Dear Patients,

Due to your difficulties, there was an indication for implanting permanent pacemaker (ES).

Here you can read all about permanent pacemaker

Before the implantation procedure

 Upon admission to the hospital, series of tests will be performed: blood tests, ECG recording, heart and lung X-ray, echocardiography, and several others if needed.

The day before the procedure, you will receive informed consent that you are required to read and sign if you consent to the procedure.

Here you can download and complete consent forms for implantation a permanent pacemaker.

The evening before the procedure, it is recommended that you shower with an antiseptic shampoo which you can get at the hospital ward where you will be hospitalized.

On the day of the procedure, you must be on an empty stomach! You can have a normal dinner the day before and drink fluids by midnight. After that you have to fast. If you are taking therapy, you will need to take the necessary medications in the morning as instructed by your doctor. In the morning before the procedure, the nurse will set you a vein line (a thin plastic tube for medication administration and infusion) and shave the skin under the left or right collarbone. If you are coming from home, you can shave the skin yourself if you feel comfortable, but you must take care not to damage the skin. Be sure to consult a nurse if you are not sure.

On the day of the procedure you will receive an antibiotic through the vein before the procedure and, if necessary, several hours after. The antibiotic is used to prevent possible infection linked with the procedure. Please alert the medical staff if you are allergic to any drug.

Before nurse escorts you to the operating room or the EP laboratory, you will have to remove all the jewellery you wear and dentures if you have them. Also, nail polish needs to be removed. If you are wearing a hearing aid, do not remove it in order to communicate normally with laboratory personnel.

In the operating room, you will be placed on the operating table, and electrodes will be attached to your skin to monitor your heart rate during the procedure. After the staff has disinfected the operation area, you will be covered with blue/green sterile compresses. From that moment it is very important for you to remain stationary and to follow the instructions of the medical staff. It is also important that you immediately inform the medical staff of eventual symptoms, such as pain, nausea, vomiting, coughing, irritation, etc.

The doctor will anaesthetize the area under the left or right collarbone you will not feel any pain during the procedure, but you will have the sense of touch. In rare cases, the procedure is performed under general anaesthesia. At the same area a small incision will be made. Electrodes are carefully placed through the vein, and since the blood vessels are not sensitive to pain, no additional anaesthesia is required. The entire procedure is performed under X-ray control. When the electrode is positioned in the desired location in your heart and its function is tested, it connects to the implanted battery of the pacemaker under the skin into a small pocket below the collarbone and the area is sutured with several sutures. While positioning the electrodes in your heart, you may experience irregular heartbeat, which is a normal and harmless occurrence.

The procedure can take 1-2 hours.

Two hours after surgery:

• you can get out of bed and take a walk
• you can walk only in the ward
• you may eat and drink
• you may go to the toilet
• you may normally perform personal hygiene while being careful not to moisten the wound (seek the assistance of a nurse or family/freinds who come to visit)
• you can take a full shower after stitching (day 8) in case the wound is clean
• you can feel pain at the implantation area and you can get a prescribed analgesic for it (inform your doctor or nurse)
• inform the nurse if you notice a frequent irritant cough or trouble with breathing

During the first month after implantation:

• avoid quick or wide shoulder movements where the pacemaker is implanted
• avoid raising your arm beyond shoulder level
• avoid lifting and moving heavy objects, heavy physical labour
• avoid using high vibration devices (eg. drill)
• avoid sleeping on the side on which the pacemaker is implanted
• keep the wound dry and clean
• after the incision is dry, treat the skin with pH neutral creams
• avoid wearing tight clothing that could irritate the skin above the sutured area

It is important to contact your doctor if:

• you notice the redness and/or swelling of the wound
• secretion is released from the incision
• you are feeling symptoms such as fever, dizziness, chest pain, prolonged fatigue and/or weakness

Take your medication regularly and accurately as prescribed.

Symptoms and signs of failure of the permanent pacemaker. Also consult your doctor if you notice any of the following symptoms:

• irregular pulse
• dizziness, light-headedness, loss of consciousness
• shortness of breath, suffocation feeling, fatigue at the lowest activity
• frequent hiccups

Going regularly to scheduled check-ups. Go to the check-ups regularly as scheduled in your discharge letter (every 6-12 months) and make sure you schedule your appointment on time to avoid waiting. You can schedule your appointment in our cardiology out-patient clinic in person or by telephone (+385 1 37 87 951). Please leave your contact number on which you are always available and let us know if you have changed your place of residence. If the staff cannot admit you to scheduled appointment, you will be notified by telephone. Also, if you are not able to come to your appointment, please inform the nurses at the number listed above, in order for other patients to use the appointment time.

At the appointed check-up, firstly the ECG is recorded, and after that the pacemaker function is checked with the programmer and according to result your therapy is prescribed. The programmer is a device similar to a laptop that communicates wirelessly with the pacemaker. With pacemaker it is possible to adjust and change the parameters of electro stimulation without the need for surgery. The doctor will also check the condition of the pacemaker’s battery, and can also predict the time of replacement.

Please always carry the Pacemaker ID card with you.

This document contains the most important information about your pacemaker. In case of an emergency, this document will provide valuable information to medical personnel and may save your life. Please carry it always with you, especially when travelling or going for medical examinations, preferably in your wallet with other documents.

Basic information.

With the cardiac pacemaker, you can continue with a normal life. You can continue to do your usual day-to-day activities, chores. You can shower, bath and swim. You can drive a vehicle, and using a seat belt doesn’t present a problem. It is recommended to use some kind of pad above pacemaker for the first couple of months. You can engage in hobbies, sports (however, not contact sports) and normally engage in sexual activity.

Electrical Appliances.

Newer pacemakers have protection against interference from electrical appliances. However, if you experience symptoms of a pacemaker’s (power) failure in the vicinity of the appliance, move away from the appliance or unplug it and the pacemaker will resume normal function.

You can freely use all household appliances: microwave ovens, TVs, radios, personal computers, laptops, video games, remote controls, washing machines, dryers, vacuum cleaners, etc. Devices such as cell phone, hair dryer, electric razor or drill should also be used with a little caution – always keep them in the opposite hand from the pacemaker and at least 15 cm away to minimize danger. You can seamlessly walk through alarm doors at stores, banks and airports. In case that the alarm sounds, you will present your pacemaker identification document.

The following devices should be avoided: electric welding machines, high-voltage electromagnetic devices (transformer stations), high-power transmitters, wearing magnetized jewellery or similar material, handheld metal detectors, using firearms, and generally working with heavy vibrational equipment (motor chain saw).

You are required to tell your doctor during medical examination that you have pacemaker, and most medical examinations such as heart and lung X-rays, mammograms, ultrasounds, dental repair and dental X-rays can be performed with caution. Please consult with your cardiologist in case that radiation therapy, magnetic therapy and/or and TENS therapy is recommended, as well in the case of electrocautery surgery. Magnetic resonance imaging (MRI) is also possible, however the consultation with cardiologist is obligatory and frequently the periprocedural check-up is recommended.

If you have been appointed for any surgery, you should consult your cardiologist first. In some situations, the pacemaker needs to be adjusted for surgery.

Pacemaker’s replacement.

After the pacemaker starts signalling that a replacement is required, it can continue to operate normally for several months. When your doctor determines that it is time for a replacement, you will be admitted for a hospital treatment. The pacemaker’s battery is removed by minor surgery. The electrodes remain in the heart in condition that they function properly, and are connected to the new PM’s battery. A shorter hospital stay is usually required (usually 2 days).

If you have general questions about your cardiac pacemaker, you can always contact your doctor or nurse.