Before and After your 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 then it is usually okay to continue this for the procedure and if you are on a newer anticoagulant [rivaroxaban (Xarelto), apixaban (Eliquis) or dabigatran (Pradaxa)] these are usually withheld for 24 hours prior to the procedure. 

 

If you are on an anti-platelet medication such as clopidogrel (Plavix), prasugrel (Effient) or ticagrelor (Brillinta) then these medications are usually withheld for 3 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 the time of the procedure. 

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Diabetes Medications

Since it is important to fast for six hours prior to the procedure, if you are on tablets for diabetes you should hold these on the morning of the procedure. These tablets include metformin (Diaformin), gliclazide (Diamicron) or sitagliptin (Januvia), amongst others. 

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If you are taking dapagliflozin (Forixga) or empagliflozin (Jardiance) for diabetes or heart failure then these medications should be withheld for three days prior to your procedure. If you are taking semaglutide (Ozempic, Wegovy, Rybelsus), tirzepatide (Mounjaro), liraglutide (Saxenda, Victoza) or dulaglutide (Trulicity) for diabetes or weight loss then you can continue them but you MUST have a clear fluid diet for 24 hours prior to your procedure (similar to a colonoscopy). Clear fluids include water, juices without pulp, clear fat free chicken or beef broth, plain coffee or tea without milk or cream and clear sodas like lemonade or plain jelly.

 

If you are taking a fast acting insulin (Novorapid, Humalog, Actrapid, Apidra, Fiasp) then you should NOT take this while you are fasting. If you take a long acting insulin like glargine (Optisulin or Toupee), detemir (Levemir) or degludec (Tresiba) then you should continue these for your procedure. If you are taking a premixed or an intermediate acting insulin such as NovoMix, Humalog Mix or Protaphane then you should usually take half of your usual morning dose and omit your lunchtime dose while fasting.

 

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 (02 4952 3900) or if after hours your local emergency department. 

 

Driving

The minimum non-driving period for a private vehicle licence is 2 weeks and the minimum non-driving period for a commercial licence is 1 month following a pacemaker of defibrillator implant. If you have had a cardiac arrest (with no reversible cause) then the minimum non-driving period in 6 months for a private licence and you will generally not be able to hold a commercial licence. You should clarify things with your specialist if you have and further questions. 

 

Activities

Gradually increase your activity with the affected arm until you have a good range of movement without pain over the next week. For 4-6 weeks after the pacemaker implant you should not carry heavy objects (≥2 kgs) with the arm on the pacemaker side. Activities such as golf, tennis and swimming should not be performed for 6 weeks following.

 

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 carefully for other important information. If you have a return of your previous symptoms or other concerns, please notify your cardiologist. 

 

You should see your GP in 10 days to have your dressing removed and the wound looked at. You should then have a follow up appointment in 2-4 weeks to have your device checked initially and then most pacemaker/defibrillator checks will be performed via the home monitor which sits beside your bed or talks to your device through your mobile phone. The monitor for your device does not substitute for emergency care and if you feel unwell you still need to see your local doctor or call 000/present to an emergency department.