Pacemaker Surgery

What is a pacemaker?
A pacemaker is a small device that uses electrical impulses to control the speed and rhythm of your
child's heartbeat. A pacemaker is surgically placed (implanted) in the body. It has two parts:

The pacemaker itself is a metal box with a battery. It delivers electrical impulses to the leads.
The leads are wires connected to the pacemaker. They carry the electrical impulses to the heart
muscle.

Preparing for an operation to put in a pacemaker

Speak to your child about what is going to happen
What, when, and how you tell your child about the operation for a pacemaker will depend on how
grown up and mature your child is. Talk to your child in a way that she can understand. You can use the
information on this page as a start.

A few days before the operation, let your child know that she will be going to the hospital for an
operation. It is important to be honest. Your child will feel less anxious and scared when she knows
what to expect. Children also take their behavioural cues from the adults around them. If you speak to
your child in a calm manner without anxiety about the upcoming operation, your child will feel less
anxious and scared.

Let your child know that she may have pain and needles before and after the operation. Comfort your
child and let her know that you will be with her as much as you can. Your child should also understand
that the operation is needed and that the doctors and nurses are there to help.

Your child will need to stay in the hospital for a few days. You can stay with your child during this
time.

Clinic visit before the operation

Your child will need to visit the cardiac pre-operative clinic a few days before the operation. During
this visit, the nurses will let you and your child know more about the operation. The doctor will also
discuss the details of the operation with you, including how the surgery will be done, where the
incision (surgical cut) will be made, and the risks of the operation.

Your child may also need one or more of the following tests:

an electrocardiogram, also called an ECG, which measures and records the electrical activity in the
heart
 blood tests
a chest X-ray, which takes a picture of your child's heart
an echocardiogram, which is a type of ultrasound that can take moving pictures of the heart's
muscles and valves at work

Eating and drinking before the operation

Your child must stop eating and drinking several hours before the operation. The table below tells you
when your child must stop eating and drinking. The nurse will discuss this with you during your clinic
visit to the hospital before the operation.

What your child can eat and drink before the operation
Time before What you need to know
procedure

Midnight before the No more solid food. This also means no gum or candy.
procedure Your child can still drink liquids such as milk, orange juice, and
clear liquids. Clear liquids are anything you can see through, such
as apple juice, ginger ale, or water.
Your child can also eat Jell-O or popsicles.
6 hours No more milk, formula, or liquids you cannot see through, such
as milk, orange juice, and cola.
4 hours Stop breastfeeding your baby.
2 hours No more clear liquids. This means no more apple juice, water,
ginger ale, Jell-O, or popsicles.

A team of professionals will perform the operation at the hospital

Your child's surgery will be performed at the hospital, in a special laboratory or operating room.
Doctors, nurses, and an anaesthetist will all help during the operation. An anaesthetist is a doctor who
is specially trained to give anaesthetics, the medicines that keep your child asleep and feeling no pain
during the operation.

The morning of the operation

Your child will be admitted to the Cardiology Inpatient Unit. To get ready for the operation, your child
will be given an intravenous (IV) tube. An IV is a small tube put in the vein of an arm or leg so that the
doctors can easily give your child medicines.

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During the operation
Your child will be given a general anaesthetic to put your child to sleep during the operation.

Sticky pads may be placed on your child's chest at the beginning of the operation. If necessary, these
pads can be used to maintain your child's steady heart beat during the operation.

During the operation, the doctor will put in a pacemaker or replace your child's current pacemaker.
There are 2 types of pacemakers your child may receive: a transvenous pacemaker, or an epicardial
pacemaker.

Operation to put in a transvenous pacemaker

A special catheter may be passed through a vein in the groin if your child needs temporary pacing
during the procedure. If used, this catheter will be removed at the end of the operation.
An incision is made in the chest. The doctor makes a pocket between the layers of muscle and
inserts the pacemaker into this pocket.

Pacemaker Types

A transvenous pacemaker lead is passed through a vein to the correct location inside
the heart. An epicardial pacemaker lead is stitched to the outside of the heart
muscle.

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 The pacemaker lead is then passed through a vein near the shoulder to the correct location inside the
heart. The doctor uses special X-ray pictures called fluoroscopy to make sure the lead is put in the
right place in the heart muscle.
The doctor then connects the pacemaker to the lead and the chest incision is closed with stitches.
Over time, these stitches will dissolve on their own. The incision site is covered with a bandage.

Operation to put in an epicardial pacemaker

A small incision is made in your child's chest to put the lead(s) on the heart.
One end of the lead is stitched on the outside surface of the heart muscle and the other end connects
to the pacemaker.
The surgeon makes a pocket between the layers of the chest wall or abdomen muscles and inserts
the pacemaker into the pocket.
The incision is then closed with stitches. Over time, these stitches will dissolve on their own. The
incision site is covered with a bandage.

How much time the operation will take

Your child's surgeon will let your know how long the operation should take. The length of time will
depend on what type of pacemaker is used and if there are any complications during the operation.

After the operation

After the operation, your child will be moved to a recovery room to wake up from the anaesthetic. It is
likely that your child will remain in the recovery room for a couple of hours. Then she will go back to
the cardiology inpatient unit. You will be able to visit your child in the recovery area once she is ready.

The doctor will come and talk to you about your child's operation.

Because of the general anaesthetic used during the operation, your child may be very sleepy for several
hours. Your child may need to stay in bed for about 4 hours after the operation. During this time, the
nurse will check your child's blood pressure, breathing, and incision(s) regularly.

After your child is awake, she will be allowed to drink liquids and slowly begin eating and drinking
normally again.

Your child may also have another electrocardiogram and chest X-ray.

Your child will also get antibiotics through the IV tube for about 2 days following the operation. These
medicines fight infection.

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Managing your child's pain
Your child may be sore around the incision site(s) and will receive pain-relieving medicine.

Your child may also have an upset stomach for a short time after the operation. This is likely due to the
anaesthetic. If your child has an upset stomach, your child's nurse will give your child medicine to help.

Monitoring your child after the operation

The incision site(s)
The doctors and nurses will monitor your child's incision site(s) for bleeding and signs of infection.
These signs include fever, redness, swelling, and drainage around the incision.

Checking that the pacemaker is working properly

Your child's pacemaker will be checked with a small machine called a Holter monitor. The monitor
checks your child's heartbeat. Your child will wear the Holter monitor for 12 to 24 hours following the
operation.

After the doctors have the results from the Holter monitor, the pacemaker technologist will test your
child's pacemaker with a small computer. The test does not hurt.

Going home
After all the tests on the pacemaker are done and your child has finished the antibiotics, your child
should be ready to go home.

Before you leave, members of your child's health care team, such as the doctor, pacemaker
technologist, and nurses, will teach you:

how to care for your child with a pacemaker

signs and symptoms to watch for
how to tell if there is something wrong with the pacemaker
when to seek medical attention

Follow-up visits
Your child will need regular follow-up appointments to the pacemaker clinic to make sure the
pacemaker is working well. Before you leave the hospital, you will be given an appointment for your
first follow-up visit.

Write the date and time of the appointment here:

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Generally, the first follow-up appointment at the pacemaker clinic is between 1 and 2 months after the
operation. Eventually, your child's follow-up appointments will become less frequent, such as every 6
months.

Key points
A pacemaker is a small device that uses electrical impulses to control the speed and rhythm of your
child's heartbeat. Your child will have an operation to implant the pacemaker.
Your child will need to stay in hospital for a few days after the operation.
Members of your child's health care team will teach you about the pacemaker and what to watch for.
Your child will need regular follow-up appointments to make sure the pacemaker is working well.