INSTALLATION OF A PACEMAKER
A pacemaker or a cardiac stimulator is an electronic device designed to ensure the electrical activity of the heart, which is essential for contraction.
This small device consists of 2 parts: the box containing the electronic circuits and the battery, and the electrodes that provide electrical communications between the heart and the box.
To find out more: What is a pacemaker?
When its installation is required
Installation of a pacemaker is required for patients with certain heart rhythm disorders.
This installation occurs during a short hospitalization when it is a situation requiring a rapid correction of the cardiac electricity or as a short hospitalisation when it is required without urgency.
You must have an appointment
When the doctor recommends the installation of a pacemaker, he or she makes a request to a competent institution.
The hospital then communicates with the patient in order to plan a preparatory appointment before the one-day surgery.
It is important to bring your list of medication at this meeting.
The day of the intervention
The day of the intervention, the patient is welcomed by the team responsible for his or her preparation. The patient must be fasting as of midnight the day before.
Before the procedure, it is important for the patient to follow the doctor's instructions on the usual medication taken. Some medications, including blood thinners, must be stopped on the day before admission, if not the same day. In case of doubt, the patient must refrain from taking his medication and inform the medical team as soon upon arrival at the hospital.
A short questionnaire, including questions on any known allergy, is completed by the patient prior to the procedure to ensure that the file is up to date.
The patient must put on a hospital gown.
A nurse will then install one or two venous accesses through which an intravenous solution could be administered. These venous accesses will also be used for the administration of medication, if necessary, during the examination.
The patient may have to stay in the hospital until the next morning.
The call to the room
When the time comes, the patient is called to the room where the procedure will take place.
Antibiotics are administered through the small catheter previously installed in a vein to prevent infection. Once all preparations are complete, the patient leaves for the intervention and returns afterwards.
The entrance to the room
Another team greets the patient and helps him move from the stretcher to the examination table.
The room can be intimidating; it looks like a surgery room. Staff wears surgical clothing, masks and caps, as well as leaded clothing to protect them from X-rays required for all patients undergoing this type of intervention.
The temperature is cold to allow the equipment to work properly.
The maximum comfort of the patient is ensured and, knowing that he or she naturally experiences some anxiety, sedation is always given through the catheter in the vein.
The upper body of the patient is completely bare and electrodes, small electrical sensors, are placed directly on the skin in different places.
The installation of the pacemaker is usually done at the top left of the chest. A particularly cold liquid is used to generously disinfect this area.
It can happen that this liquid causes a slight temporary burning sensation heating, especially in men whose chest had to be shaved.
After disinfection, the patient's chest is covered with a sterile drape to prevent the risk of infection. At this point, the patient is asked to remain still.
This procedure is not done under general anesthesia. Local anaesthesia is used; only the area of intervention is frozen to make it unresponsive.
The procedure itself
The installation intervention of a pacemaker is actually very simple.
Since the box has to be inserted under the skin, a short incision is made from which a small pouch is created. From there, the main vein, the subclavian vein of the arm, is located and then punctured to allow the introduction of one or some probes; these are also called "electrodes".
The electrodes are installed with the help of X-rays that allow the doctor to ensure their proper positioning and, consequently, their proper functioning.
When everything is in place, the pouch is closed with melting stitches, or, in other words, stitches made with a thread that will be resorbed in the following days.
Returning to the preparation room and surveillance
The patient is transferred to the room where he or she was received in the morning. A period of surveillance begins to ensure that the patient is well and the pacemaker is working properly.
The length of this period varies from one center to another and, of course, according to the patient’s condition.
When the patient leaves
Before leaving the hospital, the patient receives an information sheet listing the characteristics of the pacemaker, its serial number, and the name of the manufacturer.
The patient will receive a similar plastic card through mail a few days after returning home.
What's next at home?
Written recommendations for care, supervision and precautions for a few days following this intervention are provided to the patient before being given permission to leave. This document is very important because the patient often forgets the verbal advice given by the medical staff.
To know more (on line soon): What to do or not to do following the installation of a pacemaker?
Life can resume its course quite normally after this recovery time.
Myths or truths?
Several myths exist about the prohibition of manipulating different objects because of the presence of a pacemaker.
The cell phone and microwave ovens do not cause any interference. Pacemakers installed for several years now are immune to electromagnetic interference.
The use of the cell phone should be done with minimal distance from the pacemaker. A distance of 10 to 15 centimeters is fully in line with safety standards.
Follow-up of the pacemaker or cardiac stimulator
An appointment at a specialized clinic is usually scheduled 1 to 2 months after the intervention. A doctor checks the wound and analyzes the pacemaker using a device connected to the cardiac stimulator. This doctor is perfectly capable and ready to answer any questions the patient may have regarding the device.
Afterwards, follow-ups can be done in two ways
The subsequent follow-ups can be done in two different ways, either by making an appointment at a specialized clinic or without even having to leave home.
The most common way
In general, people go to a pacemaker clinic once or twice a year.
For more information: Pacemaker Clinic -lien
Without leaving home
The other way is remote communication between the pacemaker and the specialized center which receives the information from the device.
A wireless device is placed in the bedroom. The information collected is transmitted to the center. Thus, this kind of constant communication sometimes makes it possible to establish diagnoses more quickly than those made during periodic visits to the clinic.
This approach is particularly useful for patients who have to travel a long distance to get to the specialized clinic, sometimes in weather conditions that are not always favourable.