Normally, the electrical impulse begins at the sinoatrial (SA) node, located in the right atrium. The electrical activity spreads through the walls of the atria, causing them to contract.

Next, the electrical impulse travels through the AV node, located between the atria and ventricles. The AV node acts like a gate that slows the electrical signal before it enters the ventricles. This delay gives the atria time to contract before the ventricles do.

From the AV node, the electrical impulse travels through the His-Purkinje network, a pathway of specialized electricity-conducting fibers. Then the impulse travels into the muscular walls of the ventricles, causing them to contract. This sequence occurs with every heartbeat (usually 60-100 times per minute).

If the electrical pathway described above is interrupted for any reason, changes in the heart rate and rhythm occur that make a pacemaker necessary.

Pacemakers are used to treat brady-arrythmias, slow heart rhythms that may occur as a result of disease in the heart’s conduction system (such as the SA node, AV node or His-Purkinje network). Pacemakers are also used to treat syncope (unexplained fainting spells)

What happens before the procedure?

Before the procedure begins, a nurse will help you get ready. You will lie on a bed and the nurse will start an IV (intravenous line) in a vein in your arm or hand. The IV is used to deliver medications and fluids during the procedure.
To prevent infection and to keep the pacemaker insertion site sterile:

An antibiotic will be given through the IV at the beginning of the procedure

The left or right side of your chest will be shaved

A special soap will be used to cleanse the area

Where is the pacemaker implanted?

The transvenous approach is the most common method. A local anesthetic (pain-relieving medication) is given to numb the area. An incision is made in the chest where the leads and pacemaker are inserted. The lead(s) is inserted through the incision and into a vein, then guided to the heart with the aid of the fluoroscopy machine. The lead tip attaches to the heart muscle, while the other end of the lead (attached to the pulse generator) is placed in a pocket created under the skin in the upper chest.

How are the leads tested?

After the leads are in place, they are tested to make sure they function properly and can increase your heart rate. This lead function test is called “pacing.” Small amounts of energy are delivered through the leads into the heart muscle. This energy causes the heart to contract.Once the leads have been tested, the doctor will connect them to the pacemaker. The rate and settings of your pacemaker are determined by your doctor. After the pacemaker implant procedure, the doctor uses an external device (programmer) to program final pacemaker settings.

What will I feel?

You will feel an initial burning or pinching sensation when the doctor injects the local numbing medication. Soon the area will become numb. You may feel a pulling sensation as the doctor makes a pocket in the tissue under your skin for the pacemaker.

How long does the procedure last?

The pacemaker implant procedure may last from 1-2 Hours

How many days to stay in the hospital?

You will be admitted to the hospital and stay overnight after the procedure. Usually you will be able to go home 4-5 Days after pacemaker implantation.