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Pacemaker Placement

How does a pacemaker work?
Pacemakers are a necessary and effective way to treat some problems with the heart's electrical or conduction system. Although more common in adults, pacemakers can be safely implanted at any age, from infancy through old age. Pacemakers use batteries as their energy source. The batteries have a life span of 7 to 15 years depending on the type of pacemaker and amount of time the heart requires pacing. Pacemakers use wires or leads to deliver the energy from the batteries to the heart. The wires also have a limited life span. Therefore, a child may be scheduled for a first-time pacemaker, replacement of the batteries or replacement of the leads. Pacemaker implantation in children is done under general anesthesia so your child will be asleep during the entire procedure.

What is involved in the placement of a pacemaker?
If your child is scheduled for placement of a pacemaker, you will receive confirmation of the date of the procedure and the time you should arrive at the hospital by mail. Usually, your child will need to be seen the day before the procedure for some tests. This visit usually involves a complete history and physical examination, an echocardiogram, chest x-ray, ECG, and blood work. You will also talk to an anesthesiologist during this visit. The pre-procedures visit usually lasts 2 to 3 hours. Children should have nothing to eat or drink for 6 hours before the procedure. Exact instructions will depend on the time the procedure is performed and will be given to you during the pre-procedure visit.

There are two different methods of pacemaker placement. The method to be used for your child will be determined by your cardiologist. One method, most commonly used for infants and toddlers, is called transthoracic and is done in an operating room. The wires that pace the heart are placed on the surface of the heart. The other method, usually used for older children, is called transvenous and is done in the cardiac catheterization laboratory. The wires used to pace the heart are placed inside the heart chamber.

What happens after pacemaker placement?
Following pacemaker placement, your child will be taken to the recovery room until he or she has fully recovered from the effects of the anesthesia. You will be able to join your child in the recovery room when he or she awakens. Following the recovery period, your child will be taken to the inpatient cardiology unit, and will stay until discharged from the hospital. The usual hospital stay for placement of a pacemaker is one to two nights. During this time, the pacemaker will be checked and the heart rhythm monitored to be sure the pacemaker is working properly. You will also be provided a transtelephonic transmitter and instructed in its use. The transmitter will enable us to check the pacemaker through the telephone.

2006: Information reviewed and approved by Laura Bell, RN, MSN, PNP Pediatric Cardiac Surgery and Lynda Dettling RN, BSN.


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