Pacemaker surgery

Before implanting/operating a pacemaker, a detailed examination of the patient is both necessary and possible, as this is not an emergency operation and can therefore be well planned. It usually lasts less than an hour and can usually be performed under local anesthesia, only in a few exceptional cases a general anesthesia is necessary. The operation begins by making an approximately 5 to 6 cm long skin incision under the collarbone and exposing the underlying vein.

This is then opened and the pacemaker electrode is inserted into the blood vessel through this opening. The probe (=electrode) is then advanced into the heart under constant X-ray control. In a single-chamber pacemaker, it is then placed in the part of the heart muscle that is to be stimulated (i.e. either in the atrium or ventricle).

In a dual-chamber pacemaker, one probe is placed in the atrium and one in the main chamber. The optimal transmission of the current pulses to the heart muscle is then checked by a few measurements. Only when it is certain that this works without problems, the electrode is then finally connected to the pacemaker.

Once the electrodes are fixed, the physician forms a “tissue pocket” for the pacemaker. This can be located either under the skin or under the chest muscle. In very rare cases, the pacemaker is also implanted in the abdomen.

Once this is completed, the incision is still sutured and the patient is given a sterile dressing. In the first few days after the operation, the patient must then take it easy. He must not spread or lift the arm more than 90 degrees and must not expose the shoulder to any major stress, as the electrodes need some time to grow in and run the risk of shifting during major movements.

If swellings in the area of the pacemaker pocket, fever, dizziness or chest pain occur after the operation, a doctor must be consulted immediately. Complications that can occur during implantation/operation of a pacemaker are mainly bruising and nerve irritation in the area of the pacemaker pocket. In rare cases, injuries to the pleura or an infection can also be triggered.

It may also happen that the probe is not attached correctly to the pacemaker or breaks or that the device itself does not function properly. However, this will be detected when the pacemaker is checked. In addition, the so-called “pacemaker syndrome” can occur, in which the atria are no longer able to fill the chambers completely with blood, resulting in insufficient cardiac output. Sometimes the pacemaker can also trigger a contraction of the diaphragm through electrical stimulation, which can lead to hiccups.