Pacemaker Surgery and Implantation

Pacemaker Surgery for Arrhythmias

Depending on the type of arrhythmia, pacemaker surgery may be required to treat the condition. Procedures include:

Pacemaker implantation

Pacemaker implantation is the placement of a small battery-powered device under the skin below the collarbone to provide a healthy heart beat and rhythm for patients with a slow heart rate (bradycardia) or a condition known as heart block where electrical impulses from the heart’s top chambers (atria) cannot reach the lower chambers (ventricles).

Procedure details

Physicians make a small incision near the patient’s collarbone and create a small pocket under the skin for placement of the pacemaker. The pacemaker’s wire is inserted into the heart’s right ventricle (lower chamber) and into the heart’s right atrium (top chamber). The pacemaker is implanted under the skin and the wires are connected to it to control the heart’s rate.

Additional patient information

  • The pacemaker surgery procedure is performed under sedation or general anesthesia.
  • Patients will stay overnight in the hospital for observation.
  • The pacemaker incision must be kept clean and dry for 2 weeks following implantation.
  • Patients must not raise their left arm above their shoulder for 4 weeks.

AV node ablation and pacemaker implantation

An AV node ablation and pacemaker implantation is performed by using radiofrequency heat to cauterize the heart’s AV node. This eliminates the electrical pathway between the heart’s atria (top chambers) and its ventricles (lower chambers). Physicians insert a small battery-powered pacemaker in the patient to provide a healthy beat and rhythm for the ventricles.

AV node ablation and pacemaker implantation is an option when antiarrythmic medications or a radiofrequency ablation cannot manage a heart arrhythmia where the atria beat at an extremely rapid rate, causing the ventricles to beat at an unhealthy high rate. Left untreated, patients with this type of arrhythmia can ultimately experience a weakening of the heart muscles, a serious condition called dilated cardiomyopathy. Scripps physicians use single, dual and triple (biventricular) pacemakers in this procedure.

Procedure details

Physicians make a small incision near the patient’s collarbone and create a small pocket under the skin for placement of the pacemaker. The pacemaker’s wire is inserted into the heart’s right ventricle (lower chamber) through a vein in the arm that travels to the chest and connected to the pacemaker.

After physicians implant the pacemaker, a catheter is inserted into the heart through a vein in the upper leg. Physicians cauterize the AV node and the pacemaker now controls the beats of the heart’s chambers.

Additional patient information

  • An echocardiogram may be performed to determine best course of action and type of pacemaker to use.
  • The AV node ablation and pacemaker implantation are performed under general anesthesia.
  • Patients are required to lay flat for 4 hours immediately after the procedure and remain overnight in the hospital for observation.
  • Patients may experience soreness in their groin area where the catheters are inserted in the legs to reach the heart. If the pain doesn’t improve over time, patients may be prescribed medication before being discharged to go home.

Cardiac resynchronization therapy (CRT) with biventricular pacemaker

Cardiac resynchronization therapy (CRT) with biventricular pacemaker implantation is an option for patients whose heart muscle has weakened and is contracting abnormally. The condition results in inefficient heart pumping and a decline in heart health. CRT aims to resynchronize the heart and improve pumping efficiency.

Procedure details

Physicians make a small incision under the left collarbone and create a pocket under the skin for the special CRT pacemaker or defibrillator. Three wires are advanced to the heart though a vein in the left arm. One wire is placed in the heart’s top right chamber (right atrium). The other two wires are placed opposite each other – one on the right and the other on the left ventricle.

All three wires are then connected to the special CRT pacemaker or defibrillator, which is implanted under the skin. Once activated, the pacemaker will detect a heartbeat in the top chamber and then pace both sides of the bottom chamber at the same time. This restores synchrony in the bottom chamber and improves the heart’s pumping efficiency.

Additional patient information

  • The pacemaker procedure is performed under sedation or general anesthesia.
  • Patients may go home the same day or stay overnight in the hospital for observation.
  • The CRT incision must be kept clean and dry for 2 weeks for implantation.
  • Patients must not raise their left arm above their shoulder for 4 weeks.

Scripps physicians are international leaders in the development of CRT therapy.