown and slippers. Do not forget to pack some clean clothes to go home in as well.

You might also like to bring something to do such as a book, knitting, crossword puzzle etc. Do not forget to pack your reading glasses and dentures if you need these.

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What happens when I go home?

As a general rule, your pacemaker will not restrict you from getting back to a normal life. One of the benefits of a pacemaker is to help you live a happy and active life for a long time. However, there are a number of important things to remember.

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Be careful not to knock the skin over or near the pulse generator. Apart from hurting yourself, a hard knock may actually break the skin and this could lead to infection.

If your wound becomes inflamed, hot, painful, swollen or weeps you should contact your local GP (family doctor) IMMEDIATELY. If you are unable to contact your GP (family doctor) then you should go to the emergency department of your nearest public hospital as soon as possible.

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Check ups

You will be pleased to know that modern pacemakers can be fine-tuned painlessly from outside the body using a radio wave programmer.

Your pacemaker will require checking on a regular basis and will be checked late in the evening or on the morning after your surgery by the Pacemaker Technician. Your Pacemaker Technician will advise you when to come back for your next check up and will also arrange for you to be monitored by either your local Pacemaker Clinic or your Cardiologist. It is important that you continue to have your pacemaker checked at least every 6 to 12 months so that any problems can be detected early.

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Normal Activity

During the first week after your operation we ask that you do not raise the arm on your operated side above your head. This will help prevent the pacemaker leads from dislodging. You can shower normally but take care when washing your hair (arm movement) and when dressing. You may resume normal activities such as sex, golf, fishing, swimming and gardening after 2 weeks. You can also return to work at this time too.

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As a general rule you should not drive for at least 2 weeks following the implantation of your pacemaker. Again, this is to ensure that the leads have had time to become fixed into position. It is important that you abide by your surgeon's instructions about when you can return to driving as there maybe legal implications if you have an accident even if you are not the driver at fault.

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Contact Sport

While a pacemaker will not normally restrict your activity level, it is important that you refrain from playing contact sport such as Football as this may dislodge the pacemaker leads or you may break the skin over the pulse generator and this can lead to infection.

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Will normal household appliances affect my pacemaker?

The technology used in pacemakers today is very advanced and your pacemaker is protected from electrical interference. Microwave ovens, personal computers and most electrical tools will not affect your pacemaker. However, it is possible that you may set off airport security machines.

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Will my pacemaker be affected by Mobile Phones?

Generally, your pacemaker will not be affected by mobile phones either used by you or by someone close by. However, you should refrain from putting the mobile phone directly over the area of the pulse generator (ie in your shirt pocket) or holding it between your ear and your shoulder.

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Can I use an Arc Welder?

Arc Welding may interfere with the correct operation of your pacemaker. If you want to use an arc welder please check with your Pacemaker Technician for further details regarding your specific pacemaker. The precautions should still be made even when a Pacemaker Technician has given you permission:

Precautions for persons with pacemakers near electric arc welding. Electric arc welding produces intense electric and magnetic interference which may, in some cases, interrupt the function of cardiac pacemakers. Welding interference will not permanently damage the pacemaker. Persons with a pacemaker should not go near electric welding until they have discussed this matter with their physician. These recommendations are intended only for conventional electric welders. Welders over 400 amps, automated spot welders, r-f welders, induction welders, and similar industrial equipment require additional precautions. Consult your physician for information about these if necessary. Pacemaker wearers who weld are advised to observe the following precautions:

  1. Use acetylene or other non-electric welding when application is suitable.
  2. Wear non-conductive gloves. Dry leather, fireproof cloth or rubber gloves are fine. Dry shoes are also advised. Do not work in a wet or damp area.
  3. Do not use current settings that are higher than necessary. Never exceed 400 amps.
  4. Connect the "ground" clamp to the metal as close to the point of welding as possible.
  5. Keep the cables close together by twisting them around each other.
  6. Position the welding machine and excess cable away from the wearer.
  7. Arrange work such that the cables extend away from the wearer.
  8. Do not weld with rapidly repeated short bursts. Wait about 10 seconds between each weld. When having difficulty starting a weld on a dirty surface, do not strike the rod in a rapidly repeated manner. Wait about 10 seconds between each attempted start.
  9. If you feel light-headed, dizzy or faint, immediately stop the weld, lay the rod down and move away from the welding machine if it is close. Arrange your work in advance so that if the handle and rod should be dropped due to a dizzy spell, they will not drop into the metal being welded. For similar reasons, do not work on a ladder or in a cramped, confined location.
  10. Do not work alone. Work only in the presence of an informed person who understands these recommendations.
  11. Avoid being near spot-welding equipment if it does not have more than five seconds time between welds.
  12. Consult your physician regarding any questions you may have.

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Other Dental and Medical services?

The normal drills and other dental devices will not affect your pacemaker. However, some specialised types of x-rays such as MRI may interfere with your pacemaker. You should always remind your doctor that you have a pacemaker implanted whenever you are required to have any sort of x-ray examination.

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What if I think my pacemaker is not working correctly?

You should contact your local GP (family doctor) IMMEDIATELY. Your GP (family doctor) will be able to arrange for you to have a thorough check up and can refer you to a Cardiologist or Pacemaker Clinic in your area if required. If you are unable to contact your local GP (family doctor) then you should go to the emergency department of your nearest public hospital as soon as possible.

You should contact your GP (family doctor) IMMEDIATELY if you notice any of the following:

  • Your wound becomes INFLAMED ("looks nasty")
  • Hot
  • Unusually Painful
  • Swollen
  • Red
  • Weeps
  • Or if you develop an unexplained FEVER (high temperature)

If you are unable to contact your GP (family doctor) then you should go to the emergency department of your nearest public hospital as soon as possible. Please do not delay, quick attention will ensure you get the best performance from your pacemaker.

Contact Numbers

Concord Pacemaker Clinic

The Repatriation General Hospital, Hospital Road, CONCORD NSW 2137, Tel: 02 9767 5000

RPAH Pacemaker Clinic

Royal Prince Alfred Hospital

Page Chest Pavilion, Missenden Road, CAMPERDOWN NSW 2050, Tel: 02 9515 6111

Sydney Cardiothoracic Surgeons

Suite 304 RPAH Medical Centre, 100 Carillon Avenue NEWTOWN NSW 2042, Tel: 02 9550 1933

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