What is a pacemaker?
The pacemaker is a tiny battery-powered machine that helps to regulate your heart’s rate and rhythm. Using a long wire or lead, it sends electric energy signals to the heart. A pacemaker is used when the heartbeat is not fast enough or lacks appropriate rhythm coordination between the top and bottom chambers of the heart (atria and ventricles) to supply your child's body with adequate blood supply.
What does as pacemaker look like?
The pacemaker is a thin disc with a metal case. The pacemaker weighs about 1-2 ounces. The leads are floppy, soft, insulated wires. These leads carry signals from the pacemaker to the heart's upper right chamber (atrium) or lower right chamber (ventricle) or to both chambers. Sometimes these leads get to the heart through the body’s veins (transvenous system) and sometimes they are placed on the surface of the heart (epicardial system).The cardiologist will decide which part of the heart needs to be paced depending on the type of rhythm problem in your child's heart.
How and where the leads are placed in the heart
There are 2 ways to place a lead: transvenous or epicardial.
- Transvenous: the lead is threaded into the heart through a vein.
- Epicardial: the lead is directly attached to the outer portion of the heart muscle.
When this method is used to implant a pacemaker, a small incision is made in the side of the chest near the shoulder. The leads are threaded through a vein into one or both of the right-sided heart chambers. The leads are attached to the pacemaker and the system is programmed for your child's needs. The pacemaker is then placed in the pocket that was made under your child’s skin and the incision is closed.
This method is mostly used for children whose veins are large enough to thread a lead through them. As your child grows, the length of these leads may become too short and may need to be replaced or threaded farther in. Your child’s doctor will check for this as your child grows.
With this method, the leads are directly attached to the outer heart layer (epicardium). A small midchest incision is made. A second small incision is made on the upper part of the abdomen for the pacemaker generator. The leads are then passed under the skin and are attached to the pacemaker generator. This method is mostly used for infants or small children who need a pacemaker.
Programming the pacemaker
The cardiologist will use a machine called a programmer to set the pacemaker. By placing the wand of the programmer over the area of the pacemaker, the rate (speed) or the amount of energy needed to stimulate the heart can be checked. This helps the doctor to know that the heart is pumping enough blood and oxygen to the body.
Length of hospital stay
When a child comes in for placement or replacement of the pacemaker generator or the leads, he is often admitted the morning of the procedure. After the pacemaker has been put in place your child will go to the Post Anesthesia Care Unit (PACU) until he awakens. If your child requires further monitoring or pain control he will go to the Intermediate Care Unit (IMCU) overnight for close monitoring. The length of stay can change depending on your child's needs.
The cardiologist or the nurses will review discharge information with you before your child goes home.
- Keep the pacemaker incision site clean and dry and loosely covered with gauze for 7 days after surgery.
- Leave the dermabond or steri-strips on until they fall off.
- If transvenous approach was used for lead placement, your child will be taught exercises to practice with the arm on the pacemaker side.
- Your child can return to normal activity and return to school. However, he should not play high contact sports such as football, wrestling or karate.
- If the wound appears red, swollen, painful, and warm to the touch or begins draining, call the cardiologist right away.
- You will be taught how to do telephone transmission of the pacemaker system from your home.
- If your child complains of feeling weak, dizzy or "funny" in any way, you should always call to transmit. You will be taught how to do telephone transmission of the pacemaker system from your home. This information helps the cardiologist determine if your child’s pacemaker is working properly.
Disclaimer: This information is not intended to substitute or replace the professional medical advice you receive from your child's physician. The content provided on this page is for informational purposes only, and was not designed to diagnose or treat a health problem or disease. Please consult your child's physician with any questions or concerns you may have regarding a medical condition.