Replace a pacemaker generator that is at the end of its service life. The remaining lifespan of a pacemaker is determined during visits to the Pacemaker Clinic. The battery in a pacemaker does not stop suddenly but rather loses its charge slowly, which lets the cardiologist plan the replacement date.
This procedure takes less than one hour. The total hospital stay is approximately 24 to 48 hours.
Preparing for a pacemaker generator change procedure
(some tests may be done during pre-admission):
- Blood tests
- Chest X-ray
- Pregnancy tests in fertile women
- Follow-up by a nurse
- Follow-up by a doctor (explanations, risks and benefits and signature of consent form)
- Take your usual medication according to your prescription
- Be fasting from midnight the night before the exam, but note that this does not apply to medication (follow your doctor's instructions)
- Shaving of the chest and groin area (to create a sterile area and better adherence for electrodes and dressings)
- Shower with an antiseptic soap
Recommendations to prepare for the procedure:
- Health insurance card.
- Montreal Heart Institute (MHI) card.
- An updated list of medications provided by your pharmacy.
- Your medication (not all medications are available at the MHI).
- Comfortable clothing: dressing gown, slippers, tissues, books, etc. However, do not bring jewellery, extra cash, credit cards or valuable objects.
- If you have sleep apnea, bring a continuous positive airway pressure (CPAP) machine.
On the day of the procedure:
- Remain fasting; however, this does not apply to certain medications.
- An IV line is inserted into the arm.
- Take the time to go to the bathroom and put on a hospital gown. Remove your underwear.
- You will be taken to the EPS room on a stretcher or in a wheelchair.
The procedure is conducted in the EPS room in an aseptic environment:
- Patients lie down on their backs on the exam table.
- The skin is disinfected with a liquid antiseptic and then covered with a large sterile field.
- After local anesthesia is applied to the skin, the electrophysiologist makes an incision in the pacemaker scar. The doctor removes the generator and then disconnects the leads, which are checked to make sure they are still intact. A new generator is then attached and reinserted under the skin. The electrophysiologist finishes by suturing the incision and applying a dressing.
Follow-up and side effects
When you go back to your room:
- Stay in your bed until the next morning and keep your arm still so that the compress over the incision stays in place.
- Setup of a heart monitor.
- Vital signs are checked regularly (blood pressure, heart rate, temperature, breathing).
- The dressing is checked to see if there is any bleeding or a hematoma.
- If the patient is in pain, an analgesic is administered.
- A light meal is served one hour after the procedure.
- Medication is taken as per usual.
- Anticoagulants can be taken in the evening or according to doctor's orders.
The next day:
- A nurse helps the patient get up for the first time.
- The IV line is removed.
- The compression dressing is removed.
- A cardiologist comes to examine the wound, prescribe medication, assess the recovery time and sign the discharge.
- Since patients cannot drive, they must ensure that someone can take them home before leaving the hospital.
Documents given to patients before discharge:
- Temporary pacemaker identification card (a permanent card will be sent by mail).
- Information booklet about your pacemaker.
- Written recommendations for the week following a replacement procedure.
Confirming an appointment at the Pacemaker Clinic
- Your appointment will be sent to you by mail.
- It is important that you keep the appointment at the clinic to ensure your pacemaker is working properly and to determine the date that it will be replaced.
Recommendations for the week following the implantation of a pacemaker:
- If you have PAIN: Take 1 to 2 tablets of Tylenol® (acetaminophen) every 4 hours (do not take aspirin UNLESS a doctor has already prescribed that you take it once a day).
- DRESSING: Remove the transparent oval bandage and the small butterfly closures after 5 days. Even if there is blood under the dressing, leave the dressing in place for 5 days unless it becomes soaked with blood.
- Removing the dressing: Carefully remove the adhesive tape. If it is difficult to remove, press a piece of tape onto the side of the dressing to start an edge. Continue to remove the tape until all sides detach from the skin. Slowly remove the dressing. The small butterfly closures will come off at the same time. Clean the wound by dabbing it with a mild soap. Do not cover with another dressing unless the wound is seeping.
- Take a shower instead of a bath during the first week and avoid getting water directly on the wound.
- Avoid raising your arm closest to the pacemaker site above the level of your heart.
- PREVENTING INFECTIONS: Practise good hand hygiene; do not scratch the wound; clean the wound every day with water and mild soap; avoid wearing a chain or necklace; to look at the wound, use a mirror instead of looking down towards the wound (since the nose and mouth contain germs).
- SIGNS OF INFECTION: Redness, swelling, pain, heat, occasional weeping from the wound and fever.
- SIGNS OF HEMATOMA: Swelling of the wound and sometimes bleeding.
- If one or more of these signs appear, apply a dressing or towel over the wound and go to the nearest emergency room. Also advise the nurse in Routine Follow-Up for electrophysiology by calling:
514-376-3330, extension 2244 (Monday to Friday from 7:30 a.m. to 3:30 p.m.)
Or the Emergency Department at 514-376-3330, extension 3000
- Driving a car: Permitted 2 weeks after the implantation of the pacemaker or according to your doctor's orders.
- Physical activity: Do not perform any intense physical activity with the arm on the side of the pacemaker for 1.5 months. Note that the heart rate increases gradually during an activity, contrary to tachycardia, which starts suddenly.
- Sex: The same recommendations as for physical activity.
- Professional activities: Patients can return to work after recovering or according to the doctor's recommendations.
- Travel: When travelling abroad, show your pacemaker identification card to airport security.
- Daily activities: Avoid magnetic fields and industrial motors. If necessary, discuss this with your doctor.
- Use a cell phone on the opposite side of your pacemaker; do not put it in a pocket close to the pacemaker.
- Advise medical staff that you have a pacemaker during the following procedures: procedures using a radio knife, radiotherapy, magnetic resonance imaging, external electric cardioversion, and radiofrequency ablation.
Adult Congenital Heart Disease Center