How long does it take to recover from a pacemaker surgery

If you've been told you need a pacemaker, you're not alone. In the United States, nearly 200,000 people a year have pacemaker surgery. And, as the population ages, the numbers will continue to rise. The reasons for pacemakers vary, but all recipients have something in common: the recovery period. What happens after the pacemaker procedure and what is it like living with a pacemaker? Knowing what to expect can make it easier to plan for your recovery.

The Pacemaker Procedure

Pacemaker insertion is a minor surgical procedure performed in a hospital. The doctor performing the procedure is an electrophysiologist—a cardiologist with additional expertise in heart rhythm disorders. It takes about 2 to 3 hours to complete and most patients stay overnight after the procedure. Before the insertion, a nurse or technician starts an intravenous (IV) line to administer a sedative and possibly other medicines.

Most pacemakers are a two-component system: the pulse generator and one or more wires. The doctor injects a local anesthetic in the skin around the area where the pacemaker and the wires will be inserted—usually just under your collarbone. The wires (leads) are placed first. After making a small incision and using X-ray for guidance, the doctor threads the wires through a vein until they reach your heart. The pacemaker (the generator) is placed just under the skin and hooked up to the wires. Your doctor will test the pacemaker and close the incision.

The procedure is simpler and shorter for the relatively new leadless pacemaker, a single-component device that is much smaller than the traditional pacemaker. Instead of inserting the pacemaker in the chest and connecting it to wires in the heart, the leadless pacemaker sits directly in the heart. The doctor makes a small incision in your groin to access the femoral vein, then uses a catheter to guide the device into the vein, up into the heart's right ventricle (lower chamber), and attach it to heart muscle. It requires a small incision in the groin. People with certain heart conditions, such as heart failure, affecting only the lower chambers of the heart may be candidates for a leadless pacemaker.

Recovering from Pacemaker Insertion: Hospital Stay

Your care team will move you to a recovery room after the procedure. A nurse will monitor your vital signs and, if you had a sedative, watch as you fully wake. Once you are awake, the nurse will move you to another hospital room for your overnight stay.

You may have some pain from the incision. You may also have some soreness around the pacemaker area as your body adapts to having the device under your skin. The nurse can give you a pain reliever if you are uncomfortable.

Once the sedative wears off, your nurse will help you get out of bed. You may feel a bit dizzy or lightheaded at first, so it’s important to get up slowly.

Your doctor will program your pacemaker while you are in the hospital. You will likely schedule a return visit so your doctor can check the pacemaker’s settings.

Recovering from the Pacemaker: At Home

Although a pacemaker insertion is a minor surgical procedure, taking precautions at home will help you heal properly with little risk of complications. Your doctor may recommend slightly different instructions, but in general, these are the precautions for patients who have received a pacemaker:

• Keep the incision dry for a week, so no showering.

• Only remove the bandage when your doctor permits—typically two days to a week after the implantation.

• Do not move the arm on the pacemaker side above shoulder level for a few weeks.

• Take medication for pain as directed by your doctor, if necessary. Pain and tenderness should start to decrease over a few days.

• Watch the incision site for signs of infection, such as increased pain, redness or tenderness around the incision, pus, and/or fever.

Ask your doctor when you can resume your usual activities. Oftentimes, doctors recommend that you avoid anything strenuous that could pull or put force on the insertion site. The general rule of thumb is not to lift anything 10 pounds or more for at least one week, maybe longer. You should also avoid activities that could cause a blow or trauma to the chest area, such as contact sports. Ask your doctor about driving, as this may also be restricted for as long as a week.

Pacemaker Side Effects

Most people who receive a pacemaker don’t experience any side effects other than some pain or discomfort when the device is implanted. However, there is a small risk of complications including:

• Infection at the insertion site

• Bleeding, bruising, or swelling

• Bleeding in the heart at the lead sites

• Damage to the veins where the leads were inserted

Living with Pacemaker Monitoring

Today, pacemakers use wireless technology for remote monitoring. This means your doctor can check how well the device functions without seeing you in person. Your doctor also monitors the device's battery. Pacemaker battery life ranges from 5 to more than 10 years. Although remote monitoring cuts down on in-person office visits, you will still need to see your doctor for regular checkups.

Special Considerations for Cardiac Resynchronization Therapy (CRT) Pacemakers

Most pacemakers function to remind your heart to pump a minimal number of beats per minute. However, patients with some types of heart failure need cardiac resynchronization therapy (CRT) from a special pacemaker—a biventricular pacemaker. This type of pacemaker stimulates the heart's lower chambers (ventricles) and one upper chamber (atrium), synchronizing them so they beat more efficiently and effectively.

There are three wires with CRT pacemakers: the two that are used for most regular pacemakers, and a third that is placed on the left side of the heart. This allows the pacemaker to stimulate your heart if it beats too slowly and stimulate the chambers to beat in tandem, resynchronizing them, if needed. CRT can relieve symptoms for people with advanced heart failure, reducing hospital admissions and improving quality of life.

Because of the complexity of biventricular pacing and seriousness of the patient's underlying health condition, remote monitoring and follow-up care for CRT can be more time-consuming than traditional pacemaker therapy. If you have a biventricular pacemaker, current guidelines recommend seeing your doctor every six months.

Pacemaker insertions are becoming an increasingly common procedure. While every doctor and facility may have slightly different guidelines for managing your pacemaker and your health, following the instructions promotes faster recovery, which allows you to live with greater peace of mind.

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