Before and After a Pacemaker or Defibrillator Implant

Before the Procedure:

Before stopping any medications it is important to confirm with your doctor or Hunter Heart staff that it is safe to do so. If you are on an anticoagulant medication it is common to withhold these medications prior to the procedure. If you are on warfarin this is usually withheld for 3 days prior to the procedure and if you are on a newer anticoagulant (rivaroxaban, apixaban or dabigatran) these are usually withheld for one dose prior to the procedure.

If you are on an anti-platelet medication such as clopidogrel, prasugrel or ticagrelor then these medications are usually withheld for 5 days prior to the procedure and if you are on aspirin then this is usually fine to continue. Most other medications should be continued as usual and can be had with a sip of water up to two hours before hand. Since it is important to fast for six hours prior to the procedure, if you are on medications for diabetes you should clarify with your doctor what to do with these.

After the Procedure:

You will have a small scar over the pacemaker site. The stitches are dissolving and the pacemaker may be felt as a small lump underneath the skin. The dressing over the pacemaker site is waterproof but the area should still be kept as clean and dry as possible. The dressing should stay on for ten days until which time you should see your doctor (general practitioner or cardiologist) to have it removed.

Complications

If you feel any of the following:
Heat, pain, discomfort from pressure within the pacemaker site, numbness or tingling down your arm, swelling, redness/inflammation or rash, please contact your GP, specialist or local emergency department. If there is any bleeding underneath the waterproof dressing please do not remove it. Place a clean pad or cloth over the area, apply firm pressure and contact your specialist (4952 3900) or if after hours your local emergency department.

Driving

The minimum non-driving period for a private vehicle licence is 2 weeks. If you did not have fainting, dizziness or blackouts prior to your pacemaker implant then it is reasonable to resume driving after one week if you feel well. The minimum non-driving period for a commercial licence is 1 month.

Activities

Gradually increase your activity with the affected arm until you have a good range of movement without pain over the next week. For 4 weeks after the pacemaker implant you should not lift your upper arm (on the pacemaker side) above the horizontal or carry heavy objects with that arm. Most machines and devices will not interfere with a pacemaker (such as microwaves, computers, hairdryers, electric blankets and most power tools). Mobile phones and tablets should not be placed directly over your pacemaker and strong magnets and electric fields should be avoided (such as radio towers and heavy duty power equipment). Medical procedures such as radiotherapy for cancer or surgical procedures using diathermy near your pacemaker or defibrillator can cause interference so be sure to tell any doctors or medical staff about your device.

Follow-up

Please read the accompanying booklet that you will receive with your pacemaker carefully for other important information. If you have a return of your previous symptoms or other concerns, please notify your cardiologist.

You should have a follow up appointment in 1-2 weeks to have your device checked.

The picture above shows a typical example of different implantable cardiac devices. On the left (the largest device) is a subcutaneous defibrillator. This device uses a lead that travels in front of the sternum and not into the heart. It might be used in younger patients who would otherwise have leads inside their hearts for many years. The next largest device is an implantable defibrillator that uses leads implanted through a vein and into the heart. It can perform pacing functions for slow and rapid heart beats and shocks in the event of a cardiac arrest. The next largest device is a dual chamber permanent pacemaker and the smallest device is an implantable loop recorder that can be used for diagnosing cardiac arrhythmias in patients with recurrent syncope (fainting). It continuously records the hearts rhythm for up to three years and can transmit alerts over a mobile network for monitoring from home. A 50-cent coin is shown for comparison.