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What Is Involved in a Pacemaker Replacement?

A pacemaker permanently monitors the heart's rhythm in both the atria and ventricles.
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  • Written By: Erin J. Hill
  • Edited By: Bronwyn Harris
  • Last Modified Date: 18 March 2014
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In most cases, a pacemaker replacement is a minimally invasive surgery that involves opening a small area beneath the collarbone, usually at or near the original implantation incision site, and changing the device’s generator. The wires, or leads, which span from the generator to the heart are typically left in place. A replacement may need to be done occasionally when the batteries begin to weaken or if the device malfunctions.

The pacemaker is a device which attaches to the heart and sends tiny electrical signals to stimulate a contraction, or “heartbeat,” if the heart begins to pump too slowly. It consists of a small generator and two leads which are inserted into the right ventricle and right atrium. The generator is a very small computer which can be programmed to intervene if the heart rate drops below a certain level. More sophisticated models can even detect when the person is exercising, walking, climbing stairs, or breathing rapidly and will regulate the heart rate based on physical activity levels.

Occasionally, the batteries which power the generator will weaken and a pacemaker replacement will be needed. This typically involves the removal of the old generator and the insertion of a new one. A small opening is cut on the patient’s chest and the old device is removed. Then, a new generator is inserted and attached to the leads. This procedure is typically guided by a specialized x-ray machine.

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Most patients can receive a pacemaker replacement at an outpatient procedure using local anesthesia. The incision is normally around three inches (7.6 cm) long and causes minimal pain and few complications. Occasionally infection or bleeding may occur, although risks are not common with this type of surgery.

Very rarely, a pacemaker replacement may be needed due to a faulty generator or other system malfunction. This is unlikely, but it has been noted with a few patients. Routine maintenance visits are required to ensure that the device is working properly and that no complications have occurred. The procedure required in case of a faulty device is the same as is required during a routine replacement.

Patients should request exact information regarding pacemaker replacement surgery before the procedure will be done. Although typically uncomplicated, every patient is an individual and certain health conditions may mean the operation will be performed in a different way. Additional instructions and information may also be offered while scheduling the appointment, such as whether or not colon irrigation is required, the type of surgery being done, and aftercare arrangements during recovery.

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