The procedure in which a permanent pacemaker used for slow heart rhythm or conduction disorders is placed, and the follow-up program in which the device's programming, battery, and lead status are regularly monitored.
Indication
- Symptomatic sinus node dysfunction (significant bradycardia, dizziness, syncope)
- Advanced AV block (Mobitz type II and complete block) — DDD/VVI mode decision is based on the clinical picture
- Bradycardia-tachycardia syndrome
- Permanent atrial fibrillation with slow ventricular response
- Cardiac syncope and treatment-resistant fainting episodes
- Indication for cardiac resynchronization therapy (CRT) in some heart failure patients
Preparation
- Pre-procedure ECG, blood tests, and chest X-ray
- No food or drink for 6-8 hours before the procedure
- Adjustment of blood thinners and antiplatelet medications with the physician
- Reporting allergies and history of previous surgeries/implants
- Cleaning of the area below the collarbone and IV access prior to the procedure
How it's performed
- The area below the collarbone is numbed with local anesthesia
- A subcutaneous pocket is created with a small incision
- Lead(s) are advanced into the right cardiac chambers via the subclavian or cephalic vein
- Leads are positioned appropriately under fluoroscopy (live X-ray) guidance
- Lead measurements are taken; the pacemaker device is placed into the pocket and programmed
- The skin is sutured, sterile dressing is applied; a follow-up X-ray is obtained
Post-procedure
- Discharge within 24 hours after the procedure; restriction of shoulder movements during the first week
- Dressing care, suture removal, and wound monitoring are planned
- First pacemaker check-up after 4-6 weeks; subsequent check-ups generally every 6 months
- Device programming, battery life, and lead threshold values are evaluated at each check-up
- The cardiologist must be informed before MRI, strong magnetic fields, and certain medical devices
Risks
- Hematoma in the pocket, infection (pocket infection)
- Pneumothorax (air leakage into the pleural cavity, rare)
- Lead displacement or fracture
- Vascular injury, very rarely cardiac wall perforation
- Device malfunction and need for battery replacement in the long term
FAQ
Is a permanent pacemaker implanted under general anesthesia?
No, it is mostly implanted under local anesthesia and, if needed, light sedation; the patient is awake throughout the procedure.
How long does the pacemaker battery last?
In modern devices, battery life is generally 7-12 years; the duration varies depending on device type and usage intensity.
Can I use mobile phones, microwave ovens, and similar devices?
Yes. Holding the phone to the ear opposite the pacemaker is a sufficient safety measure; everyday devices like microwave ovens generally do not pose a problem.
Can I undergo MRI?
If the device is MRI-compatible, scanning is possible under specific conditions; before scanning, evaluation must be done together with the cardiologist and radiologist.
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