The Procedure

Generally, a pacemaker insertion follows this process:

You will need to remove your clothing and will be given a gown to wear. You will also need to remove any jewelry or other objects that might interfere with the procedure.

You will be asked to empty your bladder prior to the procedure.
You will receive a sedative medication in your IV before the procedure to help you relax. However, you will likely remain awake during the procedure.

Lying on your back on the procedure table, you will be connected to an electrocardiogram (ECG) monitor using small, adhesive electrodes. The ECG machine records the heart’s electrical activity and monitors the heart during the procedure.

The staff will monitor your vital signs (heart rate, blood pressure, breathing rate, and oxygenation level) throughout the procedure.

The medical team will place large electrode pads on the front and back of your chest. The team will then clean the pacemaker-insertion site with antiseptic soap, and place sterile towels and a sheet around the area.

You will receive a local anesthetic injection into the skin at the insertion site. Once the anesthetic has taken effect, the physician will make a small incision at the insertion site.

The physician will insert a sheath, or introducer, into a blood vessel, usually under the collarbone. The sheath is a plastic tube through which the pacer lead-wire will be inserted into the blood vessel and advanced into the heart.

Once the lead wire is inside the heart, it will be tested to verify proper location and that it works. There may be one, two or three lead wires inserted, depending on the type of device your physician has chosen for your condition.

The physician might use fluoroscopy, (a special type of X-ray displayed on a TV monitor) to assist in testing the location of the leads.

After the lead wire is attached to the generator, the physician will slip the pacemaker generator under the skin through the incision, which is just below the collarbone, usually on your non-dominant side. (If you are right-handed, the device will be placed in your upper left chest. If you are left-handed, the device will be placed in your upper right chest).

The team will observe the ECG to ensure that the pacer is working correctly. Then the physician will close your skin incision with sutures and apply a sterile bandage/dressing.